Worldwide, there have been improvements and innovations in healthcare around the world which have led to a decline in the number of women dying from childbirth over the last 30 years. But in the United States, the numbers are increasing at a very alarming rate.
The United States is the only developing country with such alarming increases in deaths of mothers in the 21st Century. The American maternal mortality rate has more than doubled from 10.3 per 100,000 live births in 1991 to 23.8 in 2014. Over 700 women die annually of complications related to pregnancy in the United States, and two-thirds of those deaths are preventable.
A report from the Commonwealth Fund released in December 2018 found that American women have the greatest risk of dying from pregnancy complications among the 11 highest-income countries in the world. The most discouraging factor of all is the massive disparities among the races in the United States. Black women are three to four times more likely to die in childbirth than white women, regardless of education, income, or any other socio-economic factors. This disparity is the primary reason for the United States shortfall when compared to other affluent countries around the world. According to statistics, black mothers in the U.S. die at the same rate as pregnant women in Mexico or Uzbekistan.
Some of these deaths can be explained by the high rates of Cesarean-section deliveries in the United States. Data from the CDC indicates that the overall cesarean delivery rate in the United States increased 60% from 1996 through 2009, from 20.7% to 32.9%. In 2018, according to the CDC, nearly one-third of births continue to be delivered by cesarean every year. Studies have shown a significant difference in the rate of C-section based on race. For example, 36% of births among non-Hispanic black women are C-sections compared to 30.9% for non-Hispanic white women. In addition, once a woman has a C-section, her future deliveries are much more likely to result in another C-section. This is, in part, because it can be difficult to find providers who will support a vaginal birth after a woman has had a Cesarean, even though they can be done safely.
With the rise in concern in 2018 around maternal mortality, the federal government is taking steps toward addressing the problem with the Preventing Maternal Deaths Act, signed in December 2018, which provides federal grants to states to investigate the deaths of women who died within a year of being pregnant. This was a much-needed initial step but with the 2020 elections upon us, will candidates see this as a top priority?