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The United States still has a higher rate of women dying during pregnancy, childbirth, or postpartum than all other high-income countries, even despite recent declines in the U.S. maternal mortality rate, a new report shows.
There were about 22 maternal deaths per 100,000 live births in the United States in 2022, the most recent year for which data are available. That rate was more than double, and sometimes triple, what was seen in most other high-income countries that year, according to the report released Tuesday by the Commonwealth Fund, a private foundation focused on health care-related issues.
The new report shows that the maternal mortality rate among black women in the United States is still higher, at nearly 50 deaths per 100,000 live births.
Meanwhile, half of the high-income countries in the new report recorded fewer than 5 maternal deaths per 100,000 live births, and one country recorded zero maternal deaths: Norway.
Unlike Norway and some other peer countries, “the United States has a maternity care workforce shortage problem, which is set to get worse,” said Munira Juneja, lead author of the report and senior researcher at the International Program for Health Policy and Practice Innovations. In the Commonwealth Fund.
She noted that access to midwives in the United States is limited, as they provide support to the patient from the prenatal period until postpartum.
“We are in short supply of midwives, and midwives are underutilized, while in most other countries midwives vastly outnumber obstetricians. They are part of their health care systems. Midwifery care is not sufficiently integrated into Our system.
In the United States, “there are many barriers to access to midwifery care, while other countries don't have that,” she said. “They are able to make sure that every woman gets care, whether in some cases it's an obstetrician or a midwife in most cases.” Cases.” “In the United States, we are the only country in this analysis that does not have a comprehensive health system. Nearly 8 million women of reproductive age do not have health insurance.
In Norway, which has universal health coverage, antenatal care is free, and high-risk pregnancies are actively identified.
Researchers at the Commonwealth Fund analyzed maternal mortality data from 14 high-income countries: Australia, Canada, Chile, France, Germany, Japan, Korea, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.
The data, which came from the US Centers for Disease Control and Prevention and the Organization for Economic Cooperation and Development, showed that the top three countries with the highest maternal mortality rates are the United States, Chile and New Zealand. Chile and New Zealand each recorded about 14 deaths per 100,000 live births.
The three countries with the lowest maternal mortality rates are Norway with a rate of zero, Switzerland with a rate of 1 death per 100,000 live births, and Sweden with about 3 deaths per 100,000 live births.
During the Covid-19 pandemic, maternal mortality rates increased in Australia, Japan, the Netherlands and the United States, according to the report, which indicates that the increase may have been due to a rise in Covid-related infections and complications worsened by the virus. or a delay or reduction in access to care at that time. More recently, maternal mortality rates have begun to decline in Chile, Norway, and the United States.
The maternal mortality rate in the United States decreased from 32.9 maternal deaths per 100,000 live births in 2021 to 22.3 per 100,000 in 2022, according to data from the Centers for Disease Control and Prevention.
“It is encouraging to see fewer maternal deaths in the United States in 2022, but the United States remains an outlier, and racial disparities are deeply troubling,” said Dr. Lori Zephyrin, senior vice president for health equity advancement at The Commonwealth Fund. He said in a press release.
“It is time to focus equity by diversifying the workforce and addressing racial inequities in health care quality and access,” she said. “Now is the time to prioritize what we know already works well in other countries: expanded health insurance coverage, stronger workforces and support systems, and paid maternity leave.”
The new report cites the U.S. health care system, policy differences, and neglect of maternal care — where residents have little or no access to maternal health care — as among the factors driving the high maternal mortality rate in the United States. .
The United States and Canada have the lowest total numbers of midwives and obstetricians caring for pregnant and postpartum mothers, with just 16 and 13 providers per 1,000 live births, respectively, according to the new report. In Canada, the maternal mortality rate is estimated at about 8 deaths per 100,000 live births.
More than 2.2 million American women of childbearing age — 15 to 44 years old — live in maternity care deserts, according to a 2022 report by the nonprofit March of Dimes. Last year, a separate analysis found that hospitals in a tenth of U.S. counties lost units Their birth in the past five years.
Midwives “could help address the maternity workforce shortage in the United States, where nearly half of counties lack a single gynecologist.” An estimated 8,000 additional obstetricians are needed to meet demand — a number that could rise to 22,000 by 2050, according to the new report.
In addition, nearly two-thirds of maternal deaths occur in the postpartum period, up to 42 days after birth, and American women are less likely to make home visits after giving birth, according to the new report. All countries in the report, except the United States, included at least one home visit within a week after birth. At the state level, only some Medicaid programs in the United States cover these visits.
“The World Health Organization recommends at least four health checkups in the first six weeks after giving birth, yet two in five American women — often younger, low-income, and uninsured — skip their only postpartum checkup,” according to the New report.
In the first week after birth, the most common contributors to maternal death were severe bleeding, high blood pressure and infection, while cardiomyopathy — a disease of the heart muscle — was the leading cause of death later in the postpartum period, according to the new report.
The United States also stands alone as the only high-income country without a federally mandated paid leave policy for postpartum mothers, according to the new report. American women are less likely to have guaranteed paid leave than women in other high-income countries, where at least 14 weeks of paid leave are mandated.
“Maternal mortality is a preventable problem, and this one is a problem that can be solved. A lot of countries have been able to figure out ways to make this happen so that all women are in good hands when it comes to having a baby and after giving birth. We need to expand this to include women,” said Juneja. In the U.S. too.” “We know that most deaths occur during the postpartum period — so we make sure we have federally mandated paid leave, and make sure we make it easier for women to get postpartum care, which means having home visits and not forcing Women should go to the doctor.
According to the new report, racial disparities in maternal mortality rates persist not only in the United States but in other parts of the world where some women do not have access to postpartum support.
“In the United Kingdom, for example, black women are four times more likely to die than white women. In Australia, indigenous women are twice as likely to die from maternal complications than non-indigenous women,” the researchers wrote.
“Our findings suggest that undersupply of maternity providers, especially midwives, and lack of access to comprehensive postpartum support, including maternity care coverage and paid maternity leave, are contributing factors,” they wrote. “Because these two factors disproportionately affect women of color, focusing equity in any future policy changes will be key to addressing the crisis.”
The Commonwealth Fund report “highlights the need to strengthen maternal health care and maternal health equity in the United States,” said Dr. Tochi Iroko Males, a family physician in Long Island, New York, and chairman of the board of directors of the American Family Academy. Doctors who were not involved in the new report.
“For us in family medicine, we know that we play a critical role in providing obstetric care throughout pregnancy and the postpartum period, which is essential, and maternal health care cannot stop after a patient gives birth,” she said. Her American colleagues should pay attention to maternal health complications — such as myocarditis or mental health conditions — in their postpartum patients, as the majority of maternal deaths occur during that period.
“The postpartum patient's body is still going through tremendous physical, hormonal and emotional changes that you can't really overlook,” she said. “Our training as family physicians helps us examine and treat the full range of physical, emotional and social needs during pregnancy and the postpartum period.”
Adding more birth workers to the maternal health care workforce remains an important component and a major need, said Dr. Michelle Owens, an obstetrician-gynecologist in Jackson, Mississippi, who was not involved in the new report.
“But we also need to make sure we have systems in place to facilitate escalation of care when needed so that every person at birth has access to the right care at the right time. Diagnosis Treating complications in a timely manner is essential to ensure the overall health and safety of our mothers and their babies.”
“ACOG recommends that pregnant mothers participate as active partners in their care, attend their scheduled appointments during and after pregnancy, and consider pregnancy planning in order to improve pregnancy outcomes,” she added. “Finally, patients need to feel empowered to express their concerns to health care providers, and for providers to listen to their concerns and work collaboratively with patients to resolve their concerns.”
The report joins several other studies that have highlighted the high rate of maternal mortality in the United States, said Dr. Christopher Zahn, interim CEO and head of clinical practice, health equity and quality at ACOG.
“Despite recording different time periods and using different methodologies, what we can confidently conclude from these reports is that the number of maternal deaths in this country remains unacceptably high,” wrote Zahn, who was not involved in the latest Commonwealth Fund report. In an email message.
“In 2016, the public was surprised to learn from a widely reported study in The Lancet that the United States had the highest maternal mortality rate compared to other developed countries. The Commonwealth Fund report shows that nearly a decade later this is still the case. “This is obviously discouraging news, but we must also acknowledge that despite collective efforts to improve maternal health outcomes, we have faced enormous setbacks,” Zhan said, referring to disruptions in access to care due to the COVID-19 pandemic. Coup Roe v. Wade and persistent health inequalities resulting in racial and ethnic disparities.
“Weaknesses in our policies and systems have been long-standing pain points, and it is clear that they all contribute to the poor maternal health outcomes we see today,” he added. “ACOG will continue its work improving quality and safety in maternal health care, educating its members about the necessity of eliminating racism and bias in medicine and advocating for supportive policies for both physicians and patients in an effort to improve outcomes.”
