Over the past two decades, every wealthy nation saw significant drops in maternal mortality—except for the United States. As maternal mortality dropped in European nations, it nearly doubled in the United States. In 2015, 25 women per 100,000 died giving birth in the U.S. In Finland, Greece, and several other countries, the rate is 3 per 100,000.
Despite these stunning numbers, maternal mortality has received very little attention until recently. For two decades, American women have died of mostly preventable causes as public health agencies, the media, and health institutions sat passively by.
As states such as Georgia, Texas, and Missouri have moved to enact restrictive abortion laws, maternal mortality has taken center stage. We know that if abortion is limited or banned, more women will die in a country that is already letting women die at alarming rates. Yet much of the discussion of maternal mortality is informed by stereotypes, myth, and conjecture. That’s due in large part to the fact that, until recently, most states didn’t even bother to track maternal mortality. Thanks to the hard work of scientists, healthcare providers, and researchers across the country, we now know a lot about maternal mortality. We also know how to prevent it—yet most states continue to do nothing.
Here are the key facts you need to know about this crisis.
Maternal Mortality is Preventable
Discussions of maternal mortality often frame it as a preventable tragedy. The data makes it very clear that, in a wealthy nation with access to basic medical care, there is no reason for a person to die giving birth. In most European nations, maternal mortality is virtually unheard of. The U.S. maternal mortality rate is eight times as high as the rate in Finland. In Georgia, where maternal mortality is higher than in many war-ravaged countries, the maternal rate is more than 15 times higher than European nations.
The women in the U.S. are not different types of humans from those in other countries. Differences between women do not account for these deaths. Instead, research consistently shows that most deaths would be prevented with appropriate medical care. One conservative estimate found that 63% of maternal deaths are preventable, but other figures put it much higher, particularly when women get appropriate prenatal and postpartum care.
Low-Quality Healthcare is a Primary Culprit
Media coverage often blames women for their own deaths, citing factors such as obesity, smoking, or not accessing prenatal care. The data does not support this claim. Victim-blaming is a distraction from the real issue, which is that healthcare for most pregnant people is terrible. Data from the Maternal Mortality Review Committee suggests that at least 57% of maternal deaths are due to provider and institutional factors. This may actually underestimate the role of healthcare systems in the crisis. Some analysts have criticized these committees for being too eager to blame women or too quick to issue recommendations that imply women cause their own deaths.
Nationwide, black women are four times more likely to die from pregnancy than white women. Some stories dismiss these deaths as attributable to lifestyle or socioeconomic factors. Yet many women who have died have been highly educated, young, and healthy. One woman who died, Shalon Irving, was even an expert in maternal health working to end maternal mortality.
Racism, not race, is killing black women. An avalanche of research has shown that doctors provide lower quality care to black patients. A 2012 study found a correlation between experiences of racism and birth outcomes. Twenty-one percent of black women giving birth say they were exposed to racist language or behavior during the birth. Research also shows that doctors believe inaccurate racist stereotypes about black patients, such as that they feel less pain.
Most Maternal Deaths Happen After Birth
In the popular imagination, maternal deaths are a tragic occurrence during or immediately after childbirth. The reality is that the majority of deaths—about 60%—occur in the postpartum period. While most pregnant people see a doctor or midwife at least weekly during the last weeks of pregnancy, this changes after the baby is born. Most doctors recommend a follow-up at six weeks postpartum, which leaves patients with no medical care during the highest risk time. This sends a clear message: once the baby is out, we no longer care what happens to the person who gestated and birthed the baby.
Midwives Could Help End the Crisis
A turf war between doctors and midwives is driving maternal death statistics higher. Citing fears of giving birth in the hospital, some women are now giving birth at home. For low-risk women, this may actually be safer. Yet many states refuse to license or credential homebirth midwives, even though that research consistently shows that homebirth is safer when midwives are licensed. Moreover, some doctors refuse to partner with midwives. This means that homebirth midwives who need to transfer to the hospital may experience care delays.
Midwives can also attend hospital births. Midwife-attended births have lower rates of complications, require fewer interventions, and ensure that a birthing person gets consistent care. A recent ProPublica investigation found that a greater role for midwives could lower maternal mortality.
Simple Hospital Improvements Could Save Lives
Some hospitals have successfully enacted measures to reduce maternal mortality. In California, the use of hemorrhage carts is saving lives. Hospitals that work to reduce their c-section rate also have lower maternal mortality rates. Unnecessary c-sections increase the risk of death during or after birth. C-sections also increase the risk of life-threatening complications, such as placenta accreta, in subsequent pregnancies.
Domestic Violence is a Common Pregnancy Occurrence
While discussions of maternal mortality often focus on childbirth, there’s another important culprit: violence against women. Homicide is the second-leading cause of death among pregnant women. At least 6% of pregnant women are abused by their partners, and some estimates put the figure much higher.
Providers Aren’t Listening to Women
Women must give birth in a healthcare system that routinely ignores the voices of people giving birth. Twenty-eight percent of women who give birth in hospitals say they experienced some form of abuse during the birth. Two percent report physical or sexual abuse by healthcare providers, and 12% say their healthcare providers refused to give them treatment or help they asked for. Ninety percent of people giving birth receive at least one medically unnecessary intervention that increases the risk of birth. Twelve percent did not consent to these interventions.
When ignoring the needs of women becomes the norm, so too does refusing to tend to their urgent medical needs. No wonder so many stories of women who die during childbirth feature doctors who refused to listen. Kira Johnson slowly bled to death after a c-section. As she begged for help, healthcare providers told her she wasn’t a priority.
A Profit Motive Drives Up C-section Rates, Kills Women
Any analysis of maternal deaths needs to look at the extraordinarily high c-section rate. About a third of women give birth via surgery, though in some hospitals the rate is as high as 50 or even 60%. Differences in pregnancy risk or health do not explain this disparity. Instead, research consistently finds that certain hospitals are simply more likely to cut women. No doctor is going to recommend a c-section and then admit that the c-section is medically unnecessary. Yet many c-sections are indeed unnecessary. This puts women in the terrible position of having to question their doctors at a time when their life and the life of a baby may hang in the balance.
So what’s behind the high c-section rate? Doctors commonly claim it’s fears of malpractice litigation, while hospitals insist that something special or unique about their patient population demands an extraordinarily high c-section rate. The research tells us money is key. When doctors have a profit motive to perform c-sections, they’re more likely to do so. One analysis found much higher c-section rates at for-profit hospitals—9 percent at a nonprofit hospital, as compared to 47 percent at a for-profit facility.
Abortion Bans Will Kill Women
Some states have maternal mortality rates that make our shameful national rate look good. It is safer to give birth in Vietnam, Ecuador, Iraq, and 100 other nations than it is to give birth in Georgia. And yet, like many states with high maternal mortality rate, Georgia’s response to this crisis has been to attempt to ban abortion. We don’t need to speculate about what will happen. Abortion clinics in Georgia and across the nation allow women and their doctors to decide what risk they are wiling to undertake. They save lives. Abortion bans kill women.
Women will do whatever it takes to control their bodies. The high worldwide death rate from unsafe abortions is sad testimony to this fact. Illegal abortions are a key driver of maternal mortality across the globe. And now, Republican lawmakers are keen to drive maternal mortality even higher by forcing American women to return to back alley abortions—all under the guise of concern for life.