The figures come from a World Bank
study. What is even worse is that while mortality rates in other industrialised nations are in decline, the rates in the U.S.
actually increased by 30 per cent in the first decade of the 21st century.
These results cannot be explained by the fact that the U.S. does not spend enough on health care and particularly maternal care. A 2013 report
by Truven Health Analytics claims that the U.S. actually spends more on maternal health care than any other country! There is no simple explanation as to why the U.S. has such a dismal result for such high expenditures.
One factor is the fact that women in the U.S. are having children when they are older increasing the risks in childbirth. Another factor is the rise of obesity among those who are pregnant increasing the likelihood of complications.
Another important factor is that many pregnant women do not have insurance. While these women are eligible for Medicaid according to the American Congress of Obstetricians and Gynecologists they do not receive as many prenatal services and are likely to have more health problems when they become pregnant and so are more likely to have problems during the pregnancy.
Minority women are often without insurance. In 2012, 23 percent of African-American women lacked insurance and even more 36 percent of Hispanic women lacked insurance.
The New York Women's Foundation
in 2013 found that black women in New York city had a maternal mortality rate of 79 per 100,000 live births compared with 10 for white women. The rate for black women in New York is worse than it was for women in Iraq or Syria in 2010.
A study by Amnesty International
in 2011 in a report called Deadly Delivery found that pregnant women in low income areas had twice the chance of maternal death as those in high income areas. Black women were four times as likely as white to die in childbirth.
Even white American women who are more likely to have insurance and positive birth results have worse expectations than their counterparts in 24 other industrialized nations. One reason for this is that in almost every other advanced industrial country has comprehensive maternal maternal health care that is either free or inexpensive. In the UK midwives visit mothers at home. In the Netherlands over 16 percent of births are at home by midwives and covered by insurance. In France women stay a week in the hospital and during that time receive training in care of the baby.
In contrast in the U.S. insurance will usually cover only what is considered medically necessary. Women are usually discharged a day or so after birth with a check up six weeks after the birth. The expansion of health insurance coverage by Obamacare will at least guarantee that more women will be insured before pregnancy but there are other problems with the Act and it does not address many other factors.
In the U.S. most women give birth in hospitals under the care of very expensive health care professionals such as doctors. In many countries births are attended by midwives often at home. This is far less expensive than using doctors and many women prefer giving birth at home. In the U.S. only less than 8 percent of births are assisted by midwives.
The U.S. also has very high rates of Cesarean sections more than 30 per cent. This is more than twice the rate suggested by the World Health Organization. Having these operations when they are not necessary increases rather than reduces risks. Eugene Declercq
, a professor of maternal and child health at Boston University said:
"In the United States, if you define all births as 'potentially dangerous', then you would make the argument that you need a specialist for every birth. That perspective has persisted, and, given that, we've got a problem,”
Improving maternal care in the U.S. will involve much more than increased spending. Better care can be provided at lower costs simply by recognizing that child birth is more than just a medical process that needs very expensive technical expertise. In many cases much lower cost alternatives can provide more care and more effective and humane care as has been shown by the example in the many industrialized countries that have universal health care systems.