Maternal Morbidity in The United States
Understanding the Crisis
The United States is grappling with an alarming rise in maternal morbidity, marking a serious public health issue. This increase is particularly concerning among non-Hispanic Black women, who face disproportionately higher rates of maternal mortality.
Key Challenges
A significant contributor to this crisis is the shortage of maternity care providers, especially midwives, and insufficient postpartum care. Additionally, systemic issues like limited healthcare access, chronic conditions, and racial disparities in healthcare are exacerbating the problem (Centers for Disease Control, n.d.)
Racial Disparities: Racial and ethnic disparities are stark in the context of maternal deaths. Non-Hispanic Black women face a maternal mortality rate 3.5 times higher than their non-Hispanic white counterparts. Leading causes of death among Black women include postpartum cardiomyopathy and blood pressure disorders like preeclampsia and eclampsia, with mortality rates significantly higher than for white women (National Institute of Health, n.d.). In addition late maternal deaths, occurring between six weeks and one year postpartum, are also disproportionately higher among Black women (National Institute if Health, n.d.)
Causes of the Increase in Maternal Morbidity: The rise in U.S. maternal mortality is multifaceted. Key factors include access to healthcare, underlying chronic conditions, structural racism, and implicit bias. Issues like uncontrolled hypertension or diabetes pre-pregnancy amplify risks during pregnancy. Additionally, the lack of interprofessional teams trained in best practices and the closure of maternity units in rural and urban areas contribute to poor maternal outcomes (American Medical Association, n.d.)
Maternal Care Deficits: The U.S. faces a significant undersupply of maternity care providers, especially midwives, and lacks comprehensive postpartum supports. In contrast to other countries where midwives outnumber obstetricians, the U.S. has an overrepresentation of obstetrician-gynecologists (ob-gyns) and a general shortage of maternity care providers. This shortage is exacerbated by uneven insurance coverage for midwife services, particularly in nonhospital settings. Moreover, postpartum care in the U.S. is often inadequate, with many women having only a single physician visit post-delivery, if any (Commonwealth, n.d.).
Actionable Solutions
Increasing Maternity Care Providers: Addressing the shortage of midwives and obstetricians is crucial. This involves reforming healthcare policies to facilitate training and recruitment, and adjusting state laws to improve access to midwifery services.
Enhancing Postpartum Care: The U.S. needs to adopt more comprehensive postpartum care guidelines, ensuring multiple health check-ups in the weeks following childbirth. Extending Medicaid coverage can provide more stable and long-term care.
Paid Maternity Leave: Implementing nationwide paid maternity leave policies can significantly improve health outcomes for mothers and children.
Addressing Racial Disparities: Tackling racial disparities requires a dedicated effort to eliminate structural racism and implicit bias in healthcare. Ensuring equitable healthcare access for all racial and ethnic groups is essential.
Improving Prenatal and Preconception Care: Early and effective care for managing chronic conditions like hypertension and diabetes is vital, especially before and during pregnancy.
Community Advocacy: Engaging in community-level interventions and advocating for policy changes can address social determinants affecting maternal health.
The Road Ahead
The rising trend of maternal morbidity in the U.S. is a call to action for healthcare providers, policymakers, and communities. By addressing these challenges through comprehensive approaches and systemic reforms, the U.S. can safeguard the health and wellbeing of mothers across the nation. This is not just a healthcare issue but a societal one, requiring collective efforts and sustained commitment.
References
American Medical Association. (n.d.). What’s behind the spike in U.S. maternal mortality. AMA. Retrieved from https://www.ama-assn.org/delivering-care/public-health/what-s-behind-spike-us-maternal-mortality
Commonwealth Fund. (n.d.). Maternal Mortality and Maternity Care in the US Compared to 10 Other Developed Countries. Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-other-countries
Centers for Disease Control and Prevention. (n.d.). Severe Maternal Morbidity in the United States | Pregnancy | Reproductive Health. CDC. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
National Institutes of Health. (n.d.). NIH-funded study highlights stark racial disparities in maternal deaths. NIH. Retrieved from https://www.nih.gov/news-events/news-releases/nih-funded-study-highlights-stark-racial-disparities-maternal-deaths