Among high-income countries, the United States has the highest maternal mortality rates, reflecting deaths from complications of pregnancy and childbirth, a new international comparison from the Commonwealth Fund shows. And even more troubling trends stemming a serious shortage of maternal health providers — particularly midwives — may lie ahead.
The report, Maternal Mortality and Maternity Care in the U.S. Compared to 10 Other Developed Countries, compares the U.S. to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.
Key findings include:
- Pregnancy and childbirth are more dangerous for women in the U.S. U.S. women have the highest death rate from complications of pregnancy and childbirth – 17 deaths per 100,000 live births – a maternal mortality rate that is more than double the rates of most other high-income countries. In the Netherlands, Norway, and New Zealand, for example, there are three maternal deaths or fewer per 100,000 live births.
- The U.S. has a shortage of maternity care providers, and a far lower supply of midwives than other high-income countries: The U.S. and Canada have the lowest overall supply of midwives and ob-gyns, with 12 and 15 providers per 1,000 live births, respectively. All other countries have a proportion two to six times greater. And in many of these countries, midwives, which are proven to improve birth outcomes, play a central role in maternity care provision. Unlike in the other countries surveyed, ob-gyns in the U.S. and Canada far outnumber midwives.
- More than half (52%) of maternal deaths in the U.S. occur after birth. The majority of postpartum deaths happen between one week after birth and up to one year after childbirth, a period also known as the “fourth trimester.”
- Access to home visits after childbirth is guaranteed to women in other countries, but not in the U.S. All countries, apart from the U.S., guarantee at least one visit by a midwife or nurse within one week of childbirth. Evidence suggests that home visits are associated with improved mental health and breastfeeding outcomes, as well as reduced health care costs.
- The U.S. is the only high-income country that does not guarantee paid maternity leave to mothers after childbirth. All countries in the study, apart from the U.S., mandate at least 14 weeks of paid leave from work, with most mandating more than six months.