While maternal mortality rates across the world have fallen by nearly 50% over the last 25 years, rates in the United States have risen during that same time period, according to a new global survey published Thursday by the United Nations and World Bank.
Maternal mortality is defined as the death of a woman during pregnancy, childbirth, or the first six weeks after giving birth. Globally, approximately 303,000 maternal deaths were documented in 2015, down 44 percent from 1990’s total of 532,000. Over the same period, the approximate global lifetime risk of maternal death fell from 1 in 180 mothers to 1 in 73 — a remarkable achievement that should be celebrated.
But in the U.S., the maternal death rate has climbed from 12 per 100,000 live births in 1990 to 14 per 100,000 in 2015, making it one of just 13 countries worldwide — including Venezuela, North Korea and Zimbabwe — where maternal mortality rates have worsened over the past quarter century.
By comparison, rates in Sweden, Switzerland, Spain, Norway, Italy, Iceland, Greece and Kuwait have remained below 10 deaths per 100,000 births for the last 25 years. And with Canada’s rate remaining stable over the years at seven deaths per 100,000 births, mothers in the U.S. are now twice as likely to die as their neighbors just to the north.
The new data are part of an analysis, Trends in Maternal Mortality: 1990 to 2015, which looked at the world’s progress toward reaching the UN’s Millennium Development Goals. The UN target is to get the global average maternal death rate below 70 per 100,000 live births by 2030, with no country averaging worse than 140. The current global average is 216 deaths per 100,000.
Underpinning the increase in the number of maternal deaths in the U.S. are a number of factors, including inequities in health care and rising rates of obesity, diabetes and other chronic diseases that can complicate pregnancies.
High rates of unintended pregnancies also contribute greatly to U.S. maternal mortality rates. Outcomes of unintended or mistimed pregnancies are significantly worse than for planned pregnancies, underscoring the importance of ensuring access to reproductive health care, including contraception and family planning services — both of which are under attack by conservative politicians. Moreover, many pregnant women — particularly those with unintended pregnancies — struggle to get adequate prenatal care, which further increases the risk of maternal mortality.
Maternal mortality rates in the U.S. are also influenced by profound racial disparities. Nationally, black women are almost four times more likely to die during pregnancy and childbirth compared to white women, a disparity that persists across all levels of income, age, and education. In high-risk pregnancies, the disparities are even greater, with African-American women 5.6 times more likely to die than white women. Among women diagnosed with pregnancy-induced hypertension (eclampsia and pre-eclampsia), African-American and Latina women are 9.9 and 7.9 times more likely to die than white women with the same complications. Women of color are also less likely to go into pregnancy in good health due to the chronic, cumulative health effects of racism and discrimination, along with a lack of access to preventive and maternal health care services.
All of these factors have an impact on the health of U.S. mothers, as well as their children. The U.S. has the highest rate of first-day infant mortality of any country in the developed world. More than 11,000 newborn babies in America die each year on the same day they are born — which is 50 percent more first-day deaths than all other industrialized countries combined. And the rate of death for children under the age of five is 7.1 per 1,000 live births — putting the U.S. on par with Bosnia and Herzegovina, Qatar, and Uruguay.
According to Save The Children, which releases rankings on the best countries for mothers every year, the United States continues to fall behind in this area. Although the U.S. used to be among the top 10 countries on the organization’s list, it dropped to 31st place in this year’s rankings. “The United States is among the countries that has made the least progress since 2000 on maternal and child survival,” Save The Children reported. “Evidence shows that the health of American mothers and children is falling behind.”