Maternal Mortality: Causes, Differences, and Solutions
By: Sania Patel
According to the World Health Organization (WHO), maternal mortality is defined as the death of a woman while pregnant or within forty-two days of termination of pregnancy, irrespective of the duration and site of the pregnancy or its management. Accidental or incidental causes are an exception. Since 1990, several global organizations – the WHO, UNICEF, World Bank Groups, and the United Nations Population Division – have reported a decrease in maternal mortality rates. However, a 2017 study by the WHO reported that the US was one of only two countries to report a significant increase in its maternal mortality ratio (the proportion of pregnancies that result in the death of the mother), since 2000. While maternal deaths in the US have leveled in recent years, the ratio is still considerably higher compared to other developed countries.
There are various reasons as to why maternal mortality is exceedingly high in the U.S. compared to other developed regions. However, the most prominent cause is racial inequality, which is only the outline of the series of issues that occur with maternal care. Economic differences, discrimination, and limited access to prenatal and postpartum care are just a few issues that stem from racial inequality. Dr. Michael C. Lu, the associate administrator of the US Department of Health Resources and Services Administration, states, “Today African American women are still three times more likely to die during pregnancy and childbirth as [white women], and it’s a gap that we haven’t been able to close for decades.”
Many minority groups have been poorly educated in topics like maternal health and childbirth due to the continuity of America’s socio-economic stratification, which often leads to improper prenatal and postpartum treatment, Thus, complications emerge both during and after childbirth. Minorities are also affected by discrimination and malpractice in hospitals. Countless reports have outlined instances where mothers have been harassed, denied certain childbirth procedures, and even physically harmed by the attending doctor. Furthermore, the Georgia Birth Advocacy Coalition claims that 1 in 3 women report their births were traumatic, and 16% develop PTSD after giving birth due to their unfavorable experience in the hospital.
Another challenge minority groups face is economic differences. On average, 77.8% of minorities receive a high school diploma, and only 42% of them go on to graduate from a four-year college or university. Due to the lack of education, most minorities often hold lower-class job positions. With overwhelming health care costs, many women neglect prenatal and postpartum care. According to a 2004 CDC report, 0.23% of women in the US chose to give birth at home. However, this percentage has increased to 0.89% in 2012, as home birth is recorded to be 68% less expensive than hospital delivery.
The US faces the issue of racial inequality, which in short further develops economic unsustainability, leading to decreased access to prenatal and postpartum maternal care. Racial inequality connects to economic differences that relate to poverty, limited access to healthcare, and untreated chronic conditions, all of which are the main causes of maternal mortality, according to Hartford HealthCare.
Data from other developed countries, such as the United Kingdom, can potentially provide some insight into the implementation of efficient maternity care. In 2017, the maternal mortality rate for the UK was 7 deaths per 100,000 live births, which is substantially lower compared to the US’s estimated ratio of 20.1 deaths per 100,000 live births. Essentially, the US healthcare system is not a singular institution or organization, but rather multiple systems with very little coherence. In other words, the US healthcare system is “a mix of public and private for-profit and nonprofit insurers and health care providers” (The Commonwealth Fund). In addition, the federal government provides funding for the national Medicare program, which supports adults ages 65 and older, people with disabilities, low-income individuals, and veterans. However, the complex nature of the U.S. healthcare system causes medical costs to be practically unreasonable for most US citizens. In fact, an annual data report from the Health Cost Institute states that average healthcare prices have increased year after year with rates that were 15% higher in 2018 compared to 2014.
In contrast, the UK healthcare system is a government-sponsored universal program known as the National Health Service (NHS). Unlike the US, all English residents are automatically entitled to free public healthcare through the NHS, as its budget is funded primarily through general taxation. According to the Healthcare Administration, medical costs in the UK are very low when compared to those in other developed countries, particularly the US.
Since 2007, the Centers for Disease Control and Prevention’s National Center for Health Statistics has not published an official maternal mortality rate. Marian Mcdorman, who works for the Maryland Population Research Center reacts to this startling fact as follows:
“It’s a total embarrassment that international databases such as the Organization for Economic Cooperation and Development list a dash for the US’s maternal mortality rate when a country like Mongolia is able to report one.”
In order to decrease the US’s maternal mortality rate, racial equality and economic sustainability must be achieved within the healthcare system. U.S. citizens must also be more informed about current issues within contemporary medicine and should focus on enhancing healthcare programs for the benefit of all people. By directing collective attention towards various contributors of maternal mortality, including reproductive and socioeconomic factors as well as the health care delivery system, the US will progress towards a more effective medical future in all aspects of human health.