The U.S. loses mothers at a much higher rate than any other industrialized nation — Why?
More than half of maternal mortalities occur between 1 week and 1 year postpartum. What are we doing to support new mothers?
When I tell people that the United States has the highest maternal death rate of any industrialized nation, the most common response is incredulity. “That can’t be true,” they tell me — but it is. And it’s not even a close margin.
The United States has a maternal mortality rate nearly three times higher than the next closest country, France. The U.S. rate in 2020, the latest year for which the Centers for Disease Control and Prevention has data, is 23.8 maternal deaths for every 100,000 live births. France has 8.7, while New Zealand has 1.7. The rate of Black women dying of pregnancy-related causes in the U.S. is triple the rate for white women, at 55 per 100,000 live births.
Utah rates, current through 2019, reflect the national trend of increasing maternal mortality rates from 2017 levels. Utah’s Public Health Indicator Based Information System shows a rate of 16.5 in 2017, 23.3 in 2018 and 25.6 in 2019. The CDC reported last September that data from Maternal Mortality Review committees in 36 states found that a whopping 85% of deaths were preventable.
This week, the American College of Obstetricians and Gynecologists observed “Maternal Health Awareness Day,” with the theme “Know Why.” “Understanding the underlying causes of maternal deaths and the critical role that standardized data play in identifying causes and creating solutions is the first step in eliminating poor maternal health outcomes,” said Dr. Iffath Abbasi Hoskins, the group’s president.
The 2022 CDC report on 2017-2019 U.S. maternal mortality found that mental health conditions were the leading underlying cause of maternal mortality among white, Hispanic, American Indian and Alaska Native populations, while cardiac and coronary conditions were the leading underlying cause of death for Black mothers. According to the Utah Department of Health, 45% of maternal deaths in Utah in 2015-2016 were accidental drug related causes and known suicide.
Nationally, 22% of the maternal deaths occurred during pregnancy and 25% occurred between the day of delivery, up to one week after the birth. Significantly, more than half of the maternal deaths occurred between 8 days and 365 days after delivery.
The American College of Obstetricians and Gynecologists noted this week that the end-of year package that Congress passed included a permanent option for states to extend Medicaid coverage from 60 days to 12 months, a policy “long advocated for and ... still urging Congress to make mandatory.”
In Utah, Rep. Rosemary Lesser, D-Ogden, is running a bill to do just that. A retired OB-GYN, she is sponsoring HB84, Postpartum Medicaid Coverage Amendments, so that moms who have postpartum complications are covered for the full year following birth. “For too long the singular focus in pregnancy care has been in achieving a healthy outcome for a mother that ended at delivering. Now it is clear that it is crucial to consider the medical and mental health challenges that may exist for many months after delivery,” she said. Already, 35 other states have or are planning to expand Medicaid to cover a 12-month postpartum period. She would like to see Utah become the 36th.
In Monday’s Social Services Appropriations Subcommittee, the Utah Department of Health and Human Services told the committee that Medicaid covers approximately 20% of the births in Utah, that Utah has one of the highest postpartum depression rates in the country, that more than half of the pregnancy related deaths come in the first postpartum year, as noted above, and that the 7 to 12 month range is the period of greatest risk for postpartum overdoses. The department asked that the 12-month expansion be funded at $2,948,500 ongoing, which would cover approximately 2,550 mothers.
Gov. Spencer Cox has also made expanding postpartum Medicaid coverage a budget priority.
Holly Richardson is the editor of Utah Policy.