U.S. Lags Behind All Other High-Income Nations on Maternal Mortality

Women in the U.S. — particularly Black women — have higher rates of maternal death than any other high-income nation, and the U.S. lacks federal policies that could support these women, according to a new report by the Commonwealth Fund.

In 2022, the U.S. had 22.3 maternal deaths per 100,000 live births, far more than other high-income nations. Chile and New Zealand were next-highest at 14.3 and 13.6, respectively, but all other high-income nations had less than 10 maternal deaths per 100,000 live births, reported Munira Gunja, MPH, senior researcher at the Commonwealth Fund’s International Program in Health Policy and Practice Innovations, and colleagues.

Black women in the U.S. had the highest number of maternal deaths per 100,000 live births at 49.5, compared to 19 among white women, 16.9 for Hispanic women, and 13.2 for Asian women.

“Other countries have been able to achieve zero or close to zero maternal deaths a year,” Gunja told MedPage Today. “So we know from our research that there are ways to really reduce or eliminate all of these preventable deaths and it’s time that we really take action to reverse this trend and really help women in this country.”

For many countries, including the U.S., maternal mortality rose during the pandemic, and though those rates are now declining, U.S. rates remain the highest.

Two-thirds of pregnancy-related deaths in the U.S. occurred in the postpartum period and American women were least likely to have supports like home visits or paid leave during this critical time.

In terms of maternity care providers, the U.S. lags behind as well, with 12 ob/gyns and four midwives per 1,000 live births (16 total). Other high-income nations have between 26 (South Korea) and 92 (Chile) total number of ob/gyns and midwives per 1,000 live births. The difference is primarily in the number of midwives, who often play a central role in providing maternity care in many of these countries. In most high-income nations (except the U.S., Canada, and South Korea), midwives outnumber ob/gyns.

The U.S. is also the only high-income nation without a federal paid leave policy. By comparison, on the low end, Switzerland has 14 weeks paid leave and on the high end, Norway has 86 weeks paid leave.

The report concluded that “an undersupply of maternity providers, especially midwives, and lack of access to comprehensive postpartum support, including maternity care coverage and mandated paid maternity leave, are contributing factors” to the maternal mortality crisis.

“The U.S. just doesn’t have support at a federal level in place. And so ultimately, what happens is that we leave a lot of women behind, and it disproportionately affects lower income women and Black women in this country,” Gunja said.

Veronica Gillispie-Bell, MD, an ob/gyn at Ochsner Medical Center in Kenner, Louisiana, and an expert on maternal mortality and disparities, told MedPage Today that the U.S. has not “designed our healthcare system for patients to be connected to care during what we know now is the most vulnerable time in terms of maternal mortality.” She also noted that the U.S. doesn’t have enough care providers and doesn’t bring care to patients with home visiting.

“So all of this, to me, speaks to a solution,” she said.

For instance, she said collaborative care models involving midwives could free up ob/gyns‘ attention for more high-risk patients that require a higher level of care. Gillispie-Bell also emphasized that improving disparities involves combatting systemic racism as well as improving the health system itself.

Commonwealth researchers primarily used data from the CDC and the Organization for Economic Co-operation and Development (OECD), which tracks health measures across 38 high-income nations including the U.S. — though the team excluded U.S. data since it did not correspond with the latest from the CDC. They analyzed CDC’s National Vital Statistics Systems data from 2022 for U.S. maternal mortality rates and the latest data from the CDC’s Maternal Mortality Review Committees in 36 states for maternal death timing.

Gunja noted that there wasn’t a perfect cross-country comparison for some outcomes, like timing of maternal death. Plus, since the maternal mortality crisis is so much more severe in the U.S., it’s difficult to compare the rates among subpopulations in the U.S. and abroad. OECD data may also mask differences in how different countries collect health data.

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