The maternal mortality rate … The U.S. and Canada have the lowest overall supply of midwives and ob-gyns — 12 and 15 providers per 1,000 live births, respectively (Exhibit 3). 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. ), on behalf of MBRRACE-UK, Saving Lives, Improving Mothers’ Care: Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17 (National Perinatal Epidemiology Unit, University of Oxford, Nov. 2019). The United States has the highest maternal mortality rate of any developed country and the … Monetary conversion rates. Pregnancy-associated death: Death while pregnant or within one year of the end of the pregnancy, irrespective of cause. Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth. Maternal (mother) and neonatal (baby) outcomes, including lower maternal mortality and morbidity and reduced stillbirths and preterm births. Declercq and Zephyrin, Maternal Mortality: Primer, forthcoming. 4 (July–Aug. 1 (Jan. 2020): 77–84. The maternal mortality rate for 2018 is 17.4 deaths per 100,000 live births. Some U.S. states have strengthened access to midwives and achieved positive outcomes.25 During the COVID-19 pandemic, as demand for midwifery care has grown in the U.S. (as it has around the world), several states issued emergency orders expanding midwifery services to pregnant women, including Maine, New Jersey, and New York.26, While the ACA requires Medicaid to pay for midwifery care provided in freestanding birth centers, more needs to be done to expand access to services and make them more affordable. For everyone. Dodge et al., “Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting,” American Journal of Public Health 104, no. This analysis used data from the 2020 release of health statistics compiled by the Organisation for Economic Co-operation and Development (OECD), which tracks and reports on a wide range of health system measures across 37 high-income countries. Under-5 mortality rate, , 2012. 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). Maternal mortality rates calculated without using information obtained from the checkbox are also presented for 2002, 2015, 2016, 2017, and 2018 to provide comparisons over time using a comparable coding approach across all states. The well-being of mothers and babies should be a top policy priority in all countries. 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. More than half of recorded maternal deaths occur after the day of birth. (eds. Annual rate of reduction (%) Under-5 mortality rate, 1990-2000. Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA). Placing a priority on natural reproduction processes and relationship-building, midwives also can help address the social and personal needs of mother, baby, and family.8 Ob-gyns, meanwhile, are physicians trained to identify and intervene in abnormal conditions that come up before, during, and after pregnancy. 2. 18 (May 10, 2019): 423–29. Donna L. Hoyert and Arialdi M. Miniño, “Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release,” National Vital Statistics Report 69, no. 16. 1. 2020). The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … Under-5 mortality rate, , 1990. What has happened in the United States has been an increase in maternal mortality since 2003, actually going against the Healthy People 2020 goal of decreasing maternal mortality to 11.4 deaths per 100,000. Maternal mortality: Death while pregnant or within 42 days of the end of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. CONCLUSIONS: Maternal mortality continues to be an issue in developed countries, such as the United States and Canada. Data on maternal mortality ratios, supply of midwives, and supply of ob-gyns were extracted in August 2020. The global rate is 211 maternal deaths per 100,000 live births. State or national public policy meetings require diverse stakeholders to discuss the existing issues and resolve them. Almost all maternal deaths (99%) occur in developing countries. 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. 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. ), Building Primary Care in a Changing Europe (European Observatory on Health Systems and Policies, 2015). Data on paid maternity leave are from the OECD’s Family Database. Christine MacArthur et al., “Effects of Redesigned Community Postnatal Care on Women’s Health 4 Months After Birth: A Cluster Randomised Controlled Trial,” Lancet 359, no. Drivers of Maternity Care in High-Income Countries: Can Health Systems Support Woman-Centred Care? Insurance coverage. This issue brief provides an overview of differences in maternal mortality, maternal care workforce composition, and access to postpartum care and social protections in the U.S. compared to 10 other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.2 We use the most recently available data from the Centers for Disease Control and Prevention (CDC), the Organisation for Economic Co-operation and Development (OECD), and earlier Commonwealth Fund studies.3. The United States has the highest maternal and infant mortality rates among developed nations. Eugene Declercq and Laurie Zephyrin, Maternal Mortality in the United States: A Primer (Commonwealth Fund, forthcoming). 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. The proportion of these deaths varies across regions, Maternal Mortality Rate TheHealthSite - 10/14/2018 2:27:00 AM 2015): 314–17. (UNFPA, 2014). 32. CDC twenty four seven. Trends and Characteristics of United States Out-of-Hospital Births 2004–2014: New Information on Risk Status and Access to Care, Making a Case to Reduce Legal Impediments to Midwifery Practice in the United States, Effects of Redesigned Community Postnatal Care on Women’s Health 4 Months After Birth: A Cluster Randomised Controlled Trial, A Randomized Trial of Single Home Nursing Visits vs. Office-Based Care After Nursery/Maternity Discharge: The Nurses for Infants Through Teaching and Assessment After the Nursery (NITTANY) Study, Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting, Extending Medicaid Coverage for Postpartum Moms, Maternity Leave and Related Types of Leave, Mapping Integration of Midwives Across the United States: Impact on Access, Equity, and Outcomes, COVID-19’s Impact on Pregnancy and Childbirth Policies, The Impact of the Coronavirus (COVID-19) Pandemic on Maternity Care in Europe, Coronavirus and Pregnancy — Preserving Maternal Health Across the European Region, ACOG Committee Opinion No. Some young adults staying on a parent’s health plan have not had their maternity care costs covered, because the ACA only mandates maternity care coverage for primary beneficiaries, not for their children. 21. Additionally, the maternal mortality rate in the United States has risen 113% since 1990. Around one-third of U.S. pregnancy-related deaths, counted up to one year postbirth, occur during pregnancy (Exhibit 2). The U.S. has the highest maternal mortality rate among developed countries, Many factors contribute to the high number of maternal deaths in the U.S., including too few maternity care providers, especially midwives, and lack of access to comprehensive postpartum supports. Affordable, quality health care. United Nations Population Fund, The State of World’s Midwifery 2014: A Universal Pathway. See Bushman, “Role of Certified Nurse-Midwives,” 2015. 9948 (Sept. 20, 2014): 1129–45; and Jennifer E. Moore et al., Improving Maternal Health Access, Coverage, and Outcomes in Medicaid: A Resource for State Medicaid Agencies and Medicaid Managed Care Organizations (Institute for Medicaid Innovation, 2020). 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. Trade in Value Added (December 2018) Health Status. 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. To better understand the high maternal death rate in the U.S., it is helpful to know when they happen. The maternal mortality ratio, on the other hand, is the number of maternal deaths per 100,000 live births. There is no one explanation as to why the United States is seeing such high maternal mortality rates. 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* Sarah A. Donovan, Paid Family Leave in the United States, Report R44835 (Congressional Research Service, updated May 29, 2019). 2017). 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.. Its maternal-mortality rate has been steadily rising — the only developed country whose is. Tikkanen et al., International Profiles, 2020. Maternal mortality rates vary by maternal characteristics, especially maternal age and race. 1 Between 1990 and 2013, the maternal mortality ratio for the USA more than doubled from an estimated 12 to 28 maternal deaths per 100 000 births 1 and the country has now a higher ratio than those reported for most high-income countries … 33. WHO et al., Postnatal Care, 2015; and “ACOG Committee Opinion No. Maternal mortality ratio is the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births. 9304 (2002): 378–85; Ian M. Paul et al., “A Randomized Trial of Single Home Nursing Visits vs. Office-Based Care After Nursery/Maternity Discharge: The Nurses for Infants Through Teaching and Assessment After the Nursery (NITTANY) Study,” Archives of Pediatric Adolescent Medicine 166, no. Vice President, Health Care Coverage and Access, The Commonwealth Fund, Senior Scientist, Tracking Health System Performance, The Commonwealth Fund, Senior Research Associate, International Program in Health Policy and Practice Innovations, The Commonwealth Fund, Senior Researcher, Health Care Coverage and Access, The Commonwealth Fund, Senior Program Associate for Fellowships and Research, International Program in Health Policy and Practice Innovations, The Commonwealth Fund, Vice President, Delivery System Reform, The Commonwealth Fund, , Senior Research Associate, International Program in Health Policy and Practice Innovations, Harkness Fellowships in Health Care Policy and Practice, Association of Health Care Journalists Fellowships, Commonwealth Fund Fellowships in Minority Health, The Impact of the Pregnancy Checkbox and Misclassification on Maternal Mortality Trends in the United States, 1999–2017, Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends from Measurement Issues, Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017, Global, Regional, and National Levels of Maternal Mortality, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015, Midwifery and Quality Care: Findings from a New Evidence-Informed Framework for Maternal and Newborn Care, Midwife-Led Continuity Models Versus Other Models of Care for Childbearing Women, The Role of Certified Nurse-Midwives and Certified Midwives in Ensuring Women’s Access to Skilled Maternity Care, A Precious Jewel — The Role of General Practice in the English NHS, Perennial Health Care Reform — The Long Dutch Quest for Cost Control and Quality Improvement. In addition, the ACA’s 10 essential health benefits that insurers must cover, which include maternity care, apply only to individual marketplace insurance plans and small-group plans — but not employers with more than 50 workers. Although most are preventable, maternal deaths have been increasing in the United States since 2000.1 As U.S. policymakers and health care delivery system leaders seek ways to reverse this trend, countries that have achieved lower maternal mortality rates may offer possible solutions. In most other countries, however, midwives greatly outnumber ob-gyns. ; and Alison Stuebe et al., “Extending Medicaid Coverage for Postpartum Moms,” Health Affairs Blog, May 6, 2019. 28, 2016): CD004667. Though the nation's overall maternal mortality rate is high – the highest it's been in decades – some states' rates are far worse. 2 (June 2016): 116–24. Countries also have rapidly reorganized their maternity care delivery systems during COVID-19 to expand use of telemedicine and the capacity to provide home births.28 To strengthen maternity care during the pandemic, the U.S. could look to countries with long-standing experience in home births and midwifery-led care. 29. 7. 42. 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.