33. WHO et al., Postnatal Care, 2015; and “ACOG Committee Opinion No. In 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries (Exhibit 1). 5, 2015): 893–97; and Ewout van Ginneken, “Perennial Health Care Reform — The Long Dutch Quest for Cost Control and Quality Improvement,” New England Journal of Medicine 373, no. 8. Saving Lives, Protecting People, U.S. Department of Health & Human Services. 2 (June 2016): 116–24. 21. 10 (Mar. While the reasons behind the high U.S. maternal mortality rate are multifaceted, our findings suggest that an undersupply of maternity providers, especially midwives, and lack of access to comprehensive postpartum supports are contributing factors. Since more than half of maternal deaths occur after birth, strengthening postpartum care should be a priority. In most countries, maternity care is well integrated with other primary care, and midwives play an important role. The well-being of mothers and babies should be a top policy priority in all countries. Maternity leave helps women manage the physiological and psychological demands of motherhood and helps ensure financial security for families.24 All countries included in this study, apart from the U.S., mandate at least 14 weeks of paid leave from work. The maternal mortality rate is two times lower in Canada than the United States, according to a global survey conducted by the United Nations and the World Bank. Sign up to receive e-alerts and newsletters on the health policy topic you care about most. While the information collected by the OECD reflect the gold standard in international comparisons, it may mask differences in how countries collect their health data. CONCLUSIONS: Maternal mortality continues to be an issue in developed countries, such as the United States and Canada. 37. Sandhya Raman, “COVID-19 Amplifies Racial Disparities in Maternal Health,” Roll Call, May 14, 2020; Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (National Partnership for Women & Families, Apr. The World Health Organization (WHO) recommends midwives as an evidence-based approach to reducing maternal mortality.10 Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care in terms of11: Some experts note that “high-income countries with the lowest intervention rates, best outcomes, and lowest costs have integrated midwifery-led care” into their health care systems. No other industrial nation has such a high rate of maternal mortality. Declercq and Zephyrin, Maternal Mortality: Primer, forthcoming. Despite participation in the Millennium Development Goals (MDGs) and spending more than any other country on hospital-based maternity care, the maternal mortality ratio (MMR) in the U.S. remains at about 17 deaths per 100,000 live births. 736: Optimizing Postpartum Care, Effects of Medicaid Expansion on Postpartum Coverage and Outpatient Utilization, It’s Past Time to Provide Continuous Medicaid Coverage for One Year Postpartum, Increasing Postpartum Medicaid Coverage Could Reduce Maternal Deaths and Improve Outcomes, Paid Maternity Leave in the United States: Associations with Maternal and Infant Health, Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, COVID-19 Amplifies Racial Disparities in Maternal Health, Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States, Maternal Mortality in the United States: A Primer, COVID-19 and State Medicaid Budgets: How Short-Term Cuts Could Result in Long-Term Harm to Children and Families, Especially in Communities of Color, Jeopardizing a Sound Investment: Why Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm, State Policies to Improve Maternal Health Outcomes. 35. 658 women died of maternal causes in the United States. 3.7. The overall maternal mortality rate was 17.4 deaths per 100,000 live births. Data on paid maternity leave are from the OECD’s Family Database. Detailed Evaluation of Changes in Data Collection Methods, Centers for Disease Control and Prevention. 3. See Bushman, “Role of Certified Nurse-Midwives,” 2015. Gross domestic product (annual) Gross domestic product (quarterly) Composite Leading Indicators. The correction factor f… 8. 5 (May 2018): e140–e150. The American College of Nurse-Midwives estimates that approximately 60 percent of pregnancies are normal or low-risk. In England, care may be shared between midwives and obstetricians.17, In the U.S., midwife services are not uniformly covered by private insurance plans. State or national public policy meetings require diverse stakeholders to discuss the existing issues and resolve them. While international data are available regarding timing of maternal and pregnancy-related deaths, findings for the U.S. did not correspond with the latest data from the CDC. Affordable, quality health care. Maternal mortality the world over has witnessed an insignificant reduction since the inception and end of the United Nations’ Millennium Development Goals (MDGs). In the U.S. and Canada, ob-gyns outnumber midwives. Midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetrician-gynecologists, or ob-gyns (see box).9. The most recent U.S. maternal mortality ratio, or rate, of 17.4 per 100,000 pregnancies represented approximately 660 maternal deaths in 2018. Maternal mortality in 2000-2017 Internationally comparable MMR estimates by the Maternal Mortality Estimation Inter-Agency Group (MMEIG) WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division UNITED STATES OF AMERICA Year Maternal mortality ratio (MMR)a,* Maternal deaths* HIV-related indirect maternal deaths* 29. Marian Knight et al. Among these are the state licensure laws, restrictive scope-of-practice laws, and rules requiring physician supervision of midwives.19, Postpartum care is intended to ensure the physical and emotional recovery of mothers and their babies.20 Home visits by a midwife or a nurse are associated with improved mental health and breastfeeding outcomes as well as reduced health care costs.21 All countries, apart from the U.S., guarantee at least one such visit within one week postpartum, although some U.S. states provide these for Medicaid beneficiaries (Exhibit 4).22 Home visits give providers an opportunity to address mental health concerns and allow them to assess social determinants of health, including needs for food, housing, financial security, and protection from domestic violence.23. The maternal mortality rate … Simply totaling the raw, unadjusted data from all states regardless of whether they revised their death certificates results in a reported U.S. maternal mortality rate that more than doubled from 9.8 maternal deaths per 100,000 live births in 2000 to 21.5 in 2014.17 However, the adjusted maternal mortality rate increased more slowly for a group of 24 states and Washington, DC (analysis group 1, Table 1) that only included a pregnancy question after they revised their death certificates (Fig. 16. 1). This is particularly the case when services are provided in nonhospital settings, like the home or a birthing center.18 And while the Affordable Care Act (ACA) requires that state Medicaid programs cover midwifery care, the supply of providers is often so low that beneficiaries are often unable to access these services. Under-5 mortality rate, , 1990. 4 (July–Aug. The World Health Organization recommends at least four health contacts in the first six weeks, yet U.S. women typically have a single office-based physician visit within this period, and some don’t have one at all.33, Expanding eligibility for Medicaid, which pays for 43 percent of U.S. deliveries, can lead to more stable postpartum coverage.34 Currently, however, the program’s coverage extends to only six weeks postpartum. The 10 comparator countries included in this brief represent those high-income countries that take part in the Commonwealth Fund’s annual International Health Policy Survey: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. The maternal mortality ratio is used as a criterion for the quality of medical care in a country. 10. Y. Tony Yang and Katy B. Kozhimannil, “Making a Case to Reduce Legal Impediments to Midwifery Practice in the United States,” Women’s Health Issues 25, no. 11. 34. We used the latest data from the Centers for Disease Control and Prevention’s (CDC) Pregnancy Mortality Surveillance System on the timing of maternal deaths in the U.S. Health Resources and Services Administration, The Maternal, Infant, and Early Childhood Home Visiting Program: Partnering with Parents to Help Children Succeed (HRSA, Apr. The authors wish to thank Dr. Jodie D. Katon, Dr. Eugene Declercq, and Reggie Williams II for their helpful review comments; and Jesse Baumgartner and Gabriella N. Aboulafia for their careful data review. 15. New Zealand Ministry of Health, “The First-Week Visit,” last updated June 30, 2015. High U.S. Maternal Mortality Rate With the advancement of modern medicine, maternal deaths while giving birth are becoming increasingly rare in many developed countries across the world. 6. Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA). Midwifery care. U.S. Has The Worst Rate of Maternal Deaths In The Developed World More American women are dying of pregnancy-related complications and that rate is rising. Around one-third of U.S. pregnancy-related deaths, counted up to one year postbirth, occur during pregnancy (Exhibit 2). (UNFPA, 2014). In contrast, the maternal mortality ratio was three per 100,000 or fewer in in the Netherlands, Norway, and New Zealand. 13. American College of Nurse-Midwives, Ensuring Access to High Value Providers: ACNM Survey of Marketplace Insurers Regarding Coverage of Midwifery Services (ANCM, Sept. 2014); Marian F. MacDorman and Eugene Declercq, “Trends and Characteristics of United States Out-of-Hospital Births 2004–2014: New Information on Risk Status and Access to Care,” Birth 43, no. ), International Profiles of Health Care Systems 2020 (Commonwealth Fund, June 2020); and Stephen Morrissey et al., “International Health Care Systems,” New England Journal of Medicine 372, no. Additionally, the maternal mortality rate in the United States has risen 113% since 1990. In 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries (Exhibit 1). 21 percent of all maternal deaths are between one and six weeks postpartum. The estimated national maternal mortality rate in the United States is about 17 per 100,000–but is about 43 per 100,000 live births for Black women. Monetary conversion rates. In most other countries, however, midwives greatly outnumber ob-gyns. There has been renewed interest recently in investigating the United States’ rising maternal mortality rate, as studies show that the U.S. is the only developed country to see the maternal mortality rate increase as countries such as France, Spain, Germany, Canada and Portugal witness a steady decrease.. The United States (U.S.) fares worse in preventing pregnancy-related deaths than most other developed nations. The United States has the highest maternal and infant mortality rates among developed nations. Data on maternal mortality ratios, supply of midwives, and supply of ob-gyns were extracted in August 2020. All Rights Reserved. Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth. For 2018, the maternal mortality rate is 17.4 per 100,000 live births in the United States. Pregnancy-related death: Death during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. The global rate is 211 maternal deaths per 100,000 live births. Robin A. Cohen and Michael E. Martinez, Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2013 (National Center for Health Statistics, June 2014). The maternal mortality ratio, on the other hand, is the number of maternal deaths per 100,000 live births. Medicaid and CHIP Payment and Access Commission (MACPAC), Medicaid’s Role in Financing Maternity Care (MACPAC, Jan. 2020); and Sarah H. Gordon et al., “Effects of Medicaid Expansion on Postpartum Coverage and Outpatient Utilization,” Health Affairs 39, no. All other countries have a supply that is between two and six times greater. However, maternal mortality in the United States has changed very little in the past 25 years (1, 3). 26. Consumer price indices - inflation. More than half of recorded maternal deaths occur after the day of birth. 10053 (Oct. 8, 2016): 1775–812. Maternal mortality ratio (national estimate, per 100,000 live births) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Prevalence of stunting, height for age, male (% of children under 5) 23. 2 (Feb. 2018): 216–25. Kirstie Coxon et al., “The Impact of the Coronavirus (COVID-19) Pandemic on Maternity Care in Europe,” Midwifery 88 (Sept. 2020): 102779; and WHO Europe, “Coronavirus and Pregnancy — Preserving Maternal Health Across the European Region,” WHO, June 30, 2020. 40. Annual rate of reduction (%) Under-5 mortality rate, 1970-1990. Global Burden of Disease 2015 Maternal Mortality Collaborators, “Global, Regional, and National Levels of Maternal Mortality, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015,” Lancet 388, no. Eugene Declercq and Laurie Zephyrin, Maternal Mortality in the United States: A Primer (Commonwealth Fund, forthcoming). 18 (May 10, 2019): 423–29. 3 (Mar. Because what we have today in the United States is the system that's perfectly designed to yield the results that we are seeing. Emily Eckert, “It’s Past Time to Provide Continuous Medicaid Coverage for One Year Postpartum,” Health Affairs Blog, Feb. 6, 2020; Laurie Zephyrin et al., “Increasing Postpartum Medicaid Coverage Could Reduce Maternal Deaths and Improve Outcomes,” To the Point (blog), Commonwealth Fund, Nov. 21, 2019; Review to Action and MMRIA, Report from Nine Maternal Mortality Review Committees (Review to Action, 2018); and Petersen et al., “Vital Signs,” 2019. The United States has the highest maternal mortality rate of any developed country and the … Universal, comprehensive maternity care coverage, along with exemptions from cost-sharing, also are the norm in other high-income countries.29 While the ACA strengthened maternity care coverage, access to benefits often depends on type of insurance and geographic location, and out-of-pocket costs vary significantly as well.30, Postpartum care. For example, many types of non-ACA-compliant plans, such as short-term plans or association health plans as well as some student health plans, don’t cover maternity benefits. 1 (Jan. 1, 2015): 75–76. Used by the World Health Organization (WHO) in international comparisons, this measure is reported as a ratio per 100,000 births. Full details on how indicators were defined, as well as country-level differences in definitions, are available from the OECD. Used in the U.S. only, this CDC measure is typically reported as a ratio per 100,000 births. For 2018, the maternal mortality rate is 17.4 per 100,000 live births in the United States. 28. The American College of Nurse Midwives claims that the “U.S. 44 (National Center for Health Statistics, Jan. 2020); Marian F. MacDorman et al., “Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends from Measurement Issues,” Obstetrics and Gynecology 128, no. ” Health Affairs Blog, May 6, 2019 ): 885–89 et. 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