The latest issue brief from the Commonwealth Fund continues to shed light on the fact that the United States persistently has the highest rate of maternal deaths of any high-income nation and the stark inequities putting Black women at the greatest risk.
While maternal mortality rates improved slightly in the United States in 2022 amid the end of the COVID-19 pandemic, the country’s rates continue to “far exceed” those in other high-income nations, according to a new study from the Commonwealth Fund.
The report serves as a comparison of maternal mortality, maternal care workforce composition, and access to postpartum care and social protections between the U.S. and other high-income countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.
For the analysis, researchers used data from the 2023 health statistics from the Organisation for Economic Co-operation and Development, which tracks and reports on a wide range of health system measures across 38 high-income countries, and maternal mortality data from the Centers for Disease Control and Prevention’s National Vital Statistics Systems, 2022.
Here are the biggest takeaways:
- The U.S. continues to have the highest maternal death rate (22 maternal deaths for every 100,000 live births), a ratio that is more than double and sometimes triple that of any other high-income country included in the study.
- Maternal mortality is exceptionally high among Black women in the U.S. (49.5 deaths per 100,000 live births, which researchers attributed to a range of disparities in health care such as impacts of racism, stress, lack of health insurance, and bias in clinical decision-making.
- Two-thirds (65 percent) of maternal deaths in the U.S. occur during the postpartum period, from one day after giving birth to a full year later.
- The U.S. has a severe shortage of maternity care providers and an even lower supply of midwives than other high-income countries.
- The U.S. is the only high-income country where there is no federally mandated paid leave policy.
- Access to home visits after childbirth, which has shown to improve mental health and breastfeeding outcomes, is guaranteed to women in all countries included in the study except in the U.S.
“This study provides a bleak picture of how poorly the U.S. is performing when it comes to maternal mortality rates compared to other high-income countries,” said Munira Gunja, lead study author and Commonwealth Fund senior researcher, international health policy and practice innovations. “With 80 percent of Black maternal deaths in the U.S. deemed preventable, there is no doubt we are facing a critical public health crisis. It’s imperative we invest in evidence-based solutions that improve outcomes and save lives.”
The research team highlighted several contributing factors to the U.S. maternal mortality crisis: an undersupply of maternity providers, especially midwives—which the researchers explained are considered the backbone of the reproductive health system in other countries—as well as a lack of access to comprehensive postpartum support, including maternity care coverage and mandated paid maternity leave. Both factors, they noted, disproportionately impact women of color, which underscores the need for an equity-centered approach in all future policy changes.
“It is encouraging to see fewer maternal deaths in the U.S. in 2022; however, the U.S. is still such an outlier, and the racial disparities are profoundly disturbing. It is time to center equity by diversifying the workforce and addressing head-on the racial inequities in health care quality and access,” said Laurie Zephyrin, M.D., Commonwealth Fund senior vice president, advancing health equity. “Now is the time to prioritize what we know is already working well in other countries: expanded health insurance coverage, stronger workforce and support systems, and paid maternity leave.”