The maternal mortality rate in the US fifteen years ago was 12 out of every 100,000 mothers. In 2013, the last year for which there is complete data, the rate had jumped to 28 in 100,000.
The US is one of just 8 countries — along with Afghanistan and Greece for example — with a rising maternal mortality rate over the last decade, a trend which was discussed at the Women in the World conference in New York on Thursday.
Conference panelists who tried to pick apart what was driving the rate up largely agreed on some of the major contributing factors — like barriers to access to proper medical care, as well as racial discrimination.
— German Lopez (@germanrlopez) May 5, 2014
Though concrete explanations are hard to nail down, another factor in the rise is likely the US' obesity epidemic, which brings with it higher incidences of hypertension and diabetes in mothers — both conditions which can complicate birth. There has also been research showing that unexpected pregnancies are riskier pregnancies, so that a lack of access to birth control and family planning resources results in worse maternal (and infant) health outcomes.
Part of the rate increase may also be statistical, as the US has become more rigorous at collecting data.
Uneven Access and Exorbitant Costs
One of the panel members, Elise Turner of Belhaven University, advocated "pushing care to the people," saying she'd seen her fair share of roadside births when rural mothers were unable to make the trek to big city hospitals in time.
Like fire departments, she said, every town should have a patient care clinic, which would be less costly than emergency care in the long run.
"We know that good care is actually cost-efficient care," she said.
Pregnancy risks are not equally distributed among all women, and the racial disparities are stark. African-American women are 3 times as likely as their white counterparts to die as a result of pregnancy or childbirth. Higher poverty rates among women of color mean more chronic health problems and less access to prenatal care.
There are regional differences as well, with outcomes significantly worse for women in the Southern US, and again, access is probably a contributor.
Mississippi for example - which has the country's lowest physician-to-resident ratio — also failed to expand Medicaid. That left 107,000 people — about half of them women — without any insurance options.
The costs of maternal care have also risen steeply in the US and far outstrip other industrialized nations. Maternal and newborn care together are the largest category of hospital payouts for most insurers and state Medicaid programs. On average, in the United States, giving birth costs far more than in any other industrialized country.
— Jill Wodnick (@JillGW) April 23, 2014
"We spend $111 billion on childbirth related health care, but we have the worst outcomes, we rank 64th in the world when it comes to maternal mortality," said Dr. Priya Agrawal, of Merck for Mothers, a campaign by the pharmaceutical company to address those numbers.
— Dr Priya Agrawal (@priya__agrawal) April 24, 2015
More Data, More Discussion
One of the major obstacles to battle maternal mortality, panelists agreed, was the lack of consistent protocols around childbirth and maternal mortality in hospitals, and a reluctance to openly discuss the problem.
"When a mother dies, the biggest advocate [dies]. Her voice has been extinguished," said Agrawal. "And who’s left behind? A newborn who can’t talk yet, and a husband or a partner who’s grieving."
Turner also said that when "near-misses" are taken into account, the problem is even worse, and that those incidents — like a woman who has a legitimate worry being told she's ok and having complications later — are seriously underexamined as women often blame themselves afterwards.
"You’ve got to be vocal about what you need," she said. "You've got to raise a ruckus."