Maternal Mortality: Comparing the U.S. to Other Wealthy Nations
Women in the U.S. face a significantly higher risk of dying from pregnancy and childbirth complications compared to their peers in other high-income countries. Researchers attribute this to comparatively limited health care coverage and a shortage of maternal health professionals.
A report released by The Commonwealth Fund, a foundation focused on health care research, compares the state of maternal care in the U.S. with 13 other high-income countries. The study examined maternal death rates, the supply of midwives and OB-GYNs, and the amount of federally mandated paid leave for caring for young children.
In 2022, the U.S. maternal mortality rate was 22.3 deaths per 100,000 live births, more than 55% higher than Chile, the nation with the second-highest rate among those analyzed. Norway had the lowest rate with no maternal deaths per 100,000 live births, followed by Switzerland with 1.2 per 100,000.
Maternal mortality rates for individual racial and ethnic groups in the U.S. were also higher than nearly all other countries. Black women in the U.S. had the highest rate at 49.5 deaths per 100,000 live births, followed by 19 per 100,000 among white women, 16.9 per 100,000 among Hispanics, and 13.2 per 100,000 among Asian Americans.
The report shows that roughly two-thirds of maternal deaths in the U.S. occurred during the postpartum period, from one day after birth up to a year later, with more than a third occurring from one to 42 days following childbirth.
The COVID-19 pandemic in 2020 and 2021 saw an increase in maternal mortality in four of nine countries analyzed: Japan, Australia, the Netherlands, and the U.S. However, data from 2022 for Chile, Norway, and the U.S. show rates beginning to decrease.
“The increase in maternal deaths during the pandemic may have been due to respiratory or viral conditions related to COVID or conditions worsened by the virus, such as diabetes or cardiovascular disease,” the study states. Disruptions in health care delivery also resulted in delayed or decreased access to needed maternal health care globally.
More than 80% of pregnancy-related deaths in the U.S. are preventable. Lead study author Munira Gunja, a senior researcher with The Commonwealth Fund, highlights the gaps in support for women in the U.S. compared to other countries with universal health care.
Government policies significantly contribute to the disparity in maternal deaths. The U.S. is the only country in the study without a federal policy guaranteeing paid parental leave for mothers. Such a measure “allows women to better manage the physiological and psychological demands of motherhood, ensures financial security for families, and leads to lower infant mortality.”
Paid maternity leave in the U.S. is provided by states and employers. In 2023, 27% of private industry workers had access to paid family leave and 89% to unpaid family leave, according to the U.S. Bureau of Labor Statistics.
While the U.S. supply of OB-GYNs is comparable to other countries at around 12 per 1,000 live births, nearly all other countries have more fully adopted the use of midwives. Sweden, for example, has a combined rate of 69 providers per 1,000 live births, compared to 16 per 1,000 in the U.S.
“We’re not using midwives in the way other countries are,” says Gunja. “Other countries have integrated midwives into their health care systems; in the U.S., it’s a different story.”
The report also points to a lack of health coverage as a major issue. Medicaid, the largest payer of maternal care services in the U.S., covered an estimated 41.3% of all births in 2022. Federal law requires Medicaid to provide up to 60 days of postpartum coverage, with nearly all states extending that period to 12 months. However, ten states have not expanded their Medicaid programs under the Affordable Care Act, leaving many women of reproductive age without coverage.
Nearly 8 million women of reproductive age in the U.S. are uninsured, making both maternal and general health care services cost-prohibitive. The Medicaid “unwinding” process, resuming eligibility checks after continuous enrollment during the pandemic, could end coverage for many pregnant and postpartum women. As of May 23, nearly 23 million people had been disenrolled from Medicaid.
“A lot of these women aren’t getting any sort of care even before they get pregnant,” Gunja says. “So it’s no surprise they have other health issues after giving birth.”
