Most poorer countries have seen major drops in maternal mortality since 2000. While wealthy countries are generally seeing a flatlining or slight increasing trend, the rate has nearly doubled in the US. Acutely, (ie the medical issue not social causes) what is causing this to happen? What illnesses are pregnant women now getting more frequently? Why were we able to avoid these in a time (2000) where information sharing and technological capabilities were much worse? Don’t we have a good grasp on the general process of pregnancy and childbirth and the usual issues that emerge?
It seems as if the rise of technology in medicine, increasing volume of research on the matter, and the general treatment level of US hospitals would decrease or at the very least keep the rate the same. How is it that the medical knowledge and treatment regimens have deteriorated to such an extent? Are the complications linked to obesity?
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I’m European. I don’t know if and why there was an increase in maternal mortality in the US, but I do know why maternal mortality is high in the US with respect to many European countries, including my own country Belgium.
Basically, in Belgium all prenatal and postnatal care is covered by our national health insurance. All Belgians are covered, regardless of their employment status. We do pay a small fraction ourselves, but this was easy to bear financially.
In contrast, in the US health insurance is much more expensive and often tied to employment. Even with insurance, lots of women will end up with huge copays. As a result, pregnant women who happen to be poor will tend to postpone or avoid care, because they can’t afford it. This greatly increases the risk of a bad outcome.
A second important factor is that there are a lot more teenage pregnancies in the US due to the lack of sexual education and lack of access to contraception. This is especially true in the more Southern states, where religion tends to limit education and access to contraception. Teenage pregnancies have a higher risk of a bad outcome when compared to adult women in their twenties, so this also increases maternal mortality.
Finally, US has almost no paid maternity leave, when compared to minimum 15 weeks of paid maternity leave in most European countries. When women can take maternity leave in time, e.g. at 36 weeks of pregnancy or even earlier, the outcomes for both mother and child tend to be better. As such, lack of generally available maternity leave will also (slightly) increase maternal mortality.
There are many more factors at play of course, but I think that these are the most important ones when comparing Europe to the US.
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