Giving Birth in the US Is Getting Deadlier

The US has a shameful track record when it comes to maternal health. And a new report from the World Health Organization shows it’s only getting worse. Over the last two decades, much of the world made steady progress in reducing the number of deaths during or soon after childbirth, but the US headed in the wrong direction.

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Yet the US is not doing anything to address this national shame. And efforts to ban abortion will only make it worse.

The WHO report shows that maternal health improved in most countries between 2000 and 2015, though advances began to plateau — and in some places, reverse — between 2015 and 2020. The US was among just 23 countries that saw the average rate of maternal deaths increase during those two decades.

By 2020, nearly all other rich countries saw the number of deaths per 100,000 births dip well below 10, while the US saw a nearly 78% increase to 21 deaths per 100,000 births.

These data aren’t a surprise to anyone following the depressing state of health care for pregnant people in the US. The media has been hammering home the magnitude of the problem for years, and in particular shining a light on the stark inequities in care for Black women, who are more than three times as likely to die from pregnancy complications as White women. That’s true regardless of how much education they’ve received or how wealthy they are; the problem is racism, not poverty. Those disparities were only exacerbated by the pandemic.

It’s also no secret that women will be worse off in a post-Roe world. One estimate suggests abortion bans would result in a 7% increase in pregnancy-related deaths in the first year and a 21% increase thereafter. Inequities in maternal health care will deepen, with Black people expected to see a 33% increase in deaths after the first year without Roe.

Abortion bans do include exceptions to save the life of a mother or if a pregnancy is not viable. But those have little practical effect, putting women’s lives at risk. Doctors are tiptoeing through a legal gray area, refusing to end a dangerous pregnancy until it gets to the point of a medical emergency.

And forcing a woman to carry an unplanned pregnancy to term carries its own health consequences. A recent analysis of 36 studies that compared unintended pregnancies to planned ones found a host of health consequences. Unintended pregnancies were linked to higher rates of depression during and after the pregnancy, preterm births, lower birth weights, and violence.

Then there’s the poorer quality of care women stand to receive in a post-Roe world. Another study found that roughly 45% of the accredited OB-GYN residency programs in the US are in states anticipated to or that have banned abortion. Going forward, that means that at most, 56% of obstetrics and gynecology residents would have access to abortion training, whereas nearly all residents had the opportunity to participate in some form of training, whether required or optional, as of 2018.

Those skills don’t only prepare doctors to safely provide abortion care, but train them to manage miscarriages, address emergencies like uterine bleeding and even perform simple procedures like taking a biopsy.

There is no single, easy way to fix the country’s horrible track record on maternal health. To do better, we’d have to ensure women have consistent access to care, which in turn means ensuring they have consistent access to health insurance. We’d need to unwind the calamitous effects of structural racism on Black women’s health. And we’d need to restore access to abortion nationwide.

Health care needs to focus not only on a woman’s pregnancy, but on the postpartum period, when dangerous but often treatable complications can arise — about 40% of maternal deaths occur in the six weeks after a birth. Most insurance plans currently only cover one perfunctory check-up at six weeks.

Another thing that would help: if parents were granted the time and space to fully recover and learn to care for their newborn. The US is the only wealthy nation that doesn’t offer paid parental leave, despite study after study showing it leads to better health outcomes for mothers and their babies.

The stalled Momnibus Act suggests a range of other evidence-based reforms and efforts to address racial inequities in maternal care. Some of the good ideas embedded in that act include extending WIC (Women, Infants, and Children) nutrition benefits to 24 months postpartum, providing funding for community-based organizations focused on improving maternal health, studying the best ways to delivery care via telehealth, and promoting vaccines that benefit moms and babies. Given the increasingly dire headlines, Congress should feel more urgency to enact these concrete solutions.

America’s record on maternal health is devastating, and frankly embarrassing. What’s even more upsetting is that we’re doing so little to improve it.