US Remains Worst in the World for Maternal Mortality, Health Equity

A new Commonwealth Fund brief reports that the United States has maintained a global title it probably doesn’t want: the worst maternal mortality rates in the developed world.

The report found that maternal mortality is getting worse in all developed nations, but that the gap between the US and its similarly developed peers is getting bigger.

“The COVID-19 pandemic challenged health systems across the world and may have played a role in limiting women’s access to health care,” the researchers wrote.

The brief looked at maternal mortality data from 2018 until 2020 in 13 developed nations: the Netherlands, Australia, Japan, Germany, Norway, the United Kingdom, Sweden, Switzerland, France, Canada, Korea, New Zealand, and the US.

Overall, maternal mortality has gotten worse globally, even in these more developed countries. The US has seen a steady climb in maternal mortality rates, culminating in about 24 deaths per 100,000 live births in 2020. That’s preceded by around 17 deaths per 100,000 live births in 2018 and 20 per 100,000 live births in 2019.

But the US isn’t alone in these deteriorating conditions. Six of the nine countries for which the Commonwealth Fund had longitudinal data saw declines in their maternal mortality rates.

In Norway, the rate jumped from zero deaths in 2019 to about four in 2020. Meanwhile, Sweden had 3.5 deaths per 100,000 live births in 2019; that rate doubled in 2020 to seven deaths per 100,000 live births.

On the other hand, the Netherlands, Japan, and Australia all saw improvements in their maternal mortality rates. The Commonwealth Fund said it’s too early to determine why maternal mortality improved in these nations, but they had some hypotheses.

“Research has shown that in the Netherlands there was an increase in home births and vaginal deliveries and a decrease in cesarean sections (both planned and emergency) during the pandemic. These practices may have contributed to lowering maternal deaths,” they said, citing May 2022 data.

Despite mixed performance from its peer nations, the US still has the undesirable title of worst maternal mortality and worst maternal health equity in the developed world by a landslide. The nation with the second-highest maternal mortality rate in 2020 was Korea, with around 11 deaths per 100,000 live births, and the US more than doubled that with its rate.

Moreover, maternal health equity is abysmal in the United States. While the overall maternal mortality rate in 2020 was 24 deaths per 100,000 live births, that number is dwarfed when looking just at Black people. Among Black birthing people, the maternal mortality rate is about 55 deaths per 100,000 live births. That’s compared to 19 deaths for White people and 18 for Hispanic people.

It doesn’t have to be this way, the researchers argued.

“There are clear opportunities to put the U.S. on par with other countries that have implemented policies to help reduce maternal deaths,” they wrote. “These strategies include: ensuring all women have access to free or affordable primary care; comprehensive reproductive health care before, during, and after pregnancy; a maternal health care workforce mainly comprising midwives covered by insurance; and comprehensive postpartum support.”

Additionally, the researchers cited the lack of universal healthcare coverage and states that decline Medicaid expansion as limited improvement in maternal health.

There are some bright spots, they said. The Department of Health and Human Services has gone on the record as supporting the expansion of Medicaid coverage to one-year postpartum. As of October 2022, over half of US states have extended Medicaid coverage to one-year postpartum, according to the agency.

Still, the quality of care and the specter of healthcare discrimination certainly plays a role in the country’s poor maternal health record. Efforts to improve the healthcare experience for people of color and drive a diverse healthcare professional pool will be critical, the Commonwealth Fund researchers concluded.