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U.S. Women More Likely to Die in Pregnancy and Childbirth and Skip Care Because of Cost, Multi-Nation Survey Finds; C-Section Rates Rank Among Highest

Study of Women’s Health and Health Care in 11 Wealthy Nations Also Finds U.S. Women Among More Likely to Survive Breast Cancer; Report Underscores Importance of Access to Affordable Health Care

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Key findings from the Commonwealth Fund report What Is the Status of Women’s Health and Health Care in the U.S. Compared to Ten Other Countries?, released today:

  • Pregnancy and childbirth are more dangerous for women in the U.S. than in other high-income nations. U.S. women have the highest death rate from complications during pregnancy and childbirth — 14 deaths per 100,000 live births — of the 11 countries in the study. Women in Sweden and Norway have the lowest rates (four and five maternal deaths, respectively, per 100,000 live births). Potential contributing factors for the high U.S. mortality rates include lack of prenatal care and higher rates of obesity, diabetes, and heart disease.
  • U.S. women are more likely to have cesarean sections. The U.S. has among the highest C-section rates, with 320 procedures per 1,000 live births — slightly lower than Switzerland and Australia (327 and 332 procedures, respectively, per 1,000 live births). In Norway and the Netherlands, C-sections are performed at about half the rate, with slightly more than 160 procedures per 1,000 live births. Studies show that an elected C-section can increase a woman’s risk for life-threatening complications during childbirth and subsequent deliveries.
  • More U.S. women struggle to afford health care.
    • Higher out-of-pocket costs. More than one in four U.S. women (26%) spent $2,000 or more out of pocket for health care in the past year. Only Swiss women had a higher rate (28%) of spending that much. Of the remaining study countries, fewer than 11 percent of women spent $2,000 or more out of pocket.
    • Problems with medical bills. Nearly half (44%) of women in the U.S. report having a medical bill problem, such as having an insurance company deny coverage for health services. Just 2 percent of U.K. women report medical bill problems, the lowest rate in the study.
    • Skipping needed care. Thirty-eight percent of U.S. women don’t go to the doctor when they’re sick or fill a prescription because of the cost — the highest rate among the 11 countries studied. In Germany and the U.K., only 7 and 5 percent of women, respectively, report forgoing care because of costs.
  • Women in the U.S. have among the highest breast cancer screening and survival rates. Nearly 80 percent of U.S. women over age 50, and more than 90 percent of Swedish women, are screened for breast cancer — the highest rates in the study. Screenings are associated with fewer breast cancer deaths. U.S. women have among the lowest rates of breast cancer mortality, trailing only Norway, Sweden, and Australia.

Publication Details

Publication Date: December 19, 2018

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Sara R. Collins

Sara Collins
Vice President, Health Care Coverage and Access