Study Explains Why US Maternal Death Rate Is So High; Lessons for Africa

By Adebowale Bello. Freelance Health Writer. Medical review and editorial support provided by the DLHA Team.

Among high-income nations, the U.S has the highest maternal mortality rate and mothers are far more likely to die from pregnancy-related complications. When compared to other high income nations who record virtually no maternal deaths, this statistic is worrying. 

80% of maternal deaths in the USA are completely preventable. Sadly, for many women, the dream of childbirth can turn into a nightmare quickly.

A study published in the Commonwealth Fund report showed that in 2022, there were 22 maternal deaths for every 100,000 live births in the U.S. For black women, that number rises greatly to 50 deaths for every 100,000 live births. This is because they receive worse-quality care than white people.

For the purpose of the study, the researchers assessed maternal health across 14 high income nations - Australia, Canada, Chile, France, Germany, Japan, Korea, Netherlands, New Zealand, Norway, Sweden, Switzerland, U.S and UK.

When does Maternal Death Occur?

In the U.S, 1 in 5 mothers die during pregnancy. This death is linked to other medical conditions such as stroke and heart disease.

The study found out that 2 out of every 3 maternal-related deaths occur after childbirth, ranging from day one to one year after.

Severe bleeding, infections and high blood pressure contribute significantly to maternal deaths that happen in the first week after delivery. However, late maternal deaths within the postpartum period are linked to cardiomyopathy - a disease that overworks the heart, weakens it and makes it more difficult to pump blood.

Why Maternal Mortality Rate Is So High In The U.S?

There are several reasons why the U.S has a high maternal mortality rate, when compared to other high income nations. 

Foremost of these reasons is the alarmingly low number of midwives present in the United States. These professionals are capable of managing normal pregnancies, childbirth assistance and postpartum care. Yet, there are only 16 midwives available for every 1000 live births. Almost all other countries that were assessed in the study had at least two to six times more.

Statistics further show that midwives can potentially prevent 41% of maternal deaths worldwide, hence emphasising their importance.

The inadequate number of midwives in the United States makes it impossible for new mothers to benefit from high-quality postpartum care, even though this care is essential in the physical and emotional recovery of both the mother and infant. 

In other countries included in the report, midwives pay home visits on several occasions to the new mother, providing support while assessing her physical and mental health. On the contrary, the U.S has no provision for such visits.

In addition, most high income countries mandate at least 14 weeks of paid maternity leave, which could extend to a year of parental leave in some. However, the U.S does not federally mandate paid maternity leave, leading expectant mothers to forfeit their jobs so that they can care for their newborns in the first few weeks after delivery.

Even in some states where paid maternity leave is available, very few women have access to it.

What Are the Proposals to Improve Maternal Health in the U.S?

Some of proposals offered in the Commonwealth Fund report include:

• Increased access to affordable, high-quality maternity care.

• Integrating more midwives into the healthcare system.

• Implementing policies aimed at eliminating racial disparities in healthcare.

• Guaranteeing access to postpartum home visits from healthcare professionals.

• Implementing paid parental leave policies to provide vital support to mothers in the critical weeks and months after childbirth.

Are There Lessons to Learn in Africa from the US Conditions?

Even though there has been significant improvements in maternal care over the past two decades, most African nations still have very high maternal death rate that is on average twenty times that of the United States (over 400 deaths for every 100,000 live births). 

Given that most African natins are not at comparable socio-economic level with the US, some of the factors at play in African countries are similar to those identified in the United States although at more severe levels.

What lessons can African health managers and other stakeholders learn from the proposals advanced by the Commonwealth Fund report to lower maternal death rates in Africa?

Here are some suggestions:

• Train more community midwives to provide medical care during childbirth, especially in rural areas.

• Promote continuous public service awareness campaigns focused on reproductive health and the importance of seeking medical attention before, during and after delivery.

• Partner with local communities to ensure that traditional and modern healthcare systems function properly.

• Strengthen data collection to pinpoint communities with high maternal mortality rates and focus resources there.

• Develop and implement comprehensive policies aimed at reducing food insecurity and economic hardship.

• Implement social funding mechanisms to facilitate access to maternal services with minimal out-of-pocket spending at time of care.especially for low and middle income women.

Sources:

• Munira G, Evan G, Relebohile M, Laurie Z. Insights into the U.S. Maternal Mortality Crisis: An International Comparison. Commonwealth Fund. [Internet, 2024 June 4]. Cited 2024 June 13. Available from here.

• Andrea N, Ingrid K, et al. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: A lives saved tool modelling study. The Lancet Global Health. [Internet, 2020 Dec 1]. Cited 2024 June 13. Available from here

Related:

Maternal Mortality in sub-Saharan Africa: A Call to Action

6 Conditions that Put Pregnant African Women at Risk of Death

Published: June 14, 2024

Updated: June 19, 2024

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