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Although the United States has a higher rate of women dying during pregnancy, childbirth, or the postpartum period, it is higher than in other high-income countries. Recent failures A new report shows maternal mortality rates in America.
In the year There were about 22 maternal deaths for every 100,000 live births in the United States in 2022, the most recent year for which data is available. That rate was double, sometimes triple, that seen in most high-income countries that year. A report released by the Commonwealth Fund on TuesdayA private foundation focused on health care issues.
And the maternal mortality rate among black women in the United States remains high, with nearly 50 deaths per 100,000 live births, according to the new report.
Meanwhile, in the new report, half of high-income countries have fewer than 5 maternal deaths per 100,000 live births, with one country, Norway, recording zero maternal deaths.
Unlike Norway and some peer countries, “the US has a shortage of maternal care workers; It's only going to get worse,” said Munira Gunja, lead author of the report and senior researcher at the Global Health Policy and Practice Innovations Program. by the Commonwealth Fund.
She stated that she is in the United States Limited access to midwivesThey provide patient support from prenatal to postnatal period.
“We don't supply midwives, and midwives are underutilized, whereas in most other countries, midwives far outnumber o-gyns. They are part of their health care system. Midwifery care is not integrated enough with our system,” Gunja said.
In the United States, “there are many barriers to access to midwifery care, and other countries don't have that. In some cases, the ob-gyn and in most cases the midwife was able to ensure that each woman was cared for. “In America, we're the only country in this analysis that doesn't have a universal health system. About 8 million women of childbearing age do not have health insurance.
In Norway, Universal health coverage, Prenatal care is accessible free of charge.And a high-risk pregnancy is correctly identified.
Commonwealth Fund researchers 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 US.
Data from the US Centers for Disease Control and Prevention and the Organization for Economic Co-operation and Development show that the three countries with the highest rates of maternal mortality 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 zero, Switzerland with 1 death per 100,000 live births and Sweden with 3 deaths per 100,000 live births.
Maternal mortality rates have increased in Australia, Japan, the Netherlands and the United States during the Covid-19 pandemic, according to the report, which the report suggests is due to an increase in HIV-19-related infections and complications caused by the virus. or delay or reduce timely delivery of care. More recently, maternal mortality rates have begun to decline in Chile, Norway, and the United States.
of America's maternal mortality rate has decreased Maternal deaths will rise from 32.9 per 100,000 live births in 2021 to 22.3 per 100,000 in 2022, according to the CDC.
Dr. Laurie Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund, said: “It is encouraging to see fewer maternal deaths in the U.S. by 2022, but the U.S. is still very clear, and the racial disparities are very troubling. He said in a news release.
“Now is the time to put equity at the center of expanding the workforce and addressing racial inequities in health care quality and access,” she said. “It's time to learn what we know is working well in other countries: expanded health insurance coverage, strong workforce and support systems, and paid maternity leave.”
The new report cites the U.S. health care system, policy disparities and maternal care deserts — residents with limited or no access to prenatal health care — as factors behind America's high maternal mortality rate.
The US and Canada have the lowest overall supply of midwives and obstetricians to care for pregnant and postpartum mothers, with just 16 and 13 providers per 1,000 live births, respectively, according to the new report. Maternal mortality in Canada is estimated at 8 out of 100,000 live births.
More than 2.2 million U.S. women of childbearing age — 15 to 44 — live in the fertility desert; The report is from the non-profit March of Dimes In the year It was discovered in 2022 and received a different analysis last year Hospitals in 10 US states In the last five years, they have lost maternity units.
Midwives “could help address the maternal labor shortage in nearly half of the counties in the United States where there is a shortage of one obstetrician.” An estimated 8,000 more ob-gyns are needed to meet demand — a number that could rise to 22,000 by 2050,” the new report says.
In addition, nearly two-thirds of maternal deaths occur in the 42 days after giving birth, and American women are less likely to go home after giving birth, according to the new report. All countries in the report, other than the US, guarantee at least one home visit per week after delivery. At the state level, some Medicaid programs in the US cover these visits.
“The World Health Organization recommends at least four prenatal checkups in the six weeks after birth, but two out of five American women — often young, low-income, and uninsured — skip one postpartum checkup,” she said. The new report.
High blood pressure, high blood pressure and infection are the most common causes of maternal death in the first week after delivery, while cardiomyopathy – a disease of the heart muscle – is the leading cause of death in the postpartum period, according to the new report.
The US is also the only high-income country without a federally paid maternity leave policy, according to the new report. U.S. women are less likely to receive paid leave than women in high-income countries, who are allowed at least 14 weeks of work leave.
“Maternal death is a preventable problem, and it can be solved. Many countries have found ways to ensure that all women are in safe hands during and after childbirth. We need to extend that to women in America,” Gunja said. “We know it's time — so making sure we have federal reimbursement authorization, making sure we're making it easier for women to get postpartum care, which means home visits and not making women go to the doctor.”
Racial disparities in maternal mortality rates persist not only in the United States, but also in other parts of the world where some women lack access to postpartum support, the new report says.
“In the UK, for example, black women are four times more likely to die than white women. In Australia, Aboriginal women are twice as likely to die from maternal complications as non-Aboriginal women,” the researchers wrote.
“Our findings suggest that lack of access to maternity care providers, particularly midwives, and general postpartum support, including maternity care coverage and paid maternity leave, may contribute,” they wrote. “Both of these factors affect women of color, so putting equality at the center of any future policy changes will be key to addressing the crisis.”
The Commonwealth Fund report “highlights the need to improve maternal health care and maternal health equity in the US.” Dr. Tochi Iroku-MalizeA family physician in Long Island, New York and chairman of the board of the American Academy of Family Physicians, who was not involved in the new report.
“For us in family medicine, we know that we play an important role in providing prenatal care during pregnancy and postpartum, which is important, and maternal health cannot stop after the patient gives birth,” she called. Her U.S. colleagues cautioned their patients about problems related to maternal health – such as myocardial infarction or mental health conditions – in their postpartum patients, as most maternal deaths occur during that period.
“A postnatal patient's body still has huge physical, hormonal and emotional changes that you can't forget,” she says. “And our training as family physicians helps us fully assess and address physical, emotional and social needs during pregnancy and postpartum.”
Dr. Michelle Owens, MD, an obstetrician-gynecologist in Jackson, Mississippi, who was not involved in the new report, said adding more obstetricians to the maternal health care workforce remains an important component and a high demand.
But we need to ensure that we have systems in place that facilitate the escalation of care when every birth needs the right care at the right time. Timely diagnosis and treatment of complications are essential to ensure the overall health and well-being of our mothers and their babies,” Owens, a member of the American College of Obstetricians and Gynecologists, wrote in an email.
“ACOG recommends that pregnant women participate as active partners in their care, attend appointments during and after pregnancy, and consider pregnancy planning to optimize pregnancy outcomes,” she added. “Ultimately, patients should feel empowered to voice their concerns to their health care providers and have providers listen to their concerns and work collaboratively with patients to address their concerns.”
The report joins several other studies that have highlighted the United States' high maternal mortality rate, said Dr. Christopher Zahn, interim executive director and director of clinical practice and health equity and quality at ACOG.
“Despite covering different time periods and using different methods, what we can take with confidence from these reports is that maternal mortality in this country remains unacceptably high,” wrote Zahn, who was not involved in the Commonwealth Fund's latest report. In the email.
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