Why Are Maternal Mortality Rates Increasing in the US?
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Maternal mortality, the pregnancy-related deaths that occur either during pregnancy, during childbirth or within one year postpartum, is a clear indicator of the success of a country’s healthcare system. In recent years, the United States has witnessed a concerning surge in maternal mortality rates, making it the country with the greatest number of pregnancy-related deaths in the developed world.
As of 2021, there were 32.9 deaths per 100,000 live births in the U.S. alone. Numerous factors may contribute to these staggering rates such as maternal age, chronic conditions, and medical malpractice.
“…underlying health issues, such as obesity and hypertension, further increase the risk of maternal mortality.”
The trend of women giving birth at an older age has increased in recent years. While maternal age itself is not inherently problematic, older mothers may be more prone to certain health conditions, complicating pregnancy and childbirth. Additionally, underlying health issues, such as obesity and hypertension, further increase the risk of maternal mortality. Women with obesity are at a three times greater risk of dying from “thromboembolism, hypertensive complications and stroke” related to childbirth than women without obesity.
Another contributor to the maternal death rate is the prevalence of cesarean section (C-section) deliveries in the U.S, which continues to increase. While C-sections are sometimes medically necessary, their overuse can lead to surgical, anesthetic and medical complications. Both mortality and morbidity is higher in instances of C-section birth compared with vaginal delivery.
Many common labor interventions that are often medically unnecessary, such as administering epidural analgesia in some instances, can also increase the likelihood of needing a C-section. Additionally, once a mother has one C-section, she is more likely to undergo a C-section for future births, further increasing risk.
Maternal mortality includes any death within the first year of childbirth. The postpartum period is a critical time for monitoring maternal health as the body often needs extra care and nutrients. Unfortunately, many women face challenges in accessing adequate postpartum care due to factors such as lack of support and financial barriers. Discontinuity in care after childbirth may result in undetected health issues, exacerbating the risk of maternal mortality.
“…69.9 deaths per 100,000 live births among black women.”
There are also numerous disparities in access to quality healthcare, which disproportionately affect marginalized communities. Research has documented alarming racial and ethnic disparities in maternal health in the U.S. Women who identify as Black or American Indian and Alaska Native (AI/AN) are 3.2 and 2.3 times more likely to die from pregnancy-related causes than people who identify as non-Hispanic White. As of 2021, there were 69.9 deaths per 100,000 live births among black women. These numbers point to systemic issues such as racial bias in healthcare, limited access to prenatal care, and socioeconomic disparities that contribute to adverse maternal outcomes.
An attempt to reduce maternal mortality rates would need to include efforts to eliminate racial and socioeconomic disparities in healthcare. Implementing anti-bias training for healthcare professionals, increasing access to affordable healthcare, and addressing social determinants of health are essential steps.
Additionally, healthcare providers should adhere to evidence-based guidelines for C-sections, and efforts should be made to educate both healthcare professionals and expectant mothers about the risks associated with unnecessary cesarean deliveries. Encouraging vaginal births after cesarean (VBAC) when appropriate can also contribute to reducing repeat C-section rates.
It is also imperative to focus on public health as a whole in order to reduce chronic disease rates. As these rates, along with rates of obesity, continue to increase, it becomes more likely for more women of reproductive age to develop a chronic illness.
Lastly, extending postpartum care beyond the immediate post-delivery period is crucial. Policies that support longer postpartum coverage, paid leave, increased mental health support for new mothers, and continuity of care can help identify and address potential health issues in the postpartum period.