Brendan Machado

November 1, 2022

In the entire world, maternal mortality has decreased 43% since 1990. The only developed country where it has increased: The United States.

The U.S. is recognized as one of the foremost leaders in the world, playing key roles in many issues around the face of the earth. It leads the world in amount of spending on the military, and the President of the United States is considered the “leader of the free world.” Yet, there is one key area where the United States is significantly lacking compared to other first-world countries: maternal mortality. The United States ranks far behind similarly wealthy countries with a maternal mortality rate of 23.8 per 100,000 live births in 2020. Comparatively, France had a rate of 8.7 per 100,000 and the UK had a rate of 6.5 per 100,000.[i]

There are numerous reasons why the United States lags behind the rest of the developed world in maternal mortality. One of which is the number of midwives and OB-GYNs in the country. While these two jobs serve different roles, both are essential. The midwives help manage the pregnancy, assist with the childbirth, and help provide care and support in the postpartum period. OB-GYNs on the other hand are doctors that are trained to help with pregnancy from a medical standpoint and assist with any complications or problems. These two roles work concurrently with each other to make sure that the woman has the best possible pregnancy. Yet, the United States crawls behind the rest of the developed world with the number of midwives and OB-GYNs. Midwives have been shown to significantly decrease maternal mortality and reduce stillbirths and preterm births. They have also shown to have better customer satisfaction and positive maternal psychological outcomes. While the Affordable Care Act (ACA) stipulates that states’ Medicaid programs cover midwives, there are so few midwives that many people are unable to obtain that service.[ii] This is on top of the lack of OB-GYNs compared to other countries. The United States ranks second to last in number of OB-GYNs with 11 per 1,000 live births.

Another issue is the racial divide. In 2020, the number of maternal deaths per 100,000 births was 19.1 for white women. For non-Hispanic Black women, the number was 55.3.[iii] It has recently been researched that one of the leading causes for the high number of deaths is the stress that black mothers face from institutional racism. Stress is produced by the hormone cortisol, which helps regulate the body in times of distress. However, the release of cortisol has shown to slow the growth of the fetus in the mother. This is important because in the U.S., “pregnant women from minority ethnic groups report greater rates of prenatal stress than do women in majority ethnic groups”.[iv] This also contributes to the idea of the multiple-risk models. The belief is that risk factors tend to occur together. So, if someone is under a great amount of stress, they are unlikely to eat well or seek prenatal care. One part of this model is the impact of structural racism. This impacts people of color especially black mothers. Black infants born in communities with higher levels of structural racism are more likely to be small for gestational age than black infants born in communities with lower levels of structural racism. Additionally, “pregnant women in minority communities who report higher levels of concern about racial discrimination are more likely to have preterm infants than those who report lower levels of concern”.[v]

Recently, the PRO-LIFE Act was introduced in the House. This collection of bills would aim to improve maternal healthcare. One key bill in the act was the MOMMA’s Act. This would standardize maternal mortality reporting to the CDC. It would also establish regional centers through the HHS that would educate health care providers about implicit bias and culturally competent care. Furthermore, it extends postpartum eligibility for Medicaid and CHIPS for one year. These are common sense improvements that will help many mothers but especially mothers of color and mothers in poverty: the populations that truly need the help.[vi]

Another bill in the PRO-LIFE Act was the FAMILY Act. This would entitle everyone to paid leave under all insurances. It would give a monthly benefit of two-thirds of the person’s pay and up to $4,000. It would cover up to 60 days of paid leave. Paid leave has shown to have benefits for the mother and the child. 16-week paid leave replaced twelve-week unpaid leave in Norway, and it resulted in many areas of the mother’s health being improved like blood pressure, pain levels, and exercise behaviors. Research has also shown that underprivileged families benefit more from paid leave.[vii] They experienced better birth outcomes possibly because of less stress during the pregnancy. Paid leave is also linked with better child mortality rates and vaccination rates. It also allows for the mother to spend more time at home and develop the child-mother bond that is crucial for the development of the child. [viii]

Finally, these policies should be accompanied by the implementation of free healthcare coverage relating to pregnancy-related care and service. This would include abortions, all checkups, the delivery of the baby, and any services required after the birth of the child. This would significantly help with the stress of pregnancy and help provide services that are not currently available after the pregnancy. 69% of pregnancy related deaths occur after the baby is born.[ix] The leading causes are severe bleeding, high blood pressure, and infection in the week after the baby is born. Additionally, cardiomyopathy (weakened heart muscle) is the leading cause of death one week to one year after the delivery. By making all healthcare related to pregnancy and the birth of the child free, mothers would not have to decide if they can afford to go the hospital. This would alleviate the stress of medical bills throughout the entire pregnancy and ensure that better healthcare is provided to everyone.[x]

There needs to be a complete overhaul of the maternal health system in the United States. Ranking last in maternal mortality death rate while being the “leaders of the free world” is an abomination. We should be leading the way in healthcare and especially in maternal healthcare. A lot of the problems lie with the especially high rate of maternal mortality with people that are non-white. This is due to a multitude of reasons, but chief among them is racism and stress. These two combine to form a devastating effect on non-white maternal mortality. Lessening the amount of stress that a person feels during pregnancy is important for the health of the mother and health of the baby. Implementing the solutions above would be helpful in lowering the maternal mortality rate.

Edited by Patrick Swain, Kyler Kantz, and Andres Lopez.

[i] “Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries.” Maternal Mortality Maternity Care US Compared 10 Other Countries | Commonwealth Fund, November 18, 2020. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries.

[ii] Siegler, Robert S., Elizabeth T. Gershoff, Jenny Saffran, Nancy Eisenberg, and Campbell Leaper. “Chapter 2.” Essay. In How Children Develop. New York, NY: Worth Publishers, Macmillan Learning, 2020.

[iii] “Maternal Mortality Rates in the United States, 2020.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, February 23, 2022. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm.

[iv] Siegler, Robert S., Elizabeth T. Gershoff, Jenny Saffran, Nancy Eisenberg, and Campbell Leaper. “Chapter 2.” Essay. In How Children Develop. New York, NY: Worth Publishers, Macmillan Learning, 2020.

[v] Siegler, Robert S., Elizabeth T. Gershoff, Jenny Saffran, Nancy Eisenberg, and Campbell Leaper. “Chapter 2.” Essay. In How Children Develop. New York, NY: Worth Publishers, Macmillan Learning, 2020.

[vi] “H.R.3407 – 117th Congress (2021-2022): Momma’s Act.” Accessed October 18, 2022. https://www.congress.gov/bill/117th-congress/house-bill/3407.

[vii] “The Urgent Necessity for Paid Parental Leave.” Monitor on Psychology. American Psychological Association. Accessed October 17, 2022. https://www.apa.org/monitor/2022/04/feature-parental-leave#:~:text=All%20the%20mental%2C%20physical%2C%20and,and%20Youth%20Services%20Review%2C%20Vol.

[viii] “H.R.804 – 117th Congress (2021-2022): Family Act.” Accessed October 18, 2022. https://www.congress.gov/bill/117th-congress/house-bill/804.

[ix] “Pregnancy-Related Deaths.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Accessed October 17, 2022. https://www.cdc.gov/vitalsigns/maternal-deaths/index.html.

[x] “Maternal Mortality Rates and Statistics.” UNICEF DATA, July 12, 2022. https://data.unicef.org/topic/maternal-health/maternal-mortality/.

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