The most recent U.S. maternal mortality ratio, or rate, of 17.4 per 100,000 pregnancies represented approximately 660 maternal deaths in 2018. Lianne Zondag, Franka Cadee, and Myrte de Geus, Midwifery in the Netherlands, 2017 (Royal Dutch Organization of Midwives, Jan. 2017); and Dorothy Shaw et al., “Drivers of Maternity Care in High-Income Countries: Can Health Systems Support Woman-Centred Care?,” Lancet 388, no.10057 (Nov. 5, 2016): 2282–95. The well-being of mothers and babies should be a top policy priority in all countries. Because what we have today in the United States is the system that's perfectly designed to yield the results that we are seeing. All other countries have a supply that is between two and six times greater. And several countries provide more than a year of maternity leave (Exhibit 5). 22. Maternal mortality ratio (national estimate, per 100,000 live births) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Prevalence of stunting, height for age, male (% of children under 5) 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.. In contrast, the maternal mortality ratio was three per 100,000 or fewer in in the Netherlands, Norway, and New Zealand. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. In the United States, 700 women a year die during pregnancy, in childbirth, or in the months that follow. 1.4. New Zealand Ministry of Health, “The First-Week Visit,” last updated June 30, 2015. 32. While the reasons behind the high U.S. maternal mortality rate are multifaceted, our findings suggest that an undersupply of maternity providers, especially midwives, and lack of access to comprehensive postpartum supports are contributing factors. Maternal mortality rates vary by maternal characteristics, especially maternal age and race. Annual rate of reduction (%) Under-5 mortality rate, 2000-2012. Saving Lives, Protecting People, U.S. Department of Health & Human Services. 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. 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). Improved patient satisfaction and maternal psychosocial well-being outcomes, including those for postpartum depression. Robin A. Cohen and Michael E. Martinez, Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2013 (National Center for Health Statistics, June 2014). In most countries, maternity care is well integrated with other primary care, and midwives play an important role. 20. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … The World Health Organization recommends at least four health contacts in the first six weeks, yet U.S. women typically have a single office-based physician visit within this period, and some don’t have one at all.33, Expanding eligibility for Medicaid, which pays for 43 percent of U.S. deliveries, can lead to more stable postpartum coverage.34 Currently, however, the program’s coverage extends to only six weeks postpartum. 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. In the first week postpartum, severe bleeding, high blood pressure, and infection are the most common contributors to maternal deaths, while cardiomyopathy is the leading cause of late deaths.6 Previous research indicates that U.S. women experience more late maternal deaths than women in other high-income countries.7. 2 Increased rate of maternal mortality The maternal mortality rate in the United States has rapidly risen, and healthcare issues are hugely fundamental at the political level. 10053 (Oct. 8, 2016): 1775–812. The overall maternal mortality rate was 17.4 deaths per 100,000 live births. Kirstie Coxon et al., “The Impact of the Coronavirus (COVID-19) Pandemic on Maternity Care in Europe,” Midwifery 88 (Sept. 2020): 102779; and WHO Europe, “Coronavirus and Pregnancy — Preserving Maternal Health Across the European Region,” WHO, June 30, 2020. The 10 comparator countries included in this brief represent those high-income countries that take part in the Commonwealth Fund’s annual International Health Policy Survey: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. Midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetrician-gynecologists, or ob-gyns (see box).9. 2015): 314–17. 2018); Xenia Shih Bion, Efforts to Reduce Black Maternal Mortality Complicated by COVID-19 (California Health Care Foundation, Apr. 3 (Mar. Some states are expanding coverage up to one year, in line with recommendations by maternal mortality review committees and others.35, Paid leave. Rates by age are: 40 and older – 81.9 Insurance coverage. 17 percent of deaths occur on the day of delivery. (eds. Drivers of Maternity Care in High-Income Countries: Can Health Systems Support Woman-Centred Care? Global Burden of Disease 2015 Maternal Mortality Collaborators, “Global, Regional, and National Levels of Maternal Mortality, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015,” Lancet 388, no. A Woman’s Right to Health. 12 percent of all maternal deaths take place during the remaining portion of the year; these are also known as late maternal deaths. Sarah A. Donovan, Paid Family Leave in the United States, Report R44835 (Congressional Research Service, updated May 29, 2019). 3. 34. 2 (Jan. 2020): 1–18. 37. Roosa Tikkanen et al. Its maternal-mortality rate has been steadily rising — the only developed country whose is. 7. Eugene Declercq and Laurie Zephyrin, Maternal Mortality in the United States: A Primer (Commonwealth Fund, forthcoming). Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. We used the latest data from the Centers for Disease Control and Prevention’s (CDC) Pregnancy Mortality Surveillance System on the timing of maternal deaths in the U.S. ), Building Primary Care in a Changing Europe (European Observatory on Health Systems and Policies, 2015). (eds. 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. Data on maternal mortality ratios, supply of midwives, and supply of ob-gyns were extracted in August 2020. 11. 1 (Jan. 1, 2015): 75–76. 2 (June 2016): 116–24. Several factors, which can vary widely from state to state, may be limiting the supply of midwives in the U.S. S1 (Feb. 2014): S136–S143. The proportion of these deaths varies across regions, Maternal Mortality Rate TheHealthSite - 10/14/2018 2:27:00 AM Sign up to receive e-alerts and newsletters on the health policy topic you care about most. OECD Family Database, “Parental Leave Systems,” Aug. 2019. Though the nation's overall maternal mortality rate is high – the highest it's been in decades – some states' rates are far worse. The data are estimated with a regression model using information on the proportion of maternal deaths among non-AIDS deaths in women ages 15-49, fertility, birth attendants, and GDP. Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth. 2 (Feb. 2018): 216–25. Used by the World Health Organization (WHO) in international comparisons, this measure is reported as a ratio per 100,000 births. Jane Sandall et al., “Midwife-Led Continuity Models Versus Other Models of Care for Childbearing Women,” Cochrane Database System Review 4 (Apr. 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. Data on paid maternity leave are from the OECD’s Family Database. 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. 28, 2016): CD004667. Wide racial and ethnic gaps exist between non-Hispanic black (37.3 deaths per 100,000 live births), non-Hispanic white (14.9), and Hispanic (11.8) women. 29. 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). Sandhya Raman, “COVID-19 Amplifies Racial Disparities in Maternal Health,” Roll Call, May 14, 2020; Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (National Partnership for Women & Families, Apr. 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. Because of potential data comparability concerns, we omitted these findings from our formal analysis. This podcast discusses conditions known to challenge maternal safety, the high incidence of preventable harm in this population, and care bundles as an improvement strategy. The correction factor f… Annual rate of reduction (%) Under-5 mortality rate, 1990-2000. 41. CDC twenty four seven. 2. Other experts estimate that an even larger proportion of births, up to 90 percent, are considered uncomplicated. Among the key issues to address are state variations in scope-of-practice rules for health care practitioners, low reimbursement rates for midwives, and payment parity.27. Health Resources and Services Administration, The Maternal, Infant, and Early Childhood Home Visiting Program: Partnering with Parents to Help Children Succeed (HRSA, Apr. Rates also increased with age. 30. Among these are helping to manage a normal pregnancy, assisting with childbirth, and providing care during the postpartum period. 10. 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. 2020); and Yaphet Getachew et al., Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States (Commonwealth Fund, Sept. 2020). 2 (Feb. 21, 2018): e0192523. 11. 15. Consumer price indices - inflation. Monetary conversion rates. There is a striking disparity in maternal and infant mortality rates … See Bushman, “Role of Certified Nurse-Midwives,” 2015. (UNFPA, 2014). Economic Outlook. The American College of Nurse-Midwives estimates that approximately 60 percent of pregnancies are normal or low-risk. Simply totaling the raw, unadjusted data from all states regardless of whether they revised their death certificates results in a reported U.S. maternal mortality rate that more than doubled from 9.8 maternal deaths per 100,000 live births in 2000 to 21.5 in 2014.17 However, the adjusted maternal mortality rate increased more slowly for a group of 24 states and Washington, DC (analysis group 1, Table 1) that only included a pregnancy question after they revised their death certificates (Fig. 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 maternal mortality rate is two times lower in Canada than the United States, according to a global survey conducted by the United Nations and the World Bank. While international data are available regarding timing of maternal and pregnancy-related deaths, findings for the U.S. did not correspond with the latest data from the CDC. ; and Alison Stuebe et al., “Extending Medicaid Coverage for Postpartum Moms,” Health Affairs Blog, May 6, 2019. Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017. 1. This ranks last overall among industrialized countries. They typically provide care in hospital-based settings. The World Health Organization (WHO) recommends midwives as an evidence-based approach to reducing maternal mortality.10 Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care in terms of11: Some experts note that “high-income countries with the lowest intervention rates, best outcomes, and lowest costs have integrated midwifery-led care” into their health care systems. 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. 658 women died of maternal causes in the United States. 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. 12. 3 (Sept. 2016): 447–55; Building U.S. Capacity to Review and Prevent Maternal Deaths: Report from Nine Maternal Mortality Review Committees (Maternal Mortality Review Information Application and Review to Action, 2018); and Emily E. Petersen et al., “Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017,” Morbidity and Mortality Weekly Report 68, no. (eds. 35. Martin Marshall, “A Precious Jewel — The Role of General Practice in the English NHS,” New England Journal of Medicine 372, no. For everyone. 39. 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* 26. The maternal mortality rate … Since more than half of maternal deaths occur after birth, strengthening postpartum care should be a priority. 31. 8. Used in the U.S. only, this CDC measure is typically reported as a ratio per 100,000 births. Kathy Gifford et al., Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey (Henry J. Kaiser Family Foundation, Apr. See UCSF Health, “High Risk Pregnancy,” n.d. 14. Declercq and Zephyrin, Maternal Mortality: Primer, forthcoming. 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). 27. Full details on how indicators were defined, as well as country-level differences in definitions, are available from the OECD. Lauren M. Rossen et al., “The Impact of the Pregnancy Checkbox and Misclassification on Maternal Mortality Trends in the United States, 1999–2017,” Vital and Health Statistics, series 3, no. Maternal mortality rates have been stable recently, despite evidence that many maternal deaths continue to be preventable. 2017). Midwifery care. CONCLUSIONS: Maternal mortality continues to be an issue in developed countries, such as the United States and Canada. For context, Canada was the only other country during this period to experience an increase in maternal mortality over the same time period, growing just over 60% (from 4.9 to 7.9 deaths per 100,000). 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. 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