Maternal mortality rates have been steadily declining worldwide since 2000. However, in 2017, the United States was one of two countries to experience a significant escalation in their maternal mortality rate. With a rate of 17.4 deaths per 100,000 pregnancies, the US has one of the highest maternal mortality rates in the developed world. The United States also spends the greatest amount of its GDP on healthcare; however, 66% of maternity-related deaths were found to be preventable. So if money isn’t the problem, why are women still dying?
For one, the United States has a very low supply of maternal care, and in addition, is predominantly using the wrong type of care. The World Health Organization encourages the use of midwives throughout pregnancy due to overwhelming evidence of the benefits they provide. Midwives are trained to help women throughout pregnancy, during birth, and postpartum. However, OB-GYNs are the more commonly used option. OB-GYNs are only trained to intervene when problems occur in the pregnancy. In most developed countries, there are many times more midwives than there are OB-GYNs available to pregnant women. The United States has rates of 12 and 15 midwives and OB-GYNs, respectively, per 1,000 births. This indicates an overall shortage of care providers, as every other country has rates two to sixfold greater.
Although coverage for midwives is required under the Affordable Care Act, the supply is too sparse to make any significant change. In addition, required physician oversight and state licensure laws limit the number of available midwives even further. This indicates further that a lack of midwives and related resources is causing women to suffer from less treatment throughout their pregnancies.
The rates for suicidal ideation and self-harm have also risen among pregnant and postpartum women. About 13% of women experience symptoms of postpartum depression, which can lead to long-term issues for mother and child. This includes hindered motor and mental development for the child, as well as increased risky behavior by the mother. The American College of Obstetricians and Gynecologists suggests that doctors screen pregnant women for depression at least once before or after giving birth; however, this is often not the case. An estimated 66% of depressed pregnant women go undiagnosed, and only 50% of women with antepartum and postpartum depression actually obtained treatment. Since care from OB-GYNs and physicians does not extend past birth, women do not have access to the care they need to support themselves, physically and emotionally, after birth.
This problem has the potential to affect any woman across the country. However, maternal mortality rates are significantly higher for women of color. The maternal death rates for Black women are two and a half times higher than those for white women. Black infants are also most likely to die within less than a month of leaving the hospital. This isn’t just relegated to low-income populations or poor hospitals. Studies show that different levels of income and education don’t affect the maternal mortality rates for Black women. This indicates that there is institutional racism in the healthcare industry, including implicit and explicit bias.
The maternal mortality rate in the United States is a pressing issue that demands national attention. The federal government needs to encourage the creation of maternal “safety bundles”, which have already been implemented in some states. These bundles are short briefs to educate clinical staff and patients about postpartum depression, racial disparities, and health risks. In addition, hospitals need to work closely with maternal review committees and researchers to establish perinatal quality collaboratives (PQCs), a network of states, hospitals, and data with the purpose of advancing clinical best practices. California, the only state that has consistently lowered its maternal mortality rate in recent years, has attributed its success to public-private partnerships such as these. Other states, such as North Carolina, have seen success in establishing patient-based medical centers for pregnant women. These facilities care for women with pre-existing conditions and with substance use disorders, and these centers have positive effects on the health of both the women and their children.
The evidence is clear: increased care and support for pregnant women, as well as education for clinical staff, can lower the maternal mortality rate in the US. By establishing programs such as maternal safety bundles, and bridging the gap between patient and doctor, the US can better protect this generation and the next.
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