We’re The Best – in Failing Expectant Mothers

By: Alise Brillault

Many of my fellow Americans like to boast that we are Number One. In a humorous article in the Washington Post, author Ingraham lays out the statistical ways in which the U.S. is, in fact, number one – ranging from having the world’s largest economy to ranking at the top for national pride (see graph below).

Alise 1

(Figure [1])

However, this article fails to point out another crucial way in which the U.S. is also number one: in its rate of maternal mortality compared with the rest of the developed world.

Maternal mortality, or mothers dying during or after childbirth, is not only tragic but also preventable. The fact that 99% of maternal deaths occur in the developing world highlights how this issue is not a result of differences in individual health but rather inequalities in access to healthcare and the gap between the rich and the poor (WHO). In these cases, the majority of deaths are a result of: severe bleeding, infections, high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery, and unsafe abortion (WHO).

While maternal mortality rates are falling globally, one country has had the honorable distinction of seeing its rate rise: The United States. Some of the few other countries on Earth who have also seen recent increases include South Sudan and the Democratic Republic of the Congo (Tavernise, 2016).

Among advanced economies, the U.K. is the next closest country in the ranking after the U.S. – and its rate of 9.2 deaths per 100,000 live births pales in comparison to the U.S.’s rise to 26.4.

Alise 2.png

(Figure [2])

While this is shameful in of itself, what is even more appalling is looking at the data of black American women in comparison with white American women. Many discrepancies exist in the health of black women compared with their white counterparts, but maternal mortality rates are one of the most striking: black women in the U.S. are a whopping 243 percent more likely than white women to die from pregnancy or childbirth-related causes. To put things in context, the World Health Organization estimates that black American women die as a result of childbirth at about the same rate as women in Uzbekistan and Mexico (Pro Publica 2017).

There are arguments that these phenomena are related to other American trends, such as rising obesity (which can complicate pregnancy and also tends to affect black women more than white women). However, the ultimate structural difference between American society and other developed nations is not just obesity rates but our lack of universal healthcare. In the current system, many uninsured women rely on underfunded state assistance such as Medicaid- in which they tend to receive less prenatal care than other expectant mothers- or nonprofits such as Planned Parenthood- which the Republican Party is hell-bent on shutting down at every chance they get. Even insured women do not typically receive post-natal home visits, such as is typical in places like the U.K. and the Netherlands. There is also the issue of a lack of state-guaranteed maternity leave, which has many American mothers returning to work much sooner than their European counterparts. Converting our healthcare system to a universal one, as well as ensuring maternity (and paternity) leave for all new parents, are imperative first steps – although highly unlikely under the current Trump administration and Republican-controlled Congress.

Addressing the gap between white and black mothers’ outcomes is a trickier beast. While much of the discrepancy is related to black women’s tendency towards being lower income and not having health insurance, class differences do not explain the whole phenomenon (one also has to ask oneself why black women tend to be poorer than white women in the first place). Some startling data has found that black university-educated mothers are more likely to experience severe complications of pregnancy or childbirth than white women who never graduated from high school (Pro Publica 2017).

20171207-shalon-in-uniform-inline.jpg
“Shalon MauRene Irving was a lieutenant commander in the uniformed ranks of the U.S. Public Health Service.” She died giving birth. (Courtesy of Wanda Irving + PRI)

The fact that educated and relatively well-off black women die in childbirth more often than their white peers reflects how racism itself can directly affect health. Black women, living under the doubly whammy of being both black and women, have to deal with stresses that the rest of the population does not. From outright discrimination to micro-aggressions, this stress has been shown to literally age black women faster than white women and increase their susceptibility to diseases such as hypertension and diabetes (Pro Publica 2017). While women as a whole are tending to have children later in life- and age can be an important risk factor for pregnancy complications – it is argued that a black expectant mother as early as in her mid-twenties should be attended to differently than a white woman of the same age (Pro Publica 2017).

No woman anywhere should die bringing life into the world. The fact that this is happening in the richest country in the world- and at much higher rates for black American women than whites- is particularly shameful. We are a country that neither cares about its mothers as much as purported nor has progressed in terms of racial equality as much claimed. Having a sexist, racist bigot as a president and a Congress that is not much better will only exacerbate these disappointing phenomena.

Sources:
Ingraham, C. (2014, 3 July). 21 maps and charts that prove America is Number One. The Washington Post. Retrieved from https://www.washingtonpost.com/news/wonk/wp/2014/07/03/21-maps-and-charts-that-prove-america-is-number-one/?utm_term=.595da47370ec.
Pro Publica (2017, 7 Dec.). Nothing Protects Black Women From Dying in Pregnancy and Childbirth. Retrieved from https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth.
Tavernise, S. (2016, 21 Sep.). Maternal Mortality Rate in U.S. Rises, Defying Global Trend, Study Finds. New York Times. Retrieved from https://www.nytimes.com/2016/09/22/health/maternal-mortality.html.
WHO (2016). Maternal Mortality Fact Sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs348/en/.
[2] Martin, N. and Montange, R. (2017, 12 May). U.S. Has The Worst Rate of Maternal Deaths In The Developed World. NPR. Retrieved from https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world.

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