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 saw a dramatic 27 percent jump in the maternal death rate from 19 deaths per 100,000 live births in 2000 to 24 deaths per 100,000 live births in 2014. In 2015, the rate once again went up to 26.4 deaths per 100,000 live births, and it is black women who are three to four times more likely to die from pregnancy or childbirth related incidences than white women.
Whereas white women have a rate of maternal death that stands at 12 per 100,000 live births, black women die in 40 of every 100,000 live births, and the gap is widening.
Some medical experts have connected the overall rise in American maternal mortality to the rise in obesity, diabetes, and other chronic conditions among American women. Others have pointed to a possible correlation between decreased access to contraception and abortion services and increases in maternal mortality rates. Higher maternal mortality rates for black women can be partially attributed to higher levels of poverty, which can impede healthcare access. But even after accounting for socioeconomic status and level of healthcare access, black women are more likely to experience pregnancy complications than white women.
In an effort to address this epidemic, states such as North Carolina have sought to close the maternal death gap. North Carolina developed a healthcare management program for low-income women called Pregnancy Medical Home. Doctors who service Medicaid patients receive a financial incentive to fully screen pregnant women for all possible high-risk pregnancy indicators, everything from depression to diabetes. The doctor then informs the pregnancy care manager of the diagnosis so that the program can make sure that the patient can obtain the necessary medical treatment and understands how, when and why to follow the treatment plan.
The program has been successful. In 1999, the death rate for black women in North Carolina was 39 per 100,000 live births. By 2013, they managed to close that gap to a rate of 23 deaths per 100,000 live births for both black and white mothers, putting North Carolina slightly below the national average.
California has also been successful in lowering the maternal mortality rate, mainly through the creation of a maternal mortality review board which examines every single maternal death in the state to determine what the problem was and how it went unaddressed. California currently has the lowest maternal death rate in the country with 7.3 deaths per 100,000 live births; however, the black-white health gap still persists with black women almost four times more likely to die due to pregnancy-related causes than white women.
On the other side of the movement to combat maternal mortality is Texas, where the maternal death rate almost doubled between 2010 and 2012 from 72 deaths to 148 deaths, data the coincides with state lawmakers move in 2011 to cut family planning funds by 66 percent. 82 family planning clinics have been forced to close in the state since 2011, largely due to the dramatic funding cuts and the passage of draconian targeted restrictions on abortions providers that aimed to force women’s health centers to close their doors.
Unfortunately the successful Medicaid based programs in states like North Carolina are being threatened by national Republican efforts to significantly cut Medicaid funding. The most recent bill produced by Senate Republicans would slash Medicaid by 35 percent over the next 20 years, forcing states to choose between cutting a large number of people completely off of care and/or significantly limiting the quantity and quality of services available to recipients. Because half of all births in the United States are paid for through Medicaid, it is likely that pregnant women’s healthcare would be on the chopping block.
In addition, the bill could allow health insurers to opt out of covering many women’s health services, including pre- and post-natal care and contraceptive coverage. The bill would also bar Planned Parenthood from receiving Medicaid reimbursements for a year, preventing many young and low-income people from accessing affordable contraception, abortion, maternal care and other health services.
In a recent briefing on black maternal health, advocates emphasized the need to pursue research on black maternal health, protect access to reproductive, maternal and mental health services for black women, and give black mothers a platform to share their experiences.
Media Resources: Vox 7/3/17, 6/29/17; Center for Disease Control 2/21/03; NPR 5/12/17; Feminist Majority 6/19/17, 8/23/16; Feminist Majority 7/5/17