Commonwealth’s Fund Reports Addresses Maternal Mortality

A pregnant woman’s death is often determined by her race as well as the state or country in which she resides.

Maternal mortality and maternity care in the U.S. have become heavily scrutinized over the past several years. Close to 700 Americans die annually from pregnancy-related causes, with the maternal mortality rate being higher in the U.S. than in any other industrialized country. A pregnant woman’s risk of death is often determined by her race, and also, often the state or country in which she lives.

The Commonwealth Fund’s recent report, Maternal Mortality and Maternity Care in the U.S. Compared to 10 other Countries, is a must-read. The applicable definition of maternal mortality is specific: 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. Among the takeaways:

• The U.S. has the highest maternal mortality rate among developed countries, 17.4 deaths per 100,000 births. By comparison, Canada and the United Kingdom had 8.6 and 6.5 deaths, respectively.

• In the U.S., roughly 30 percent of pregnancy-related deaths occur during pregnancy, while:
  • 17 percent of deaths occur on the day of delivery, and
  • 52 percent occur after delivery, or postpartum.

• Mortality rates in the U.S. are especially high for women of color, and as much as two to three times higher than those of other populations:
  • The number of deaths per 100,000 births for Black, non-Hispanic women in 2018 was 37.1; it was 14.7 for white mothers. Hispanic women had the lowest mortality rate, at 11.8.
  • However, in some cities and rural regions of the U.S., the numbers are even higher:
    • Alabama: 36.4
    • Arkansas: 45.9
    • Kentucky 40.8
    • Washington, D.C.’s mortality rate is 33, but 59.7 for Black women.

• Concern exists regarding how much these numbers will increase during COVID, especially with so many patients opting to avoid obtaining care outside of the home, when possible.

• Under the Patient Protection and Affordable Care Act (PPACA), Medicaid is required to pay for midwives, but such care is often not accessible. The reasons vary, from state variations in scope-of-practice rules for healthcare practitioners to low reimbursement rates for midwives and payment parity.
• Although a large share of its maternal deaths occur post-birth, the U.S. is the only developed country not to guarantee access to provider home visits or paid parental leave in the postpartum period.

The Commonwealth report is a powerful read, and accessible at the organization’s website: www.commonwealthfund.org.

Limited availability of robust prenatal health programs in some regions is another factor to impact maternal mortality. Many rural communities have lost their OB units through hospital closures; more than 100 such hospitals have closed in recent years, with another 20 percent being under scrutiny. Patients end up having lengthy journeys to access care, often with fatal consequences.

A recent Monitor Mondays Listeners Survey asked listeners whether their organizations had expanded maternal health beds or services over the past year. The survey responses varied and appear here.