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?
In: 1594
Welfare as we knew it went away in 1996 and the lives of very poor women became harder as a result. (The decline in child well-being is also linked, IMO.)
America is a very rich nation superficially, but poverty runs deep if you scratch the surface.
To lay out a few facts: This NIH study shows that the US, compared to other developed countries, has a substantially higher infant mortality rate. This is a meta study, so looked accross methodologies of many different studies, and while the exact number (obviously) varied, the result was the same – looking at IMR, we are on par with Croatia, not the UK, Canada or Australia.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/)
Despite a pretty complete analysis, this data didn’t really get at a single cause. For instance, income disparity only accounts for 30% fo the gap in infant mortality compared to Finland. So, while that is a chunk of the explanation (we have great healthcare, but only if you are that has it AND can afford it). To be fair – I think this may have been obfuscated by some low income jobs having better insurance.
One thing this paper didn’t touch on was racial disparity in mortality rates. Black mothers are much more likely to die, and so are their children. Nearly double when compared to white families.
[https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/](https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/)
Why? Economics (as outlined above) account for part of it. However, you can find testimony from black doctors who know they weren’t getting the best treatment from otherwise great facilities. So, racism in the healthcare system is absolutely part of the problem. There is plenty of research out there that, in the US, black people are viewed as being more aggressive even while engaging in the same actions as white people – even when the subjects are toddlers. Combative patients generally get worse treatment.
There are many factors, but one is that maternity wards are understaffed. Hospitals don’t want to pay for nurses that aren’t doing anything, but you can’t predict when people go into labor. When I went into labor early, there weren’t enough nurses on the floor. I didn’t even get a room until I was at more than eight cm.
They don’t dedicate one nurse to stay in the room with you, even after you reach a certain level of dilation or effacement. My labor was rapid, and I spent a significant part of it laboring alone, as my husband kept running around, trying to get medical help for me. Since there wasn’t anyone there, they couldn’t tell how quickly everything was happening.
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.
My job is to track the number of kids that die in my state and I have worked here since 1995 so I have a really good handle on what is going on. There are a lot of reasons the numbers are different in the US. First of all we count all infants that even gasp for breath as a live birth, even those that are in no way viable. Human gestation is 40 weeks long, and most countries do not count any births before 22 weeks of gestation as a live birth. Which is sensible since no child under 22 weeks gestation has ever lived long enough to go home and live their life. There are infants as young as 14 weeks gestation being counted as a live birth in the US.
Secondly our medical care is partially at fault. Especially the use of IVF. IVF increases the likelihood of multiples (twins, triplets or more). Which increases the risk of prematurity, high blood pressure, placental abnormalities and other issues. Also advanced maternal age increases the chances of miscarriage or birth defects, thus increasing our infant mortality rate.
Another issue, of course, is poor prenatal care. We all know how expensive medical care is in the US and many women don’t go to the doctor until later in their pregnancy because of the expense. One of the most troubling things is the poor quality of care under Medicaid. You are offered fewer tests that could find issues if you are covered by Medicaid than you get if you are on private insurance. Which means that poor women, the ones who probably need the most help, get substandard care.
TL/DR: we count younger gestational ages, IVF is used a lot and Medicaid sucks
The US is in decline. This causes the many factors which, in aggregate, lead to worse outcomes on average.
It’s a very good sign of a healthy, or unhealthy, society. It used to be one of those things the US was “#1” in. Now we just go around claiming to be number one, but can’t remember for what.
A big factor: In rural (even semi rural) cities, hospitals and birth centers are closing. Even poorer places in big cities are becoming birthing deserts because birthing care gets harder to access
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