The United States, despite being one of the wealthiest nations in the world, is currently facing a maternal health crisis. According to a report by the Centers for Disease Control and Prevention (CDC), the maternal mortality rate in the U.S. has steadily increased over the past two decades, with Black and Indigenous women being disproportionately affected. The reasons for this crisis are well-documented, and it is important to understand every dimension of this crisis to address it effectively. Below are some of the most common causes of poor maternal health outcomes in the U.S. according to experts.
1. Racial disparities
Black women are three to four times more likely to die from pregnancy-related complications than white women. Native American and Alaska Native women also have higher rates of maternal mortality, and are two times more likely to die from pregnancy-related concerns than their white counterparts. These disparities are largely due to systemic racism and discrimination in health care. This racism often takes the form of systematic resource starvation in communities of color, the mechanisms of which are often redlining, employment discrimination, and voter suppression. Implicit bias is also at play in medical settings; for example, white physicians often unconsciously associate Black patients as being “less compliant” or are more likely to dismiss women’s reports of pain. Racism and discrimination are also chronic stressors that can erode a person’s physical well-being as much as it can affect their mental health. For a deep dive look into the maternal health issues facing communities of color, check out the grassroots organizations currently participating in the NWHN’s Health Equity and Access Leadership Training Hub (HEALTH) Program.
2. Lack of access to high-quality, affordable healthcare
According to the U.S. Department of Health and Human Services (HHS), nearly 25% of women in the U.S. receive inadequate prenatal care. Furthermore, nearly half the women of reproductive age in the U.S. are likely to skip or delay needed care because of the associated cost. Without adequate medical care, women are at a higher risk for complications during pregnancy and childbirth, which can result in tragedy. One poignant example of how this can play out is detailed in the 2022 documentary Aftershock. One of the film’s subjects, Amber Rose Isaac, died in childbirth because her platelet count had been dropping steadily during her pregnancy – something the team caring for her never indicated to her or her family. A low platelet count generally means that a C-section is not a safe delivery option, but the C-section went forward, and Amber died soon after. Amber’s case is not an anomaly. One in three women have a C-section in the United States. This number is significantly higher than most high-income countries who outrank the United States in maternal health outcomes. Obstetric training in the United States prioritizes surgery, with most providers adopting a “better safe than sorry” approach, but C-sections are not always the safer option, and these procedures are significantly more expensive than natural birth.
3. High cost and low reimbursement rates
One-third of all U.S. counties are maternity care deserts. Meaning, one-third of women in the United States lack access to a hospital or birth center providing obstetric care. This issue disproportionately impacts our most vulnerable communities. More than half of all rural hospitals do not have an obstetric (OB) unit, and OB units are more likely close in Black and brown communities and geographically isolated areas. Hospital administrators often attribute OB unit closures to low Medicaid reimbursement rates. What this means is, if a birthing person is ensured by Medicaid, Medicaid often doesn’t pay the hospital back for all the costs of care. Medicaid finances 40% of births in the United States, making it the largest payer for maternity care. Unsurprisingly, communities without access to obstetric care are more likely to be enrolled in Medicaid. Most hospitals would agree that delivering babies and saving the lives of mothers is invaluable work but every year hospitals lose millions of dollars in revenue to their OB unit. Losing an OB unit is often a strong indicator that the hospital is at risk of closure. Tasked between keeping the lights on and maintaining their OB unit, most hospitals will choose to cut labor and delivery services. The United States needs a new payment model to sufficiently cover high-quality maternity care. In the meantime, we need to get rid of laws that make home-births illegal and cut red tape for freestanding birth centers.
4. Comorbidities and chronic health conditions
Women who are obese or have chronic health conditions such as hypertension, diabetes, or heart disease are at a higher risk for complications during pregnancy and childbirth. These conditions can lead to gestational diabetes, preeclampsia, and other serious health issues, especially if they are not being properly monitored and treated. Women with fibroids may also experience pregnancy complications or struggle with fertility. NWHN supporter and podcast contributor Anna Frank, for example, struggled with years of infertility, polycystic ovary syndrome (PCOS), gestational-onset high blood pressure, and depression before successfully building her family. She credits her dedicated medical team, amongst others, with the ultimately positive outcome.
5. Advanced maternal age
Women who have children over the age of 35 are at a higher risk for complications during pregnancy and childbirth. Advanced maternal age can lead to higher rates of preterm labor, gestational diabetes, chromosomal conditions like Down syndrome, and other issues. That’s not to say thousands of women don’t safely deliver healthy babies after 35; most pregnancies of this kind are healthy and successful. And there are many women, like this Florida mom who gave birth to a healthy daughter at 54, who are challenging the old fear-based narrative of a “biological clock.” But adequate prenatal care tailored to the mother’s age and health status makes a positive difference.
6. Lack of social support
Having a child is a life-changing and life-defining event – and there’s a reason people say that it takes a village to raise one. Many new mothers lack social support during and after pregnancy and describe feeling overwhelmed. Many women lack these supports, such as access to affordable childcare or a supportive partner or family member during and after pregnancy and childbirth, and this can impact their health and their ability to care for their child. Perinatal depression, for instance, is incredibly common, affecting one in seven women during and after pregnancy. With the proper resources and increased support, many women feel better, but no two pregnancies are the same, and everyone’s journey looks different. To improve maternal health outcomes, maternal mental health services need to be fully integrated into perinatal and postpartum care.
In summary, poor maternal health outcomes in the U.S. are caused by a series of interconnecting factors, and addressing these issues will require a comprehensive approach. Stay tuned for our next post on maternal health, which will detail some promising, evidence-based solutions to the maternal health crisis.
This article was originally published on nwhn.org.