Maternal mortality, infant mortality, murder, suicide and, of course, institutional racism. The ‘Land of the Free’ isn’t a great place for expectant mothers. The outlook is bleaker in Republican states, and it’s getting worse.

Sometimes the main media outlets seem to be asleep on the job and we feel the need to fill the gap. No jokes, just a desperately sad situation for many women and families.

In terms of maternal and infant mortality the USA is the worst of the developed countries, and it is getting worse. The only major news outlets in the USA that seem to have noticed this are the New York Times, CNN and Vanity Fair!. The failure of US news outlets to report on this might be because it’s a complicated topic. It involves lots of numbers with no simple fix. Guns are also part of the picture and that will cloud any rational discussion. Another part of the problem may be because health issues become politicised, especially when reproduction is involved. It is a serious oversight when over a thousand women died because of pregnancy/birth complications in 2021, and if the current trend continues it is likely to have been worse in 2022.

Maternal mortality

This growing problem was most recently highlighted in a report on Maternal Mortality Rates in the United States, 2021 produced by the National Center for Health Statistics. This revealed that maternal deaths related to pregnancy were 1,205 in 2021. This is an increase from 658 in 2018, 754 in 2019 and 861 in 2020. For comparison purposes the deaths are expressed as the number per 100,000 live births. In 2021 it was 32.9 deaths per 100,000 live births. Previously it was 20.1 in 2019 and 23.8 in 2020. This continues a rising trend that has been apparent over the last thirty years. A comparison of maternal death rates in ten developed countries in 2017-18 had the US as the worst behind Korea, Canada, France, Germany, UK, Australia, Japan and Spain. The country with the least maternal deaths was Italy. In most countries the maternal death rates are declining while in the US they are rising. For clarity, these are deaths that are associated with pregnancy and do not include other causes such as accidents, murder, or other diseases or conditions unless they are exacerbated by the pregnancy.

The picture gets starker when ethnicity is taken into account. In 2021, the rate for Black women was 69.9 deaths per 100,000 live births. This is 2.6 times the rate for White women, at 26.6 per 100,000. The only good news to come out of this comparison is that the deaths among Hispanic women is lower than that of white women, but still rising each year.

Infant mortality

The picture doesn’t get any better when the infant mortality figures are examined. From the.2022 figures the US infant mortality rate is well down the table with 5.48 deaths per 100,000 live births. Better than Qatar (5.529), but worse than Saudi Arabia (5.295). For comparison the country with the lowest infant mortality was Iceland with 1.005 per 100,000. This is an improvement on the 1950 death rate of 31.951 per 100,000 live births.

Why is the maternal and infant mortality rates so bad?

There is no avoiding the fact that this will be political. How starkly it is political is exposed when the infant mortality rates are analysed by State and the political affiliation of the States.

The report Partisan Control of U.S. State Governments: Politics as a Social Determinant of Infant Health which looked at infant mortality rate (IMR) and perinatal mortality rate (PNMR) found an increase in Republican states, “The impacts of a Republican-controlled state Congress on IMR and PNMR are 4.2% and 8.1%, respectively”. It also found that in those states that had a sufficient Black population to provide meaningful data, the infant mortality rates were higher in Republican states.

The authors did offer some possible explanations for the higher infant mortality rates in Republican states. There are links to relevant papers within this report

For example, with smoking during pregnancy and exposure to environmental pollutants being both risk factors for poor pregnancy outcomes, part of the mechanism that may contribute to the reported associations could be that Republican administrations are found to lower cigarette taxes and deregulate environmental health protections. Republican budget proposals also tend to disservice Black people and the poor and induce fiscal deficits through tax cuts reducing access to and defunding health care. Republican politicians are more likely to weaken social welfare and other safety-net programs, undermining the support systems among vulnerable populations.

It is likely that all the above factors affecting infant mortality also apply to maternal mortality.

In the United States, about 6.9 million women have little or no access to maternal health care. This is a consequence of the medical insurance culture in the USA and the limitations of Medicaid, which is very limited in some states.

There is a growing concern of that states which have adopted anti-abortion laws will experience a disproportionate increase in maternal and infant mortality rates. The medical facilities that previously provided abortions also provided a range of support and testing for pregnant women. With the combined impact of harrasment, intimidation and funding cuts these facilities are no longer able to provide the support that they did previously.

It could be easy to think that these impacts are accidental consequences of Republican policies. Unfortunately people such as Ohio state representative Bill Dean have gone on record with comments that women “no great risk of dying” from pregnancy, adding: “Pregnancy is a natural thing that women are made for. That’s the way God made them. The myth is that it is dangerous; it’s no more dangerous than living every day.”. in further comments to belittle the problem he added “But I would imagine, a lot of times, it’s the lifestyle of the lady that’s having the pregnancy. We also have the most obese people in the whole world. It’s just individual cases.”. As this is an issue predominantly affecting the poorer sections of Society it is clear that Republicans really don’t care.

Non-pregnancy related deaths

While all the above are significant maternal mortality factors, the number one cause of death of pregnant women is murder. One in three women reporting experiences of physical, sexual, or psychological abuse by a partner in their lifetime. Reports suggest the US has a higher prevalence of intimate partner violence than other high income countries, including most European countries and Australia. Intimate partner violence is often fatal. These pregnancy associated homicides are preventable, and most are linked to the lethal combination of intimate partner violence and firearms (BMJ).

What is being done?

In 2022 the administration released a White House Blueprint for Addressing the Maternal Health Crisis. Part of this includes aims to expand healthcare coverage, support lower-income patients with support during and after a pregnancy, and address biases in healthcare that prevent patients from getting the care they need.

The plan also called on states to extend Medicaid post birth coverage to one year. The government health programme for lower-income Americans accounts for roughly 44 per cent of payments for birth-related services in states where abortion access is restricted. Whether states commit to these measures looks likely to be down to people like Bill Dean.

Additionally, the current adfministration brought in the Black Maternal Health Momnibus Act of 2021. This recognises that Black women are disproportianately affected by high levels of maternal and infant death. It is hoped that it will…

• Make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition.
• Provide funding to community-based organizations that are working to improve maternal health outcomes and promote equity.
• Comprehensively study the unique maternal health risks facing pregnant and postpartum veterans and support VA maternity care coordination programs.
• Grow and diversify the perinatal workforce to ensure that every mom in America receives culturally congruent maternity care and support.
• Improve data collection processes and quality measures to better understand the causes of the maternal health crisis in the United States and inform solutions to address it.
• Support moms with maternal mental health conditions and substance use disorders.
• Improve maternal health care and support for incarcerated moms.
• Invest in digital tools like telehealth to improve maternal health outcomes in underserved areas.
• Promote innovative payment models to incentivize high-quality maternity care and non-clinical perinatal support.
• Invest in federal programs to address the unique risks for and effects of COVID-19 during and after pregnancy and to advance respectful maternity care in future public health emergencies.
• Invest in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies.
• Promote maternal vaccinations to protect the health and safety of moms and babies.

Is there anything I can do to help?

The most powerful action you can take is to consider what you have read when it comes around to voting. How you vote is of course up to you.

There are numerous organisations that are supporting and advocating for pregnant women including…

https://www.ama-assn.org/delivering-care/population-care/ama-advocacy-improve-maternal-health

If you are affected by any of these issues…

We suggest you start looking for help at https://americanpregnancy.org/options-for-unplanned-pregnancy/financial-help-for-pregnant-women/

Disclaimer

I am from the UK so do not have a vote in the US and am not a member of, or affiliated to, any political party or lobby group.

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