Welcoming a baby to the world outside the womb is exciting, but giving birth can be scary. The reality is that childbirth can be very dangerous for both the infant and the mother. A moment that is supposed to be about life carries with it the risk of death.
Maternal mortality is defined by the World Health Organization as “[a death] from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of the termination of pregnancy.” In the United States today, the average maternal mortality rate is 17.4 deaths per 100,000 live births. This means that out of the 3,791,912 births were recorded in 2018, approximately 660 people died. When you compare those two numbers — 3.7 million and 660 — it can make the maternal deaths seem small. But all of those people were unique and unrepeatable human beings. The loss of them matters.
This rate changes if you break it down by certain demographics. Women aged 40 or older have a much higher mortality rate (81.9) compared to women under age 25 (10.6). Hispanic women have a rate of 11.8, while non-Hispanic white women have a rate of 14.7, and non-Hispanic black women have a rate of 37.1. That ratio has remained consistent over the past decade.
America’s rate of maternal death is high when compared to other developed countries. Canada and France, for example, have half the number of maternal deaths that we do: 8.6 and 8.7 out of 100,000, respectively. Australia has 4.8, Switzerland has 4.6, and Sweden has 4.3. Both Germany and the Netherlands have around 3 deaths per 100,000, while Norway and New Zealand have just under 2. When measured against our peers, America is the most dangerous place to give birth.
In countries with less infrastructure, the maternal mortality rate jumps staggeringly high. Of the fifteen countries ranking high or very high on the Fragile States index, the maternal mortality rate ranged from 31 to 1150. In Sierra Leone, 1,360 mothers die for every 100,000 live births — the highest rate in the world.
Nearly 75% of all maternal deaths are a result of one of these causes: severe bleeding (especially after birth), infections, high blood pressure during pregnancy, complications from delivery, and unsafe abortions. The remaining 25% are usually associated with infections such as malaria or chronic conditions like diabetes or cardiac diseases. Most of these complications are preventable or treatable. Many lives could be saved if offered the proper medical care.
There is a clear need for change in America, and steps are being taken around the nation to enact that change. The state of New Jersey recently announced its Nurture NJ Maternal and Infant Health Plan. Its goal is to make the state “the safest and most equitable place in the nation to give birth and raise a baby.” The plan includes more than seventy recommendations for actionable steps to improve outcomes for mothers and babies, directed at a variety of stakeholders.
One example of a strategy for change is to raise awareness, availability, and involvement of midwives. The World Health Organization recommends midwife-led care as a way to reduce the maternal mortality rate. Specifically trained to help healthy women through labor and delivery, as well as to provide postpartum support, midwives play a vital role in providing pregnancy care. Midwife-led care has been shown to offer equivalent or even better experiences than physician-led care in terms of maternal and neonatal outcomes, efficient use of health care resources, and patient satisfaction and well-being.
Other states are considering bills designed to address this problem. Minnesota, Maine, and Oklahoma have bills proposed that would expand their data collection, allowing them to get a better handle on maternal deaths and their causes. Vermont has a bill that would include additional experts, such as social workers and mental health clinicians, to serve one-year terms on the state’s Maternal Mortality Review Panel. And in West Virginia, a bill is in consideration that would create a maternal mortality review panel, among other fatality review panels.
When we work to reduce maternal deaths, we do so with the recognition that every human being has a right to live. But that right is attacked when the work includes abortion. In the institutional change section of New Jersey’s Nurture plan, action step 7.3 reads “Provide access to the full range of family planning services, including all safe and effective contraception methods and abortion care, through stronger provider relationships.” This section calls upon the governor and the state legislature to codify Roe v. Wade, ensuring abortion access within the state. This directly contradicts the life-honoring motivation of the Nurture plan.
Pregnancy should not be a death sentence. Our country is not providing the quality of care that it should be offering, and people are dying of preventable causes because of that failure. It is vital that we take steps to eliminate the gaps in our healthcare in ways that are equitable and life-sustaining for everyone.