A Troubling Trend: America’s Rising Maternal Mortality Rates

Written by Gouri Ajith and Edited by Myra Ali

Maternal mortality is widely considered to be an indicator of a country’s development. With improved awareness and health care, maternal mortality rates have recently dropped in most countries. However, the American maternal mortality rate is not only rising, but is also greater than that of any other high-income country, despite the United States spending the most money per capita on maternal care [1]. The reason preventable pregnancy complications are often so deadly for American women is apparent in the statistics of maternal mortality.

To analyze maternal mortality around the world, experts use a pregnancy-related mortality ratio to measure the number of pregnancy-related deaths per 100,000 live births; a pregnancy-related death refers to when the mother dies as a direct result of a pregnancy-related complication [2]. The U.S. maternal mortality rate increased from 7.2 per 100,000 births in 1987 to 18.5 per 100,000 births in 2013; this trend conflicts with many European, East Asian, and Latin American countries whose maternal mortality rates have fallen during the same period [3]. While the American mortality trend may be caused by an increasing amount of pre-existing conditions among expectant mothers, there are several other contributors: insufficient postnatal maternal monitoring, a lack of preparedness for pregnancy complications among healthcare providers, and an absence of objective review committees [4]. The nations with decreasing maternal mortality rates over recent years have taken steps to correct these issues. Meanwhile, American maternal care has remained constant over the years.

Two of the most common causes of maternal death in America—obstetric haemorrhage and preeclampsia—can be easily prevented if hospitals and health care providers make simple changes in maternal care practices. These conditions, characterized by heavy bleeding and very high blood pressure, respectively, are not fatal if their symptoms are recognized and treated early [1]. When the doctors and nurses on duty are either unprepared or unable to diagnose the patient, such treatable conditions can suddenly become life-threatening. For example, a mother can bleed to death within five minutes of childbirth if there are not enough pints of blood on hand. While this is nationally representative of America, states like California have made changes by implementing the California Maternal Quality Care Collaborative (CMQCC); this organization provides maternity clinicians with evidence-based toolkits that help manage labor abnormalities [5]. Furthermore, the CMQCC has established the California Pregnancy-Associated Mortality Review (CA-PAMR), which is a comprehensive review committee that identifies causative factors of maternal deaths and recommends corresponding improvements. These initiatives have helped to reduce California’s maternal mortality by 55 percent between 2006 and 2013, in sharp contrast to the national trend [5]. While programs such as the CMQCC have been successful in reducing maternal mortality, there must be improved awareness among health care providers, legislators, and the general public for systematic change to occur across America.

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