The wealthiest country in the world has staggering disparities in maternal mortality rates. Abortion bans can and will worsen those disparities.
As a maternal and child health physician, human rights lawyer, and global health advocate with decades of experience around the globe, I can tell you: The maternal mortality rate in the U.S. is horrifying.
It is so horrifying, in fact, that it doesn’t take a global health expert to tell you this. As the wealthiest country in the world, it is inexcusable that the maternal mortality rate is worsening.
What is the maternal mortality rate?
To understand the United States’ ranking for maternal mortality, it is first critical to understand how the maternal mortality rate is scored. The maternal mortality rate is a measure of maternal deaths within 42 days of pregnancy termination due to complications of pregnancy, childbirth, and the puerperium in a geographic area divided by total live births for the same geographic area for a specified time, usually a calendar year, multiplied by 100,000.
Where does the U.S. rank amongst other global powers?
According to the Center for Disease Dynamics, Economics and Policy, the estimated maternal mortality rate in 2018 in the United States was 17.4 maternal deaths per 100,000 live births, putting the United States dead last compared to similarly wealthy countries. The U.S is in 55th place on the World Health Organization’s maternal mortality rankings, behind Russia with a maternal mortality rate of 17 maternal deaths per 100,000 live births.
What’s worse than the ranking? That number has only increased since 2018. In 2019, there were 754 cases of maternal death in the U.S. and the maternal mortality rate grew from 17.4 to 20.1. The very next year, 861 women died of maternal causes and the national maternal mortality rate rose to 23.8 deaths per 100,000 live births. The United States is the only country outside of Afghanistan and Sudan where this rate is rising.
For perspective, the number of women in the United States who die giving childbirth annually has doubled over a 20-year period.
What’s contributing to this?
The United States has long viewed healthcare as a privilege, seeing it from the standpoint of insurance rather than primary healthcare available as a right. Even with the passing of the Affordable Care Act, people were not granted access to healthcare; they were granted access to the opportunity to have insurance for that healthcare. For those who are uninsured, the challenge of access to health services remains. This has grave implications for low-income women who may not be able to seek prenatal care. I’ve worked in many countries where health is held as a right, and there is—to varying degrees of quality—some form of free healthcare. In the U.S., this abysmal state of public healthcare naturally leads to the next contributor of maternal mortality rate—socioeconomic and racial disparity and bias.
The commodification of healthcare in America obviously leads to a sharp contrast in treatment for marginalized groups that have been systematically denied opportunities to wealth and prosperity. In the case of maternal healthcare, this is extremely evident. Black women are three times more likely than white women to die from pregnancy-related causes; American Indian and Alaska Native people are more than two times as likely.
Staff shortages among the healthcare workforce do nothing to help the gloomy reality of maternal mortality. Healthcare employment remains below pre-pandemic levels, with the number of workers down by 1.1 percent from February 2020. These effects are felt throughout the continuum of care, leaving patients with less access to healthcare and poorer health outcomes. These consequences are apparent within labor and delivery services and pediatric inpatient care.
Abortion bans will increase maternal mortality.
Abortion care gives women who do not wish to have a baby the promise of choice, bodily autonomy, and a future that is hers.
I am proud to have provided safe abortion care—an essential reproductive right—to countless women from varied but always challenging situations.
In India, I provided care for a young girl, barely 18, who was 14 weeks pregnant, a result of repeated sexual abuse by her brother-in-law; for a young woman who needed the procedure to survive or would otherwise leave behind a two-year-old child; for a mother of six with two previous cesareans and pregnancy related complications that would have surely killed both the fetus and her.
With the Supreme Court’s regressive decision to overturn Roe v. Wade, America has further threatened women’s bodily autonomy and decreased access to basic healthcare. This will undoubtedly lead to unsafe or delayed abortions and the forced continuations of pregnancies that will be lethal to both the fetus and mother.
So, how do we fix it?
As many of the contributing factors are deep-seated, structural issues, it can feel as though there are no promising ways to begin amending the dismal state of maternal mortality in the United States. While weighty societal and structural adjustments are required to reduce the maternal mortality rate and catch up to the standards of other countries, there are practical steps we can begin to take with policy and mobilization.
Protecting and expanding access to abortion care and taking steps to support pregnant women and families such as through child tax credits will undoubtedly help. Additionally, ensuring diversity, equity and inclusion training goes hand in hand with medical training will help eliminate bias and decrease disparities in treatment across the racial and socioeconomic spectrum.
I agree with Michele Obama when she said that a society can be measured by its treatment of women and girls. By that yardstick, the U.S. still has a long way to go. It will take a serious reckoning with our broken healthcare system and our nation’s muddled history of structural inequality to address, but it most certainly can be done.
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