The worsening state of the United States' maternal healthcare
The U.S. has the highest maternal mortality rate of any developed country. Why?
Since the pandemic, U.S. maternal mortality rates have soared and the problem is only getting worse. Here's everything you need to know:
Why does the U.S. have such a high maternal mortality rate?
According to the National Center for Health Statistics, the maternal mortality rate increased by 40 percent in 2021 compared to 2020, making the U.S. the country with the highest maternal mortality rate amongst developed countries. Maternal mortality, which refers to deaths due to complications from pregnancy or childbirth, also sees a wide discrepancy by race, with Black women recording a mortality rate double that of white women and Indigenous women at four times the rate, CNN reports.
"This is sort of my reflection on this time period, COVID-19 and pregnancy. Women were at increased risk for morbidity and mortality from COVID," Dr. Elizabeth Cherot, of the nonprofit March of Dimes told CNN. COVID exacerbated issues that were already present in the healthcare system. "In terms of issues of racial health inequities, of structural racism and bias, of access to health care, all of those factors that we know have played a role in terms of maternal mortality in the past continue to play a role in maternal mortality," said Dr. Chasity Jennings-Nuñez, chair of the perinatal/gynecology department at Adventist Health-Glendale.
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Additionally, maternal healthcare is worse in states with abortion bans following the overturning of Roe v. Wade (1973), per a report by the Gender Equity Policy Institute. The report found "people in banned and restrictive states have worse outcomes than their counterparts in supportive states," and that anti-abortion states "are less likely to enact policies, like paid parental leave, which have been shown to improve outcomes for new parents and babies."
How is U.S. maternal healthcare worsening?
More and more regions across the U.S. are finding themselves in maternal health "deserts." A 2022 study found that 36 percent of U.S. counties lack sufficient maternal health resources, impacting approximately 7 million women, NPR reports. A different study conducted in Louisiana tied maternal death and care access together concluding, "Risk of death during pregnancy and up to 1 year postpartum ... was significantly elevated among women residing in maternity care deserts compared with women in areas with greater access."
This is a problem that is only worsening. With the rise of anti-abortion laws, many maternal healthcare professionals are opting to move to locations without the laws. "Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult," said Bonner General Health, an Idaho hospital. The state has some of the most restrictive anti-abortion laws. "The Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care," the hospital continued in a news release. Leah Wilson, a doctor in Texas, explained that restrictive abortion laws "meant patients sitting there for days, actively losing nonviable pregnancies, and us waiting for something to go bad enough that we could help them."
The lack of proper healthcare coverage in these areas is complicating the problem. Experts are keeping an eye on five other states along with Idaho and Texas where maternal health could be deemed a crisis: Arkansas, Mississippi, Missouri, South Dakota, and Wisconsin. These states "have instituted abortion bans while keeping postpartum Medicaid coverage limited to 60 days," per Newsweek. By not extending healthcare coverage, many women would be forced to not seek necessary medical care. "Having any barrier to coverage in the postpartum setting is a direct barrier for accessing necessary care," explained Dr. Smita Carroll, an OB-GYN in New Mexico, to Newsweek.
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According to Carroll, "carrying a pregnancy to term has more risks than abortion care." Amy Chen, a senior attorney at the National Health Law Program (NHLP), added that "health care coverage is critical to catching and treating the health conditions and emergencies that are in part to blame for the United States' high maternal mortality and morbidity rates."
Unfortunately, a large number of those located in the care deserts are low-income and minority women located in rural areas. "In wealthier communities, private insurance helps offset low Medicaid payments to hospitals," writes The New York Times. "But in rural areas where poverty is more entrenched, there are too few privately insured patients."
What are possible solutions?
Maternal deaths are "largely preventable," according to Carroll, provided that Medicaid coverage is expanded to a year after birth. According to a report by the Center for American Progress as cited by Newsweek, "States hostile to abortion also have some of the highest rates of uninsured and comprise the majority of those still refusing to expand Medicaid."
"Physicians do not go to medical school and go into the practice of medicine because [they] enjoy interfacing with the legal profession," commented Katie McHugh, an OB-GYN from Indiana and board member of Physicians for Reproductive Health. Restrictive abortion laws end up tying the hands of physicians in terms of providing proper medical care. "Hospital closures, combined with the lack of access to outpatient and inpatient obstetrical care, results in the extremes of maternal and infant mortality that we see in my state," she added.
"What is just across the board hurting recruiting and retaining physicians right now is what's happening to reimbursement rates in Medicare and Medicaid," remarked Rep. Michael C. Burgess (R-Texas), who is also a trained OB-GYN, to Roll Call. "It is just phenomenally detrimental."
Devika Rao has worked as a staff writer at The Week since 2022, covering science, the environment, climate and business. She previously worked as a policy associate for a nonprofit organization advocating for environmental action from a business perspective.