The International Classification of Diseases (ICD-10) defines maternal death as “[the] death of a woman while pregnant or within 42 days of the end of pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” Maternal Mortality is a global issue; around the world every minute a woman dies during labor or delivery. According to the World Health Organization, two regions, sub-Saharan Africa and South Asia, account for 86% of maternal deaths worldwide. The United States is an outlier whose maternal mortality rate (MMR) is high compared with other developed countries.
Amnesty International released a report in 2010 which explained that global maternal mortality was down 34% (1990-2008) but “the US was among just 23 countries to see an increase in maternal mortality” during that time. In the United States, 18 women die per 100,000 live births—a ratio more than double that of most other high-income countries. In addition, women of color at all income levels are 3 to 4 times more likely to die from childbirth-related complications than white women.
The literature points to various reasons why the United States has the highest MMR in the developed world. But it focuses specifically on:
- Shortcomings of the US healthcare system.
- Implicit racial bias in the medical field which results in a higher maternal mortality rate for BIPOC women in the United States.
The American Healthcare System
American citizens have vastly different experiences with healthcare depending on which state they live in. Some states expanded Medicare through the Affordable Care Act while others opted for a more limited public health program. Abortion policy also varies by state, with states permitting it at different stages in pregnancy and at clinics versus hospitals.
Low income women who rely on Medicaid face several obstacles in receiving care. In 2019, 20% of obstetricians and gynecologists would not accept new Medicaid patients because of low reimbursement rates and bureaucratic delays. Postpartum care is not covered beyond sixty days of giving birth, and complications can arise up to a year after giving birth. Medicaid provided coverage for 43% of births in the US in 2018, disproportionately covering young women, women of color, and those in rural communities.
Reducing legal access to family planning services can lead to increased maternal mortality. When abortion is limited, women are more likely to turn to unsafe abortion methods which create a higher risk of maternal death or lifelong health complications. Unsafe abortions are the cause of 13% of maternal deaths globally.
Implicit Health Provider Bias
Louisiana is the state with the highest MMR in the country with 58.1 deaths per 100,000 births. In Louisiana, “59% of black maternal deaths are preventable, compared to 9% of white maternal deaths.” This is the result of both the challenges discussed above, as well as implicit bias in healthcare providers. Healthcare providers frequently hold false beliefs about black people’s pain tolerances, which influence the pain treatment they are prescribed. In addition, black mothers often find that they are not listened to or believed while reporting symptoms, and are pressured into health decisions they don’t feel are in their own or their unborn child’s best interests.