Why American mothers are more likely to die in childbirth

  • By Brandon Drennan & Chelsea Bailey
  • BBC News, Washington

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Why does the US lead the developed world in maternal deaths?

The United States is one of the richest countries in the world where it is most dangerous for a girl to be born.

Maternal deaths increased by 40% at the peak of the pandemic, according to new data released by the US Centers for Disease Control and Prevention.

In 2021, 33 women died out of every 100,000 live births in the United States, up from 23.8 in 2020.

According to the CDC, that rate was double for black women and almost three times more likely to die than white women.

Compared to other countries, the maternal mortality rate was twice as high in the US as in the UK, Germany and France; And three times more than Spain, Italy, Japan and many other countries, according to the World Bank’s latest global comparison data.

Moreover, it has been steadily increasing in the United States since at least 2000. However, the average maternal mortality rate in 37 other countries declined over the same period.

“Clearly the US is an outlier,” said Joan Costa-i-Fond, professor of health economics at the London School of Economics. “Made by Covid [maternal mortality] Bad, but it was already a big problem in America.”

Mr Costa-i-Fond said the increase in maternal mortality in the US in 2021 was the result of a “perfect storm” of events between a deadly epidemic, racial inequality, relatively low health insurance and high health insurance costs.

“Insurance design is responsible for the excessive barriers to women [in the US] face while pregnant”, he said. “Basically it’s a system that doesn’t provide care to people who need it most. It provides great care for the wealthy but below the standard of care for low-income people.”

However, in the UK and other countries in Europe, the cost of having a baby is free, compared to thousands of dollars in the US – even among the insured – and co-pays for things like pregnancy tests and postnatal care are minimal. .

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Maternal mortality rate in the US to increase by 40% by 2021

“Covid has made it worse, but [maternal mortality] A structural problem here in America,” said Mr Joan Costa-i-Fond.

The high cost of health care, combined with glaring disparities along racial and socio-economic backgrounds, has kept death rates in the United States stubbornly high for years, he said.

Also, pregnant women are at a higher risk of experiencing severe illness if infected with Covid-19. That risk increases for pregnant women living with comorbidities such as obesity and diabetes, who are more likely to experience pregnancy complications, including death.

“Low-income people in America find themselves with more needs, more disease and less coverage,” Mr. Costa-i-Font said.

Black Americans are disproportionately on the axis of the three points raised by Mr Costa-i-Font – they are the most obese or overweight in the US and 20% more likely to develop high blood pressure. The proportion of black Americans who are still uninsured is two-thirds higher than that of white Americans.

The CDC defines a maternal death as a death that occurs during pregnancy or within 42 days of pregnancy.

Experts say most maternal deaths occur shortly after childbirth, with many women forced to return to work and unable to continue post-natal care.

Black Americans in particular often work in low-income jobs that offer little to no health insurance and minimal time off for maternity leave.

Many of the same jobs, such as food service, were deemed essential during the pandemic and workers were unable to work from home. This increased Black women’s chances of exposure to Covid-19 and inadequate access to health care, contributing to higher mortality rates.

“Women say I can’t have this bleeding, these headaches, because I don’t have support afterward,” said Dr. Rosanda Mitchell, a Howard University physician who specializes in maternal-fetal medicine and high-risk. Pregnancy.

“Everyone is there during pregnancy, celebrating pregnancy,” she added. “But if most of our mothers are dying after giving birth – we need help after giving birth.”

But without systems to support workers in low-income jobs, many mothers are forced to ignore early signs of health concerns.

Some mothers, even those with health insurance, are discouraged from seeing a doctor postpartum because of the high cost and wait until the worst-case scenario, which in many cases can be too late.

Dr. Mitchell explained that until there is a broad overhaul of how the health care system works in the United States, the situation is unlikely to improve.

“It’s really hard to narrow it down to one thing,” he said. “I think some of the worst outcomes and disparities we see are all part of the bigger picture of health disparities.”

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