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June 8th, 2024 
Awake Goy 
A recent report from The Commonwealth Fund reveals that the United States continues to have the highest rate of maternal deaths among high-income nations. The findings show that, despite improvements since the pandemic, the U.S. maternal mortality rate remains alarmingly high, with significant disparities affecting Black women.
The report highlights that, in 2022, the U.S. saw 22.3 maternal deaths per 100,000 live births, compared to a median rate of 4.5 deaths per 100,000 in other wealthy countries. This stark contrast translates to a 395 percent higher postpartum mortality rate in the U.S. The report further indicates that four out of five of these deaths are likely preventable, suggesting that systemic changes could save many lives.
Examining the racial disparities in maternal mortality rates, the report found that Black women experienced a mortality rate of 49.5 deaths per 100,000 births, significantly higher than the rate for white women, which stood at 19 deaths per 100,000. This means Black women are 160 percent more likely to die from pregnancy-related causes than their white counterparts. Socioeconomic factors, access to healthcare, and systemic racism contribute to these alarming disparities.
The U.S. healthcare system’s shortcomings play a significant role in these high mortality rates. Unlike other high-income countries, the U.S. lacks a universal healthcare system, leaving nearly 8 million parents of reproductive age uninsured. This lack of coverage particularly affects racial and ethnic groups such as Black, Hispanic, American Indian, Alaska Native, Native Hawaiian, and Pacific Islanders, who are the least likely to have health insurance and most likely to face cost-related barriers to getting care.
The report also points to the critical shortage of midwives and obstetrician-gynecologists (ob-gyns) in the U.S. Midwifery-led care models have been shown to provide comparable, if not better, care than that provided by ob-gyns. However, the U.S. and Canada have the lowest supply of midwives and ob-gyns among high-income countries, with 16 and 13 providers per thousand live births, respectively. This shortage exacerbates the maternal health crisis, particularly in rural and underserved areas.
Postpartum support is another area where the U.S. falls short. Nearly two-thirds of maternal deaths in the U.S. occur within six weeks of birth, a period during which many countries provide extensive support through home visits from healthcare providers and guaranteed paid leave for new parents. The U.S. lacks federally mandated paid leave, which disproportionately affects Black and lower-income women who are less likely to have access to paid leave through their employers. Regular home visits and paid leave policies are crucial for ensuring the health and well-being of new mothers and their babies.
To address these issues, the report suggests several policy recommendations. Shifting towards a universal healthcare system could provide greater access to postpartum support for all communities, reducing maternal mortality rates. Increasing the integration of midwifery care into the U.S. healthcare system could also help address the shortage of maternity providers and improve maternal health outcomes. Additionally, implementing federally mandated paid maternity leave would provide crucial support for new mothers, particularly those from lower-income backgrounds.
Personal stories from individuals affected by the high maternal mortality rates highlight the real-world impact of these statistics. For example, Fatimah Gifford, executive director of Provide, an organization dedicated to supporting people seeking abortion and pregnancy care, noted that Black women often face disrespectful treatment from healthcare providers, including having their pain ignored and concerns dismissed. These experiences underscore the need for healthcare providers to play a deeper role in addressing racial disparities by listening to every patient and providing comprehensive health information.
Healthcare providers also face significant challenges in delivering adequate care and support. Munira Gunja, senior researcher at The Commonwealth Fund, emphasized the importance of access to postpartum care regardless of geographic location or employer. “We’re going back to pre-pandemic levels, which is a good thing, but we also know there are a lot of policies we could put in place to eliminate deaths,” Gunja said. “Access to postpartum care and maternal care in general should not be dependent on where [people] live or who their employer is.”
The international community can offer valuable lessons in improving maternal health outcomes. Nordic countries, such as Norway, reported zero postpartum mortalities in 2022, demonstrating the effectiveness of comprehensive maternal care policies. By adopting similar approaches, the U.S. could make significant strides in reducing maternal mortality rates and addressing racial disparities.
The Commonwealth Fund’s report underscores the urgent need for systemic changes to improve maternal health outcomes in the United States. Implementing universal healthcare, increasing access to midwifery care, and ensuring paid maternity leave are critical steps toward addressing the maternal mortality crisis. As policymakers and healthcare leaders consider these recommendations, the well-being of mothers and babies should remain a top priority.
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