The United States is one of the most advanced countries in the world, especially regarding healthcare. Of the top ten hospitals in the world, nine of them are in the United States.
Why then is the rate of maternal mortality so high? Among the industrialized countries, the US has the most maternal deaths, with 26.4 deaths per 100,000 live births. How can this rate be so high in a country that has access to clean water, sanitation, food, healthcare and education?
While the rate of maternal deaths appears to have risen, the reporting of these deaths is likely part of the issue. Between 1990 and 2015, maternal deaths decreased worldwide by between 30% and 45% depending on which estimates are used. During that same period, in the United States, the rate increased by 60%. The data collection could be a factor. It wasn't until the early 1990s that death certificates included information on whether or not a woman was pregnant or had given birth around the time of her death. It took until 2017 for every state to begin including this information on death certificates, so it's possible the problem has existed for much longer, it just wasn't being reported.
The protocol surrounding death certificates is governed by state laws, which differ from place to place. In some states, it's even further down the chain at the county level. With no consistent national data to go by, the maternal mortality problem was, in a way, invisible.
To compound the reporting issue, societal trends might be a factor as well. The rates of obesity and diabetes (all types, not just gestational) have gone up, and many women are delaying childbirth and waiting until their mid-30s or after to have children. In a commentary paper written by Christine Morton of the California Maternal Quality Care Collaborative (CMQCC) and published in the journal Birth, it states, "The increasing number of women who enter pregnancy with higher rates of obesity, hypertension, diabetes, abnormal placentation…are typically the first and only factors considered." Essentially, the mother is blamed according to Morton, for being "older, fatter and sicker." Morton noted however that obesity and diabetes, as well as maternal age, had risen across the globe, however, only in the United States did maternal deaths go up as well.
Experts have called for medical professionals to focus on the mother as well as the baby during obstetrical care. In a 2013 policy report, 2400 mothers across the United States were surveyed after giving birth, and nearly 25% of those who participated in the research said they held back questions or complaints from their doctors because they did not want to seem "difficult." The survey encouraged health care providers to look behind just the baby and make sure the mother is being heard as well. The video below is a production of BBC News and looks at the problem of maternal death in the United States and what can be done about the fact that America leads the world in such a terrible event.