Where would you rather give birth – in the USA or Albania? Most of you would probably say the USA yet your chances of survival would then be lower. Yes, you as a mother are more likely to die from childbirth-related problems in the USA than Albania. Does that surprise you?
New research looking at maternal mortality is out and the findings are not good for those in the American system. In 1990, the USA was ranked 22 in maternal health and mortality. This year, the USA ranks 60th after dropping from 50th in the last assessment. In fact, the US is one of only 8 countries to have seen a rise in maternal morality, up from 17.6 in 2003 to 18.5 deaths/100,000 in 2013 (the other 7 were Afghanistan, Belize, El Salvador, Guinea-Bissau, Greece, Seychelles, and the South Sudan). In 1987 that number was 7.2/100,000. [Note that these numbers are slightly different than those in the 2012 WHO Trends in Maternal Mortality which found a death rate of 21/100,000 in the USA. Regardless of which methodology is used, things are not looking good.]
Canada and New Zealand have maternal mortality rates that are half of the USA. The UK has one that is a third. Australia’s is a quarter of the USA’s. Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Romania, Kuwait, Lebanon, Iran, and Serbia all have rates that are lower than that of the USA. Countries that American citizens think are lacking in so many areas are proving they are better equipped to care for their mothers than Americans themselves are. Yet I bet you that the majority of Americans are blissfully unaware of this fact. They have to be, because if they aren’t then they are turning a blind eye to a systemic problem that is killing women every day and that is inexcusable.
What’s causing this? It’s not, as some anti-homebirthers would suggest, a rise in homebirth. Although some of the rise may be attributable to how deaths are reported, the lead researcher has stated that even with this rise, the real number is likely larger than what we are seeing now as maternal deaths are often mischaracterized on death certificates. One of the main factors is a rise in certain diseases that make pregnancy riskier, like diabetes and hypertension. There are also other heart and neurological diseases that are on the increase that necessitate higher-risk pregnancies.
If most of these increases are due to increases in diseases, why are other similar, developed countries not showing the same problems? How is all the medical technology in the world failing American mothers? The only thing I can think of is that the system as a whole is broken. At this stage, it’s hard to know what parts actually work, but clearly the system taken together doesn’t. Perhaps it’s the lack of integration, the lack of affordable care, or the focus on treatment instead of prevention. Likely it’s a mix of all of it and more. So what is the USA to do? Are Americans prepared to scrap a system that is failing so many (it’s not just maternal mortality but families being left in debt for regular procedures, people being turned away from treatment because they can’t afford it)? Are people still willing to stand up and say in the realm of health care, the USA is not best? I certainly hope so.
We may not know how to fix the system at the moment, but we do know this: A woman giving birth in China (rank of 57) now has a better chance of survival than a woman giving birth in the USA. Is that really the best the US can offer their mothers?
Oh – to answer the question of where you would be safest giving birth: Iceland with a maternal mortality rate of 2.4/100,000 (nearly 1/8 that of the USA).
 Kassebaum NJ et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2014; doi:10.1016/S0140-6736(14)60696-6.