There are endless controversies in the U.S. about contraception, rape and abortion, with politicians and activists of every stripe chiming in endlessly. But there's not much discussion of women dying in childbirth.
Maybe there should be.
A new study released by the University of Washington's Institute for Health Metrics and Evaluation (IHME) and published in the latest issue of The Lancet finds that there are only eight countries in the world where maternal mortality rates have risen since 2003, including Afghanistan, countries in Africa and Central America – and the United States.
In 2013, 18.5 mothers in the U.S. died for every 100,000 live births, compared to 7 deaths per 100,000 in Saudi Arabia, 8.2 in Canada and 6.1 in the United Kingdom.
"There's no reason that a country with the resources and the medical expertise that the US has should see maternal deaths going up," said Dr. Christopher Murray, Director of IHME and a co-founder of the Global Burden of Disease. "The next step would be to examine local-level differences in maternal deaths to look for patterns and the drivers behind those patterns."
The largest increase in mortality rates hit mothers aged 20-24. (The study did not distinguish between home and hospital births, though an unrelated study released by the Society for Maternal-Fetal Medicine last February suggested that babies delivered at home were almost four times as likely to die as babies delivered in hospital. However, that study focused only on babies' deaths, not mothers'.)
The IHME study suggests that several factors could play a role in the last decade's rise of American maternal mortality, including more women unable to access prenatal or other health services, and higher rates of pregnancies complicated by obesity, diabetes or other health conditions.
Economic factors
The inability to get adequate prenatal or maternal health care might be largely due to economic factors.
In January, for example, researchers at the University of California San Francisco compared hospitals in their state and concluded that it's effectively impossible for a woman to know in advance how much it will cost to deliver a baby: for uncomplicated births and women with no serious health issues, patients could be charged as little as $3,296 or as much as $37,227 for an uncomplicated vaginal delivery, whereas C-section costs ranged anywhere from $8,312 to nearly $71,000.
Granted, the medical field as a whole is generally opaque about pricing; another factor possibly keeping pregnant women away from prenatal care isn't even the cost, so much as fear of the [unknown] cost.
Of the eight countries to show increased maternal mortality, the U.S. was the only “high-income” one.
"We can do better"
"For American women, high-risk pregnancies and the number of women with inadequate access to preventive and maternal health care are just two potential causes of this trend," said study author Dr. Nicholas Kassebaum, Assistant Professor at IHME. "The good news is that most maternal deaths are preventable, and we can do better."
The leading cause of maternal death globally is medical complications of childbirth and the period post-delivery. Approximately one-quarter of maternal deaths were found to occur during childbirth and the 24 hours following. Another quarter happen during pregnancy, and the remaining deaths occur up to one year after delivery.
A separate study also released on May 2 in The Lancet examined child survival rates and found that 28,000 children under age 5 died in the United States in 2013. Child death rates in the U.S. declined throughout 1990-2013, but the pace of the declines has slowed. During the 1990s, child mortality declined 3.2% annually, and after 2000, the rate slowed to 1.7%.
For children, the data show that the earliest days of life are the most dangerous. In 2013, nearly 42% of global child deaths occurred in infants less than one month old. The 10 countries with the lowest child survival rates were all in sub-Saharan Africa.