Privacy Policy. Economic Outlook. Kirstie Coxon et al., “The Impact of the Coronavirus (COVID-19) Pandemic on Maternity Care in Europe,” Midwifery 88 (Sept. 2020): 102779; and WHO Europe, “Coronavirus and Pregnancy — Preserving Maternal Health Across the European Region,” WHO, June 30, 2020. 5. There has been renewed interest recently in investigating the United States’ rising maternal mortality rate, as studies show that the U.S. is the only developed country to see the maternal mortality rate increase as countries such as France, Spain, Germany, Canada and Portugal witness a steady decrease.. In the first week postpartum, severe bleeding, high blood pressure, and infection are the most common contributors to maternal deaths, while cardiomyopathy is the leading cause of late deaths.6 Previous research indicates that U.S. women experience more late maternal deaths than women in other high-income countries.7. All Rights Reserved. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. Annual rate of reduction (%) Under-5 mortality rate, 1970-1990. (eds. The authors wish to thank Dr. Jodie D. Katon, Dr. Eugene Declercq, and Reggie Williams II for their helpful review comments; and Jesse Baumgartner and Gabriella N. Aboulafia for their careful data review. Around one-third of U.S. pregnancy-related deaths, counted up to one year postbirth, occur during pregnancy (Exhibit 2). Dionne S. Kringos et al. The World Health Organization recommends at least four health contacts in the first six weeks, yet U.S. women typically have a single office-based physician visit within this period, and some don’t have one at all.33, Expanding eligibility for Medicaid, which pays for 43 percent of U.S. deliveries, can lead to more stable postpartum coverage.34 Currently, however, the program’s coverage extends to only six weeks postpartum. Sarah A. Donovan, Paid Family Leave in the United States, Report R44835 (Congressional Research Service, updated May 29, 2019). 1. 2017). A Woman’s Right to Health. Maternal mortality in the United States is gaining increased attention as a patient safety concern. Some states are expanding coverage up to one year, in line with recommendations by maternal mortality review committees and others.35, Paid leave. 3. Maternal mortality rates have been stable recently, despite evidence that many maternal deaths continue to be preventable. (eds. Dodge et al., “Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting,” American Journal of Public Health 104, no. Additionally, the maternal mortality rate in the United States has risen 113% since 1990. The World Health Organization (WHO) recommends midwives as an evidence-based approach to reducing maternal mortality.10 Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care in terms of11: Some experts note that “high-income countries with the lowest intervention rates, best outcomes, and lowest costs have integrated midwifery-led care” into their health care systems. Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth. No other industrial nation has such a high rate of maternal mortality. 2 Increased rate of maternal mortality The maternal mortality rate in the United States has rapidly risen, and healthcare issues are hugely fundamental at the political level. 18. For 2018, the maternal mortality rate is 17.4 per 100,000 live births in the United States. The proportion of these deaths varies across regions, Maternal Mortality Rate TheHealthSite - 10/14/2018 2:27:00 AM 7. These disparities are not unique to the U.S., however. Because of potential data comparability concerns, we omitted these findings from our formal analysis. Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017. Gross domestic product (annual) Gross domestic product (quarterly) Composite Leading Indicators. 3 (Sept. 2016): 447–55; Building U.S. Capacity to Review and Prevent Maternal Deaths: Report from Nine Maternal Mortality Review Committees (Maternal Mortality Review Information Application and Review to Action, 2018); and Emily E. Petersen et al., “Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017,” Morbidity and Mortality Weekly Report 68, no. Under-5 mortality rate, , 1990. All other countries have a supply that is between two and six times greater. They typically provide care in hospital-based settings. Hispanic women have the lowest rate (11.8).39 The pandemic has the potential to exacerbate existing U.S. racial disparities in maternal outcomes, as Black and Latino people have faced higher rates of economic hardship and mental health problems during the pandemic compared to their white counterparts.40. The United States (U.S.) fares worse in preventing pregnancy-related deaths than most other developed nations. Trends and Characteristics of United States Out-of-Hospital Births 2004–2014: New Information on Risk Status and Access to Care, Making a Case to Reduce Legal Impediments to Midwifery Practice in the United States, Effects of Redesigned Community Postnatal Care on Women’s Health 4 Months After Birth: A Cluster Randomised Controlled Trial, A Randomized Trial of Single Home Nursing Visits vs. Office-Based Care After Nursery/Maternity Discharge: The Nurses for Infants Through Teaching and Assessment After the Nursery (NITTANY) Study, Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting, Extending Medicaid Coverage for Postpartum Moms, Maternity Leave and Related Types of Leave, Mapping Integration of Midwives Across the United States: Impact on Access, Equity, and Outcomes, COVID-19’s Impact on Pregnancy and Childbirth Policies, The Impact of the Coronavirus (COVID-19) Pandemic on Maternity Care in Europe, Coronavirus and Pregnancy — Preserving Maternal Health Across the European Region, ACOG Committee Opinion No. maternity workforce is upside down relative to patient needs,”12 noting that the majority of births are low-risk and could be managed by midwives, family practitioners, or general practitioners.13 In several countries, including Canada, France, and New Zealand, primary care physicians also play a large role (although comparative international data are lacking). (UNFPA, 2014). 5, 2015): 893–97; and Ewout van Ginneken, “Perennial Health Care Reform — The Long Dutch Quest for Cost Control and Quality Improvement,” New England Journal of Medicine 373, no. [47] Gender bias , implicit bias, and obstetric violence in the medical field are also important factors when discussing maternal wellness, care, and death in the United States. Midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetrician-gynecologists, or ob-gyns (see box).9. World Health Organization et al., Postnatal Care for Mothers and Newborns: Highlights from the World Health Organization 2013 Guidelines (WHO et al., April 2015). 2 (Feb. 2018): 216–25. This is particularly the case when services are provided in nonhospital settings, like the home or a birthing center.18 And while the Affordable Care Act (ACA) requires that state Medicaid programs cover midwifery care, the supply of providers is often so low that beneficiaries are often unable to access these services. In the U.S. and Canada, ob-gyns outnumber midwives. The U.S. is the only high-income country that does not guarantee all mothers paid maternity leave,36 although a few states have recently introduced some paid leave.37 Women receiving paid leave use fewer health care services compared to women with only unpaid leave.38, Racial disparities. 4 (July–Aug. The global rate is 211 maternal deaths per 100,000 live births. Declercq and Zephyrin, Maternal Mortality: Primer, forthcoming. 30. Under-5 mortality rate, , 2000. Saraswathi Vedam et al., “Mapping Integration of Midwives Across the United States: Impact on Access, Equity, and Outcomes,” PLoS One 13, no. Sandhya Raman, “COVID-19 Amplifies Racial Disparities in Maternal Health,” Roll Call, May 14, 2020; Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (National Partnership for Women & Families, Apr. The U.S. and Canada have the lowest overall supply of midwives and ob-gyns — 12 and 15 providers per 1,000 live births, respectively (Exhibit 3). 13. 22. Universal, comprehensive maternity care coverage, along with exemptions from cost-sharing, also are the norm in other high-income countries.29 While the ACA strengthened maternity care coverage, access to benefits often depends on type of insurance and geographic location, and out-of-pocket costs vary significantly as well.30, Postpartum care. 9. The 10 comparator countries included in this brief represent those high-income countries that take part in the Commonwealth Fund’s annual International Health Policy Survey: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. High U.S. Maternal Mortality Rate With the advancement of modern medicine, maternal deaths while giving birth are becoming increasingly rare in many developed countries across the world. Maternal mortality the world over has witnessed an insignificant reduction since the inception and end of the United Nations’ Millennium Development Goals (MDGs). OECD Family Database, “Parental Leave Systems,” Aug. 2019. 2 (Jan. 2020): 1–18. The maternal mortality rate … See Bushman, “Role of Certified Nurse-Midwives,” 2015. More than half of maternal deaths occur in fragile and humanitarian settings. 658 women died of maternal causes in the United States. There is no one explanation as to why the United States is seeing such high maternal mortality rates. The United States has the highest maternal and infant mortality rates among developed nations. (eds. The rate declined from 607.9 maternal deaths per 100,000 live births in 1915 to 12.7 in 2007 (1-3). See UCSF Health, “High Risk Pregnancy,” n.d. 14. 32. The correction factor f… Kathy Gifford et al., Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey (Henry J. Kaiser Family Foundation, Apr. For example, many types of non-ACA-compliant plans, such as short-term plans or association health plans as well as some student health plans, don’t cover maternity benefits. 28. In 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries (Exhibit 1). Its maternal-mortality rate has been steadily rising — the only developed country whose is. This podcast discusses conditions known to challenge maternal safety, the high incidence of preventable harm in this population, and care bundles as an improvement strategy. Jesse S. Bushman, “The Role of Certified Nurse-Midwives and Certified Midwives in Ensuring Women’s Access to Skilled Maternity Care,” presentation, American College of Nurse-Midwives, Nov. 2015. 10 (Sept. 3, 2015): 885–89. Despite participation in the Millennium Development Goals (MDGs) and spending more than any other country on hospital-based maternity care, the maternal mortality ratio (MMR) in the U.S. remains at about 17 deaths per 100,000 live births. Almost all maternal deaths (99%) occur in developing countries. 26. While international data are available regarding timing of maternal and pregnancy-related deaths, findings for the U.S. did not correspond with the latest data from the CDC. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … 15. Data on maternal mortality ratios, supply of midwives, and supply of ob-gyns were extracted in August 2020. Maternal mortality rates vary by maternal characteristics, especially maternal age and race. In England, care may be shared between midwives and obstetricians.17, In the U.S., midwife services are not uniformly covered by private insurance plans. Midwifery care. 27. Simply totaling the raw, unadjusted data from all states regardless of whether they revised their death certificates results in a reported U.S. maternal mortality rate that more than doubled from 9.8 maternal deaths per 100,000 live births in 2000 to 21.5 in 2014.17 However, the adjusted maternal mortality rate increased more slowly for a group of 24 states and Washington, DC (analysis group 1, Table 1) that only included a pregnancy question after they revised their death certificates (Fig. There are three commonly used measures of maternal deaths in the United States. CDC twenty four seven. In the U.S., where maternal health outcomes are poor relative to many other parts of the world, policymakers and delivery system leaders can examine international models of maternity care to inform strategies for improvement. Maternal mortality: Death while pregnant or within 42 days of the end of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The well-being of mothers and babies should be a priority births in the United is. Covid-19 ( California Health Care Systems, ” n.d. 14 mortality continues to be an issue in developed countries maternity... Of maternity leave are from the OECD ’ s Family Database Health Systems... Saving Lives, Protecting People, U.S. Department of Health, “ international Health Care Foundation, Apr //doi.org/10.26099/411v-9255 ©! 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