A Reflection on US Maternal Mortality

There are certainly a multitude of factors that I think have contributed to the trend of increasing maternal mortality in the US over the last 25 years while other high income countries have improved this health outcome. I think one of the most obvious differences between the US and other HIC that contributes to maternal mortality is the absence of universal healthcare coverage in the US. The lack of basic healthcare coverage for women means that many women forgo getting the care they need, even when they aren’t pregnant. Lack of access to care translates to poorer health outcomes in general, and pre-existing health conditions (hypertension, obesity, diabetes, etc.) predispose women to adverse health outcomes during pregnancy. Because of the lack of coordination within the US system, there is less of a focus on preventative care compared to other countries where providers are incentivized to improve health measures. I think the US neglect to provide basic care for women throughout their lives contributes to the high rates of maternal mortality because American women may already be “sicker” when they begin their pregnancy.

Furthermore, the US system does not guarantee care for women once they do become pregnant. From what I have read, it seems that other countries place an emphasis on prenatal care as a mechanism of primary prevention for both the mother and child. However, in the US, women who are not able to afford prenatal care simply don’t get it. This is a missed opportunity to address the chronic comorbidities that complicate pregnancy and a missed opportunity to screen for other high risk conditions of pregnancy. I think that the US lack of the basic foundation of providing accessible women’s health accounts for part of the reason why our maternal mortality is so comparatively high.

The persistent racial disparities in maternal mortality in the US highlight the significance of structural racism in causing maternal death, which also separates the US from other HIC. To me, the most striking aspect of this statistic is that black mothers die at higher rates than white mothers even when confounding variables like education level and socioeconomic status are controlled for. This factor certainly sets the US apart from other countries where such trends are not seen. This demonstrates that there is something intrinsic to the experience of being a minority woman in the US that increases one’s risk for dying in the perinatal period. Potential causes of this trend include the greater allostatic load that the lived experience of racism puts on a woman's body and the biases and negative experiences many minority women have in the healthcare system leading to subpar care.

Other factors that I think might play a role in the increasingly high maternal mortality in the US include the trend to delay childbearing until later ages and the high percentage of US deliveries done through a caesarian section. I am not sure if other HIC are consistent with the US in these trends, but it is something that I am interested in looking into. All in all, it is certain that the high maternal mortality in the US is due to a multitude of factors working in concert to put American, especially minority, women at higher risk.