You're twice as likely to die during pregnancy in these three US states
It’s no secret that the US has one of the highest rates of teen pregnancy in the developed world, but there's another issue that nobody seems to want to talk too much about: the fact that more women die while bringing new life into the world in America than in any other developed country on earth. In fact, while maternal mortality rates are dropping rapidly in other parts of the world (in the UK, a man is now more likely to die while his partner is pregnant than she is), the USA is the only developed country where the number of women who die as a result of pregnancy-related complications is actually rising. In fact, between 700 and 900 women pass away every year, during what should theoretically be one of the happiest times for a family.
Maternal mortality is defined by the United Health Foundation as the "number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy". In three states, maternal mortality rates are dramatically higher. In Indiana, the maternal mortality rate stands at 41.4 per 100,000 births, almost twice the national average of 20.7 births. Louisiana has a similarly high rate, at 44.8 per 100,000 births, with Georgia pushing it even higher at 46.2 per 100,000. So, what could be contributing to these disproportionately high figures?
The relationship between poverty and access to healthcare is also believed to correlate with rates of maternal mortality across all three states. Georgia, for example, has the second highest number of individuals without health insurance, with 14 per cent of the population lacking access to medical care and vulnerable to the burden of unexpected health costs. It is also estimated that 240,000 people who sit in the Medicaid "coverage gap", earning too much to qualify under the Affordable Care Act yet too little to afford private healthcare. While doctors generally recommend that expectant mothers see a doctor within the first eight weeks of pregnancy, women falling into these groups may lack the funds to access to vital care prenatally, during childbirth and in the weeks and months following delivery.
However, poverty is only part of the problem. One common thread throughout all three states - and in fact throughout all US states - is the fact that African-American mothers are at considerably higher risk of dying during or soon after pregnancy. According to the CDC, black women are three to four times more likely to die from pregnancy-related causes nationally, a trend that is applicable to women of all socio-economic groups and education levels. It will come as little surprise then that Louisiana and Georgia are both in the top four states in terms of highest African-American populations.
A report by the Yale Global Health Partnership into racial disparity between maternal mortality rates in Georgia has declared this situation as, in part, a result of a distrust between African American women and medical professionals, which may lead to some women delaying treatment. This, it said, was down to ongoing discrimination and historically "negative interaction", as well as a perception by medics that black women were less likely to follow medical advice. In the report, it concluded that: "Reforming medical institutions to combat the structural racism embedded in them, through strategies such as providing critical training and education to health professionals, may lower patient reluctance to seek care and improve quality of care over time."
It would also be easy to argue that the rising age of mothers and the prevalence of lifestyle-related conditions such as diabetes and drinking during pregnancy may also have an impact on maternal mortality rates - after all, America is the world’s most obese nation. However, these factors are also increasingly common in other developed countries and yet their rates are remaining steady or even dropping. Even in West Virginia, the state with the second highest rates of obesity, maternal mortality rates are three quarters less than in these three states. So what else is going wrong?
Some have pointed to the disparity in where healthcare funding is spent between different states. While money has been pumped into reducing America’s infant mortality rate - a move which has seen rates fall to their lowest in history - funding for women’s services has not been so forthcoming, with just 14 per cent of publicly-funded women’s health services needs actually met in Louisiana, according to the United Health Foundation. And as the Yale report points out: "Texas reported a near doubling in its maternal mortality rate following the 2011 decision by the state legislature to remove two-thirds of the budget for its state family planning program and drastically reduce its number of women’s health clinics." With this in mind, it’s hard to underestimate the impact that finances can have on both maternal and infant survival rates.
There are also questions as to whether or not medical staff, even those who work with expectant mothers every day, are adequately trained. Worryingly, a six-month joint investigation by NPR and Pro-Publica into US-wide maternal mortality, carried out in 2017, found that "some doctors entering the growing specialty of maternal-fetal medicine were able to complete that training without ever spending time in a labor-delivery unit." It kind of begs the question: if those who women turn to to know best in the most vulnerable moments of their lives aren't experienced enough to provide the best possible care, how can survival rates be expected to improve?
Perhaps the worst part of all of this, is the CDC’s assessment that over 60 per cent of pregnancy-related deaths that occur in the US are preventable, mostly a mixture of "patient/family factors (e.g., lack of knowledge on warning signs and need to seek care) followed by provider (e.g., misdiagnosis and ineffective treatments) and systems of care factors (e.g., lack of coordination between providers)." Of course, the rates in these three states are still considerably lower than those in the developing world, where 99 per cent of all preventable pregnancy-related deaths occur. But whether because of ingrained racism, poverty or a lack of state funding for women's health, to have three states falling so far behind the national average and letting so many women die, in a country that can find enough money to send a man to space and last year spent $800 billion on defence, is simply unacceptable.