Roosevelt Institute | Cornell University

Why our Mothers are Dying and What Should be Done

By Catherine GoreyPublished February 11, 2019

Pregnant woman
Maternal mortality rates in America are comparable to those of developing countries. Tied into this issue are deeply rooted inequalities in the distribution of doctors and resources for women’s natal care.

The World Health Organization’snew guidelines on non-clinical interventions designed to reduce unnecessary caesarean sections is the first of its kind in aiming to reduce overall maternal mortality rates. This resource guide is a crucial step in realizing a critical public health: insufficient maternal care and subsequent rising rates of maternal mortality.

In 1990, only 17 maternal deaths for every 100,000 pregnant women in the United States. In 2015, it has risen to 26 deaths. American women are 50% more likely to die in childbirth. The risk is increased for women of color.

Most of these deaths occur in the weeks before or after childbirth.This statistic indicates that the issue of maternal mortality is one of structural inequalities that prevent quality and attentive care for expecting and new mothers.

This problem is two-fold in this sense: due to America’s primarily multi-payer healthcare system, mothers often rely on private insurance plans or pay out of pocket to cover maternity care. Although the Affordable Care Act made this part of insurance a mandatory benefit, small businesses, the self-employed, and extremely low-income individuals still lack sufficient coverage. The uncertainty of healthcareunder the Trump administration does not help this current state.

These sensitive groups are often the ones who require maternal care. Social determinants of poverty and low access to resources or opportunities for achievement are key predictors of teen pregnancy. This is also true for adult women, the 10 states with the highest fertility ratesare primarily rural environments: Arkansas, Texas, Kansas, Iowa, Idaho, Alaska, Nebraska, North Dakota, and South Dakota.

Increased fertility rates among these populations is a concerning trend, especially when compared to the overall decrease in childbirth in America. The decline of teen births in urban and suburban communities is not a reality in these rural areas.

With the strides in certain geographical areas, this is not a question of technology or capability of doctors; instead it is an issue of access to the specialists and complex care that women need both before, during, and after childbirth.

Only 6 percent of the nation’s ob-gyns work in rural areas, while rural America makes up 15% of the country’s population. This issue of disappearing coverage has massive consequences for women in rural areas, fewer than half of rural women live within a 30-minute drive of the nearest hospital offering obstetric services. Only 88% live within a 60-minute drive.

As a consequence of this lack of care, maternal mortality is significantly higher in rural areas. A survey by Scientific Americanfound that compared to 18.2 deaths per 100,000 live births in metropolitan, well-served areas, rural areas are much higher- 29.4 deaths.

            What can be done about this issue? America needs to reinvest in a comprehensive perinatal and postnatal care and incentivize ob-gyn placements in rural communities. Medicare coverage of childcare puts doctors at a disadvantage, the high costs of hospitalization for birth incentivize rushing patients out the door after giving birth instead of having extended and careful moderating. Extending the mandates physicians must follow for Medicare patients would ensure higher quality care at all stages of observation. These mandates should also cover pre- and post- natal services to minimize complications at birth. Additionally, this economic incentive for doctors would decrease the bias against rural American healthcare systems. Small changes such as increase in midwives, doulas, and nurse practitioners can help mediate the disparities that we see and pave the way for more equal healthcare, because our mothers all deserve the best.