Why are USA maternal health numbers so poor for an industrialized country?

Maternal Mortality

I went to Northampton, MA for New Year’s Eve and the general period of days around it. The people we were staying with are good friends of ours, and the female in that dynamic (my wife’s college roommate, in fact) is a midwife up there in the glorious Pioneer Valley. I’ll be completely honest at this moment: I’m not a woman (at least not physically), I’ve never given birth (at least not that I’m aware of), I probably spoke to my mother about anything involving her vagina approximately zero times (maybe a negative number, if that would be possible), and I’ve never even been remotely near a delivery room or even a wing of a hospital where children were entering the world (if I have, it was because I was looking for Cheetos). I know absolutely nothing about this topic, to the point that we were discussing C-Sections on 12/29 — because that’s what normal, fully-functioning 30-somethings of this world do over the holidays — and I remarked, “So that’s surgical, right? Like a surgical procedure?” My friend nodded and I said, “So what is it? Like they just rip the vagina open or something?” I’m a buffoon.

We did talk a little about maternal health numbers, and where the U.S. stands is a bit troubling, so … I decided to write a post on it. Here goes nothing. 

Back in May 2014, The Huffington Post ran an article called “The U.S. Is The Only Developed Nation With A Rising Maternal Mortality Rate.” Seems drastic and harsh, but The Huffington Post also needs a lot of clicks to draw advertisers and make money, so it’s possible this is a link-bait situation. Maybe we need to unpack it for a second.

Here’s a chart that went with that post:

Maternal Mortality, 1990-2013

Basically, measurements around maternal health tend to be done off “mortality rate per 100K live births.” We, as the United States, went from 12.4/100K to 18.5/100K from 1990 to 2013.

Amnesty USA has slightly different data, but they also agree the rate is rising.

Because human beings — and especially Americans — love to compare themselves to other countries, here’s another link-bait type headline from May of 2014 as well: herein, Salon says that the U.S. fell to No. 31 globally on maternal health; that’s roughly around Iran or Romania in terms of rankings.

That Salon data comes from “The Mothers’ Index,” which is published by Save The Children and includes data from 178 countries — 46 developed and 132 developing. PBS breaks this down a little bit better, including this handy chart — which should make you want to have a child in Scandinavia:

Where To Have A Child

The whole idea that the U.S. is “the only developed country to see a rise in maternal mortality” comes from a different study, detailed here; Greece is also among the countries that rose in maternal mortality, and I think most people would consider Greece “first-world,” even if they’re a bit of a mess and may exit the EU.

Bottom line, though: the U.S. basically spends more on health care than any major country in the world, and a large percentage of that spending does come back to issues around maternal health and pregnancy and delivering children. So if we all grew up with the mentality that throwing money at a problem will solve it (Oh Beautiful, For Spacious Skies…), why is the rate rising in the United States?

Seems there are a couple of reasons:

Women Having Children Later: In 1970, the average age to have your first child in the U.S. was close to 21. By 2008, it was 25.1. It’s a deeply anxious issue for women, for sure, but stuff like The Atlantic running a cover on how most data around declining fertility isn’t even that accurate has helped. My aunt had her final kid at 40. I know women who have kids at 42. I’m not saying that’s the best play, but I am saying that there’s something to be said for this notion overall. As recently as 60-70 years ago (a drop in the bucket historically), women essentially had no choice about when they could reproduce. Now they do. Let’s stretch that 25.1 average out a little further. That said, older first pregnancies can lead to more medical concerns, including previously-established hypertension, diabetes, etc.

Access To Care: Uninsured pregnant women appear to be eligible for Medicaid, although they tend to receive fewer prenatal care services.

C-Section Rates: Apparently C-Sections are not simply “tearing the vagina open,” but involve far more surgical finesse. The rate in the U.S. is fairly high — close to 1 in 3 births are done this way — although some believe that number is slowly declining. A C-Section, though, is a surgery. Any time a surgery is involved, complications can result.

Mistakes Made In Hospitals: Look at the three examples at the top of this paper. They all seem preventable, no? The title of that paper — also a little click bait — is “Maternal Death in the United States: A Problem Solved Or A Problem Ignored?” Indeed. It does seem a little bit like the latter, having read all this.

There’s some personal relevance in all this for me — I’d like to have a kid in the next year or so. At that point I’ll probably need to know more about it, but using this blog as a start has been helpful. It kind of seems like this trend mirrors a concern with the U.S. as a whole — because we’re a great nation with freedom and money and resources and all that, we tend to use those concepts to gloss over the stuff that we’re really effing up. There’s no way a country with as much capital as the U.S., who spends as much money on childbirth as the U.S. does … there’s no way that same country ranks around the same spot as Iran.

That said, Scandinavia just gets it — so all those countries ranking high doesn’t surprise me.


Ted Bauer


  1. First of all, Ted, I love you. You are like Neil Degrasse Tyson without focus.
    Second of all, nice work here! I think it’s an awesome summary and definitely shows personal progress on your understanding of how human babies exit the body.
    The C-section thing is the biggie, really. No one is saying we need no Cesareans. The WHO has some pretty strong research on countries with overuse and underuse of Cesarean and has found that the sweet spot (lowest rates of morbidity and mortality for mom and baby) are around 10-15%. The problem is deciding which 10-15% to cut. Every Cesarean I’ve ever called has felt pretty damn necessary, and I think most physicians would agree. The problem is what we do beforehand that makes that Cesarean necessary, and that’s where policy comes in. (Too many inductions, which lead to higher rates of Cesarean, too little recognition that vaginal birth after Cesarean is a safe option, too little patience for protracted labor and long pushing phases.) Anyway, it’s interesting stuff. The work I and other midwives do feels like a drop in the bucket most of the time, but it all adds up.
    In short, I appreciate this post. I predict you will go deep on this shit when your wifey is preggers. Prove me wrong.

Reply If You'd Like