The US is the only country in the developed world that doesn’t have mandatory maternity leave, forcing a quarter of new mothers to return to work within two weeks of giving birth. The cost of full-time childcare is 85% of the median cost of rent in some regions, leading too many women to leave the workforce to look after their kids. And perhaps most alarming, the US has the worst maternal death rate in the developed world – and the rate of women dying from pregnancy-related complications is actually rising. (For some women, their best shot at receiving maternity care in America is incarceration: they’ve got better access to care in prison than outside of it.)
Women in the United States are more likely to die from childbirth- or pregnancy-related causes than other women in the developed world, and half of those deaths may be preventable
, according to the Centers for Disease Control and Prevention.
The CDC’s pregnancy mortality surveillance system
was implemented in 1986 to track maternal deaths. Since then, the number of reported pregnancy-related deaths nationwide steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.8 per 100,000 in 2009 and 2011.
Yet it remains complicated to answer why there has been a rise in deaths and why black women are more affected than women of other races, said Dr. Michael Lindsay, associate professor at the Emory University School of Medicine
and chief of service for gynecology and obstetrics at Grady Memorial Hospital in Atlanta.
The racial divide in maternal deaths
has been persistent for decades, Lindsay said, “so the rate is not something new. It’s something we’ve known for a number of years.”
Though maternal deaths are rare in the United States, many doctors and researchers have varying ideas about what factors could be driving this longstanding racial disparity in death rates.
Some point to the differences in overall health and chronic illnesses among black and white women as a driving factor for the disparity. For instance, rates of obesity
and high blood pressure (or hypertension
) — risk factors for pregnancy complications — tend to be higher among black women.
Others point to differences in socioeconomic status, access to health care, education, insurance coverage, housing, levels of stress and community health among black and white women, including even implicit bias and variations in the ways in which health care is delivered to black versus white women.
A woman in the United States faces a one in 1,800 risk of maternal death, according to an annual report
by the charity Save the Children, the worst of any developed country in the world.
Historically, black women in low-income communities haven’t had the same access to quality care as white women in high-income communities.
Those same factors shed light on disparities not only in maternal mortality but in obesity, hypertension, heart disease
and overall health, said Dr. Elizabeth Howell, an obstetrician-gynecologist and professor at the Icahn School of Medicine at Mount Sinai.
“There are economics, social, environmental, biologic, genetic, behavioral and health care factors that all contribute to disparities in this country,” Howell said.
“It’s a complex web of these kinds of factors, and I think people are looking at and trying to figure out how these different factors actually all contribute to disparities,” she said, adding that her research has focused on the factor of quality care.
For instance, Howell and her colleagues found that black women in New York City were more likely than white women to give birth in hospitals that already have a high rate of severe maternal morbidity
or complications, according to a study published in the American Journal of Obstetrics and Gynecology
The U.S. ranked No. 42 on children’s well-being, No. 61 on maternal health and No. 89 for political status—or the participation of women in national government. Among the other statistics, the report finds that an American child under the age of 5 is nearly just as likely to die (6.9 per 1,000 live births) as one in Bosnia and Herzegovina, Serbia, Slovakia or Macedonia.