The Enigma of Uniquely Dismal Maternal Mortality Rates in the United States

Keri Tomechko

Despite being a global leader in ground-breaking biomedical research and spending “two and half times more per person on health than the OECD average,” the United States trails abysmally behind in maternal mortality rankings (Korbatov 2015). While the US actively invests resources to improve public health in other countries, maternal health within the country’s own borders not only ranks poorly but has progressively gotten worse. While global maternal mortality decreased 58.7% between 1990 and 2021, the US is the only developed country in the world in which the rate increased, climbing a notable 17% (Korbatov 2015; “Maternal” 2022). This inexcusable disparity leaves infants without mothers, uniquely impacts certain racial and socioeconomic populations, and leaves grieving partners with the sudden, immense responsibility of raising a child alone (Katella 2023).

This essay will investigate how socioeconomic factors, systemic deficits in maternal support, and racial factors and biases exacerbate maternal mortality in the US. Additionally, the paper will discuss the potential of telemedicine to reduce barriers to pregnancy care.

1 - What are the key avenues by which socioeconomic factors and institutionally reinforced lack of maternal support exacerbate maternal mortality in the United States?

The lack of support for mothers during pregnancy–particularly during the post-partum period– cannot be written off by the fact that the US does not have a collectivist culture. Rather, deficits in social and psychological support can be found rooted in medical system and workplace standards. Compared to ten other developed countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom), the US has a two to six times lower supply of maternal health providers (midwives and OB/GYNs) and is the only country that does not mandate paid maternity leave and does not guarantee access to provider home visits (Tikkanen 2020). Cesarean sections, OB/GYNs, and hospital births are standard; although the usage of doulas and midwives has been increasing, they are infrequently covered by insurance and still stand in a staunch minority in comparison to OB/GYN-facilitated births. This over-medicalization of birth is certainly a partial contributor to the problem. In fact, the World Health Organization (WHO) provides evidence and recommendations for the usage of midwives as a tool for reducing maternal mortality in healthy pregnancies; more than hospital-based care, midwives and doulas can address and tend to place a greater emphasis on the emotional, social, and personal needs of mothers and their families (Tikkanen 2020). Midwifery-led care for healthy pregnancies allows for better allocation of medical resources, reduction in unnecessary medical interventions like epidurals and C-sections (which can cause more harm that good when medically unnecessary), and heightened levels of patient satisfaction and psychosocial outcomes (Tikkanen 2020). The substantial cost of pregnancy and medical childbirth, lack of paid maternity leave, and lack of postpartum home visits leave US mothers–particularly those with less financial security–at a physical, emotional, and psychosocial disadvantage.

2 - What are the root causes of substantial racial disparities (particularly among African American mothers) in maternal mortality within the United States?

While maternal mortality in the US as a whole ranks poorly, these disparities are even further exacerbated among black mothers. In 2018, the rate of maternal mortality for black non-Hispanic women (37.1 per 100,000 births) was more than two and a half times that for white women (14.7 per 100,000 births)  (Tikkanen 2020). The explanation for this disparity is a complicated matter to dissect. On the surface level, this disparity is often chalked up to disparities in financial resources and access to quality medical care, both of which are certainly contributing factors. However, studies have found that “high-income non-Hispanic Black mothers have worse maternal and infant health outcomes than low-income non-Hispanic white mothers,” a disturbing discovery that shows that the disparities are more deeply systemic (Katella 2023).  In fact, even in the UK, maternal mortality among black mothers is five times that among white women, despite having free public health care (Tikkanen 2020). This difference is theorized to be due to overt and implicit biases from healthcare providers combined with the concept of  “allostatic load,” which is defined as “the cumulative physiological effects of chronic stress” and is believed to be heightened among black mothers, who face greater systemic, de facto, and institutional biases and stressors.

3 - Does telemedicine–which is lauded as a way to increase access to healthcare–truly stand to serve as a tool to markedly improve maternal mortality?

Since the pandemic, telemedicine has been hailed as a tool with the potential to substantially reduce disparities in access to healthcare. Currently, rural populations–which tend to be of lower socioeconomic status–face multiple barriers to accessing quality healthcare. These barriers can contribute to a lack of education about sexual health, pregnancy, and pre- and postnatal care, as well as to a lack of adherence to prenatal care, less contact with healthcare providers, and–as a result of all of these factors–higher rates of maternal mortality (Escobar 2022). By lowering the costs of visits and surpassing geographical barriers to care access, telemedicine offers a promising option for increasing the frequency and accessibility of pre- and postpartum care, including prenatal education and postnatal psychosocial support. A 2022 implementation of a telehealth and education program in a rural, low-resource region of Colombia found a reduction in perinatal mortality of 29% (Escobar 2022). While these conditions do not exactly mirror those of the US, they’re comparably promising and work towards the same goal to ”empower vulnerable women to take responsibility for their own care and treatment” (Escobar 2022).

The issue of maternal mortality in the US is complex and multi-faceted. It is evident that socioeconomic factors, institutionally reinforced lack of maternal support, and systemic racial prejudices all factor into the poorly-ranking statistics. Accordingly, it is clearly a matter of urgent concern that the US must work towards developing solutions and implementing programs that are equally intersectional in order to begin addressing this inexcusable status quo.

Works Cited

Abbasi, Jennifer. “US maternal mortality is unacceptably high, unequal, and getting worse—what can be done about it?” JAMA, vol. 330, no. 4, 2023, p. 302, https://doi.org/10.1001/jama.2023.11328.

Drenon, Brandon, and Chelsea Bailey. “Why US Mothers Are More Likely to Die in Childbirth.” BBC News, BBC, 17 Mar. 2023, www.bbc.co.uk/news/world-us-canada-64981965.

Escobar, María Fernanda et al. “Experience of a telehealth and education program with maternal and perinatal outcomes in a low-resource region in Colombia.” BMC pregnancy and childbirth vol. 22,1 604. 29 Jul. 2022, doi:10.1186/s12884-022-04935-1

Katella, Kathy. “Maternal Mortality Is on the Rise: 8 Things to Know.” Yale Medicine, Yale Medicine, 22 May 2023, www.yalemedicine.org/news/maternal-mortality-on-the-rise.

Korbatov, Anna Bella. “What Explains the United States’ Dismal Maternal Mortality RAnna Bella Korbatovates?” Wilson Center, 2015, www.wilsoncenter.org/event/what-explains-the-united-states-dismal-maternal-mortality-rates.

“Maternal Mortality.” Bill & Melinda Gates Foundation, 2022, www.gatesfoundation.org/goalkeepers/report/2022-report/progress-indicators/maternal-mortality/. 

Tikkanen, Roosa, et al. “Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries.” Maternal Mortality Maternity Care US Compared 10 Other Countries, Commonwealth Fund, 18 Nov. 2020, www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries.