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Maternal Mortality: Causes, Differences, and Solutions

By Sania Patel

Edited by Danika Suh

According to the World Health Organization (WHO), maternal mortality is defined as the death of a woman while pregnant or within forty-two days of termination of pregnancy, irrespective of the duration and site of the pregnancy or its management. Accidental or incidental causes are an exception. Since 1990, several global organizations - the WHO, UNICEF, World Bank Groups, and the United Nations Population Division - have reported a decrease in maternal mortality rates. However, in 2017, a study by the WHO reported that the U.S. was one of only two countries to report a significant increase in its maternal mortality ratio (the proportion of pregnancies that result in death of the mother), since 2000. While the maternal deaths in the U.S. have leveled in recent years, the ratio is still considerably higher compared to other developed countries.

There are various reasons as to why maternal mortality is exceedingly high in the U.S. compared to other developed regions. However, the most prominent cause is racial inequality and is only the outline of the series of issues that occur with maternal care. Economic differences, discrimination, and limited access to prenatal and postpartum care make up just the beginning of the issues that stem from racial inequality. Dr. Michael C. Lu, associate administrator of the U.S. Department of Health Resources and Services Administration, states, “Today African American women are still three times more likely to die during pregnancy and childbirth as [white women] and it’s a gap that we haven’t been able to close for decades.”

Many minorities, due to the continuity of the U.S.’s socioeconomic stratification, have been poorly educated in maternal health and childbirth, which often leads to complications during and after childbirth, due to improper prenatal and postpartum treatment. Minorities are also effected by discrimination and malpractice in hospitals. Countless reports have outlined instances where mothers have been denied certain childbirth procedures, harassed, and even physically harmed by the attending doctor. The Georgia Birth Advocacy Coalition reports that 1 in 3 women say their births were traumatic and 16% develop PTSD after giving birth due to their experience in the hospital.

Minorities also face economic differences. On average, 77.8% of minorities receive a high school diploma and only 42% of these minorities go on to graduate from a four-year college or university. Due to the lack of education, most minorities often hold lower-class job positions. Due to the economic challenges of pregnancy and health care costs, many women neglect prenatal and postpartum care. According to the CDC, in 2004, 0.23% of women in the U.S. chose to give birth at home. However, this percentage has skyrocketed to 0.89% in 2012, as home birth is recorded to be 68% less expensive than hospital delivery.

The U.S. faces the issue of racial inequality, which further develops a lack of economic sustainability, leading to decreased access to prenatal and postpartum maternal care. Racial inequality connects to economic differences that relate to poverty, limited access to healthcare, and untreated chronic conditions, all of which are the main causes of maternal mortality, according to Hartford HealthCare.

To put it simply, other developed countries, such as the United Kingdom, may offer potential lessons to the U.S. In 2017, the maternal mortality rate for the UK was 7 deaths per 100,000 live births, which, compared to the U.S. 's estimated ratio of 20.1 deaths per 100,000 live births, is substantially lower.

To put it simply, the U.S. healthcare system is not a singular institution or organization, but multiple systems with very little coherence. The Commonwealth Fund explains that the U.S. health system is a “mix of public and private for-profit and nonprofit insurers and health care providers.” Along with this, the federal government provides funding for the national Medicare program which supports adults age 65 and older, people with disabilities, low-income people, and veterans. The nature of the U.S. healthcare system causes the cost to be practically unbearable for most U.S. citizens. An annual data report from the Health Cost Institute states that average healthcare prices have increased year after year with rates that were 15% higher in 2018 compared to 2014.

The U.K. healthcare system is a government sponsored universal system called the National Health Service (NHS). The NHS consists of multiple publicly funded healthcare systems in the U.K. Unlike the U.S., all English residents are automatically entitled to free public healthcare through the NHS, as its budget is funded primarily through general taxation. According to the Healthcare Administration, the U.K. system is very low cost when compared both to other developed nations’ systems and to the extremely high cost U.S. system.

The Centers for Disease Control and Prevention’s National Center for Health Statistics hasn’t published an official maternal mortality rate since 2007. Marian MacDorman, PhD, or the Maryland Population Research Center, says, “It’s a total embarrassment that international databases such as the Organization for Economic Cooperation and Development list a dash for the U.S. 's maternal mortality rate when a country like Mongolia is able to report one.” In order to better the U.S.’s maternal mortality rate, racial equality and economic sustainability must be achieved within the healthcare system. U.S. citizens must be more informed over the current issues of the healthcare system and should focus on bettering the system for the benefit of the people. By focusing on the various causes of maternal mortality such as medicine, reproductive and socioeconomic factors, and the health care delivery system, the maternal mortality ratio will decrease and the U.S. healthcare system will head towards a prospering maternal care system.

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