Robin A. Cohen and Michael E. Martinez, Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2013 (National Center for Health Statistics, June 2014). 7. 40. Privacy Policy. The global rate is 211 maternal deaths per 100,000 live births. The United States has the highest maternal and infant mortality rates among developed nations. Jesse S. Bushman, “The Role of Certified Nurse-Midwives and Certified Midwives in Ensuring Women’s Access to Skilled Maternity Care,” presentation, American College of Nurse-Midwives, Nov. 2015. 2018); Xenia Shih Bion, Efforts to Reduce Black Maternal Mortality Complicated by COVID-19 (California Health Care Foundation, Apr. The estimated national maternal mortality rate in the United States is about 17 per 100,000–but is about 43 per 100,000 live births for Black women. This is particularly the case when services are provided in nonhospital settings, like the home or a birthing center.18 And while the Affordable Care Act (ACA) requires that state Medicaid programs cover midwifery care, the supply of providers is often so low that beneficiaries are often unable to access these services. Midwifery care. Health Resources and Services Administration, The Maternal, Infant, and Early Childhood Home Visiting Program: Partnering with Parents to Help Children Succeed (HRSA, Apr. Kirstie Coxon et al., “The Impact of the Coronavirus (COVID-19) Pandemic on Maternity Care in Europe,” Midwifery 88 (Sept. 2020): 102779; and WHO Europe, “Coronavirus and Pregnancy — Preserving Maternal Health Across the European Region,” WHO, June 30, 2020. 19. The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. Vice President, Health Care Coverage and Access, The Commonwealth Fund, Senior Scientist, Tracking Health System Performance, The Commonwealth Fund, Senior Research Associate, International Program in Health Policy and Practice Innovations, The Commonwealth Fund, Senior Researcher, Health Care Coverage and Access, The Commonwealth Fund, Senior Program Associate for Fellowships and Research, International Program in Health Policy and Practice Innovations, The Commonwealth Fund, Vice President, Delivery System Reform, The Commonwealth Fund, , Senior Research Associate, International Program in Health Policy and Practice Innovations, Harkness Fellowships in Health Care Policy and Practice, Association of Health Care Journalists Fellowships, Commonwealth Fund Fellowships in Minority Health, The Impact of the Pregnancy Checkbox and Misclassification on Maternal Mortality Trends in the United States, 1999–2017, Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends from Measurement Issues, Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017, Global, Regional, and National Levels of Maternal Mortality, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015, Midwifery and Quality Care: Findings from a New Evidence-Informed Framework for Maternal and Newborn Care, Midwife-Led Continuity Models Versus Other Models of Care for Childbearing Women, The Role of Certified Nurse-Midwives and Certified Midwives in Ensuring Women’s Access to Skilled Maternity Care, A Precious Jewel — The Role of General Practice in the English NHS, Perennial Health Care Reform — The Long Dutch Quest for Cost Control and Quality Improvement. Data on paid maternity leave are from the OECD’s Family Database. 658 women died of maternal causes in the United States. For 2018, the maternal mortality rate is 17.4 per 100,000 live births in the United States. Maternal mortality rates are 7.7 times higher among women over 40 as opposed to those under 25. Maternal mortality ratio (national estimate, per 100,000 live births) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Prevalence of stunting, height for age, male (% of children under 5) 15. 17 percent of deaths occur on the day of delivery. The well-being of mothers and babies should be a top policy priority in all countries. We used the latest data from the Centers for Disease Control and Prevention’s (CDC) Pregnancy Mortality Surveillance System on the timing of maternal deaths in the U.S. 30. Among these are the state licensure laws, restrictive scope-of-practice laws, and rules requiring physician supervision of midwives.19, Postpartum care is intended to ensure the physical and emotional recovery of mothers and their babies.20 Home visits by a midwife or a nurse are associated with improved mental health and breastfeeding outcomes as well as reduced health care costs.21 All countries, apart from the U.S., guarantee at least one such visit within one week postpartum, although some U.S. states provide these for Medicaid beneficiaries (Exhibit 4).22 Home visits give providers an opportunity to address mental health concerns and allow them to assess social determinants of health, including needs for food, housing, financial security, and protection from domestic violence.23. 9. 33. WHO et al., Postnatal Care, 2015; and “ACOG Committee Opinion No. Maternal mortality in the United States is gaining increased attention as a patient safety concern. 2 (Feb. 2018): 216–25. Midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetrician-gynecologists, or ob-gyns (see box).9. The rate declined from 607.9 maternal deaths per 100,000 live births in 1915 to 12.7 in 2007 (1-3). ANCM, Ensuring Access, 2014; and Moore et al., Improving Maternal Health Access, 2020. While international data are available regarding timing of maternal and pregnancy-related deaths, findings for the U.S. did not correspond with the latest data from the CDC. (eds. Used in the U.S. only, this CDC measure is typically reported as a ratio per 100,000 births. In the first week postpartum, severe bleeding, high blood pressure, and infection are the most common contributors to maternal deaths, while cardiomyopathy is the leading cause of late deaths.6 Previous research indicates that U.S. women experience more late maternal deaths than women in other high-income countries.7. In 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries (Exhibit 1). Pregnancy-associated death: Death while pregnant or within one year of the end of the pregnancy, irrespective of cause. State or national public policy meetings require diverse stakeholders to discuss the existing issues and resolve them. However, maternal mortality in the United States has changed very little in the past 25 years (1, 3). The correction factor f… The proportion of these deaths varies across regions, Maternal Mortality Rate TheHealthSite - 10/14/2018 2:27:00 AM Annual rate of reduction (%) Under-5 mortality rate, 1970-1990. 34. And several countries provide more than a year of maternity leave (Exhibit 5). Commonwealth Fund International Health Policy Survey. CONCLUSIONS: Maternal mortality continues to be an issue in developed countries, such as the United States and Canada. 36. Maternity leave helps women manage the physiological and psychological demands of motherhood and helps ensure financial security for families.24 All countries included in this study, apart from the U.S., mandate at least 14 weeks of paid leave from work. 10 (Sept. 3, 2015): 885–89. Among these are helping to manage a normal pregnancy, assisting with childbirth, and providing care during the postpartum period. Martin Marshall, “A Precious Jewel — The Role of General Practice in the English NHS,” New England Journal of Medicine 372, no. This ranks last overall among industrialized countries. 20, 2020). 3 (Sept. 2016): 447–55; Building U.S. Capacity to Review and Prevent Maternal Deaths: Report from Nine Maternal Mortality Review Committees (Maternal Mortality Review Information Application and Review to Action, 2018); and Emily E. Petersen et al., “Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017,” Morbidity and Mortality Weekly Report 68, no. While they all capture some aspect of maternal deaths, they are not equivalent. For 2018, the maternal mortality rate is 17.4 per 100,000 live births in the United States. Affordable, quality health care. ), International Profiles of Health Care Systems 2020 (Commonwealth Fund, June 2020); and Stephen Morrissey et al., “International Health Care Systems,” New England Journal of Medicine 372, no. 5 (May 2018): e140–e150. 31. Additionally, the maternal mortality rate in the United States has risen 113% since 1990. 1.4. Maternal mortality rates vary by maternal characteristics, especially maternal age and race. This podcast discusses conditions known to challenge maternal safety, the high incidence of preventable harm in this population, and care bundles as an improvement strategy. 7. Renfrew et al., “Midwifery and Quality Care,” 2014. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … Maternal (mother) and neonatal (baby) outcomes, including lower maternal mortality and morbidity and reduced stillbirths and preterm births. This issue brief provides an overview of differences in maternal mortality, maternal care workforce composition, and access to postpartum care and social protections in the U.S. compared to 10 other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.2 We use the most recently available data from the Centers for Disease Control and Prevention (CDC), the Organisation for Economic Co-operation and Development (OECD), and earlier Commonwealth Fund studies.3. ... Maternal and infant mortality Customise. Trends and Characteristics of United States Out-of-Hospital Births 2004–2014: New Information on Risk Status and Access to Care, Making a Case to Reduce Legal Impediments to Midwifery Practice in the United States, Effects of Redesigned Community Postnatal Care on Women’s Health 4 Months After Birth: A Cluster Randomised Controlled Trial, A Randomized Trial of Single Home Nursing Visits vs. Office-Based Care After Nursery/Maternity Discharge: The Nurses for Infants Through Teaching and Assessment After the Nursery (NITTANY) Study, Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting, Extending Medicaid Coverage for Postpartum Moms, Maternity Leave and Related Types of Leave, Mapping Integration of Midwives Across the United States: Impact on Access, Equity, and Outcomes, COVID-19’s Impact on Pregnancy and Childbirth Policies, The Impact of the Coronavirus (COVID-19) Pandemic on Maternity Care in Europe, Coronavirus and Pregnancy — Preserving Maternal Health Across the European Region, ACOG Committee Opinion No. 10053 (Oct. 8, 2016): 1775–812. Lianne Zondag, Franka Cadee, and Myrte de Geus, Midwifery in the Netherlands, 2017 (Royal Dutch Organization of Midwives, Jan. 2017); and Dorothy Shaw et al., “Drivers of Maternity Care in High-Income Countries: Can Health Systems Support Woman-Centred Care?,” Lancet 388, no.10057 (Nov. 5, 2016): 2282–95. Data on maternal mortality ratios, supply of midwives, and supply of ob-gyns were extracted in August 2020. There is a striking disparity in maternal and infant mortality rates … See Bushman, “Role of Certified Nurse-Midwives,” 2015. 37. 2 (Jan. 2020): 1–18. All Rights Reserved. U.S. Has The Worst Rate of Maternal Deaths In The Developed World More American women are dying of pregnancy-related complications and that rate is rising. In the U.S., where maternal health outcomes are poor relative to many other parts of the world, policymakers and delivery system leaders can examine international models of maternity care to inform strategies for improvement. To better understand the high maternal death rate in the U.S., it is helpful to know when they happen. 22, 2020; and Taylor Platt, States Implement Strategies to Safeguard Pregnant Women during the COVID-19 Pandemic (National Academy for State Health Policy, Apr. 2 Increased rate of maternal mortality The maternal mortality rate in the United States has rapidly risen, and healthcare issues are hugely fundamental at the political level. Detailed Evaluation of Changes in Data Collection Methods, Centers for Disease Control and Prevention. 28, 2016): CD004667. Because of potential data comparability concerns, we omitted these findings from our formal analysis. More efficient use of health system resources, including lower use of unnecessary and potentially harmful interventions like C-sections for low-risk deliveries, epidurals, and instrument-assisted births. Monetary conversion rates. Jane Sandall et al., “Midwife-Led Continuity Models Versus Other Models of Care for Childbearing Women,” Cochrane Database System Review 4 (Apr. The maternal mortality ratio is used as a criterion for the quality of medical care in a country. 2 (June 2016): 116–24. Some young adults staying on a parent’s health plan have not had their maternity care costs covered, because the ACA only mandates maternity care coverage for primary beneficiaries, not for their children. 4 (July–Aug. 32. Trade in Value Added (December 2018) Health Status. See UCSF Health, “High Risk Pregnancy,” n.d. 14. 12 percent of all maternal deaths take place during the remaining portion of the year; these are also known as late maternal deaths. The data are estimated with a regression model using information on the proportion of maternal deaths among non-AIDS deaths in women ages 15-49, fertility, birth attendants, and GDP. Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017. The maternal mortality rate is two times lower in Canada than the United States, according to a global survey conducted by the United Nations and the World Bank. Countries also have rapidly reorganized their maternity care delivery systems during COVID-19 to expand use of telemedicine and the capacity to provide home births.28 To strengthen maternity care during the pandemic, the U.S. could look to countries with long-standing experience in home births and midwifery-led care. 18. CDC twenty four seven. In addition, the ACA’s 10 essential health benefits that insurers must cover, which include maternity care, apply only to individual marketplace insurance plans and small-group plans — but not employers with more than 50 workers. While the information collected by the OECD reflect the gold standard in international comparisons, it may mask differences in how countries collect their health data. Full details on how indicators were defined, as well as country-level differences in definitions, are available from the OECD. 21 percent of all maternal deaths are between one and six weeks postpartum. 29. 23. 2020); and Yaphet Getachew et al., Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States (Commonwealth Fund, Sept. 2020). Lauren M. Rossen et al., “The Impact of the Pregnancy Checkbox and Misclassification on Maternal Mortality Trends in the United States, 1999–2017,” Vital and Health Statistics, series 3, no. Pregnancy-related death: Death during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. 3. Saving Lives, Protecting People, U.S. Department of Health & Human Services. Gross domestic product (annual) Gross domestic product (quarterly) Composite Leading Indicators. Declercq and Zephyrin, Maternal Mortality: Primer, forthcoming. For everyone. The overall maternal mortality rate was 17.4 deaths per 100,000 live births. The authors wish to thank Dr. Jodie D. Katon, Dr. Eugene Declercq, and Reggie Williams II for their helpful review comments; and Jesse Baumgartner and Gabriella N. Aboulafia for their careful data review. 6. Universal, comprehensive maternity care coverage, along with exemptions from cost-sharing, also are the norm in other high-income countries.29 While the ACA strengthened maternity care coverage, access to benefits often depends on type of insurance and geographic location, and out-of-pocket costs vary significantly as well.30, Postpartum care. Maternal mortality ratio is the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births. Sarah A. Donovan, Paid Family Leave in the United States, Report R44835 (Congressional Research Service, updated May 29, 2019). (eds. Association of State and Territorial Health Officials, “COVID-19’s Impact on Pregnancy and Childbirth Policies,” ASTHO Experts Blog, Apr. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Sandhya Raman, “COVID-19 Amplifies Racial Disparities in Maternal Health,” Roll Call, May 14, 2020; Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (National Partnership for Women & Families, Apr. Around one-third of U.S. pregnancy-related deaths, counted up to one year postbirth, occur during pregnancy (Exhibit 2). 3 (Mar. 2017). 4. Though the nation's overall maternal mortality rate is high – the highest it's been in decades – some states' rates are far worse. For example, many types of non-ACA-compliant plans, such as short-term plans or association health plans as well as some student health plans, don’t cover maternity benefits. Morrissey et al., “International Health Care Systems,” 2015. Under-5 mortality rate, , 2000. In most other countries, however, midwives greatly outnumber ob-gyns. Declercq and Zephyrin, Maternal Mortality: Primer, forthcoming. Although most are preventable, maternal deaths have been increasing in the United States since 2000.1 As U.S. policymakers and health care delivery system leaders seek ways to reverse this trend, countries that have achieved lower maternal mortality rates may offer possible solutions. More than half of recorded maternal deaths occur after the day of birth. The American College of Nurse-Midwives estimates that approximately 60 percent of pregnancies are normal or low-risk. In most countries, maternity care is well integrated with other primary care, and midwives play an important role. Wide racial and ethnic gaps exist between non-Hispanic black (37.3 deaths per 100,000 live births), non-Hispanic white (14.9), and Hispanic (11.8) women. Wide racial and ethnic gaps exist between non-Hispanic black (37.3 deaths per 100,000 live births), non-Hispanic white (14.9), and Hispanic (11.8) women. The World Health Organization (WHO) recommends midwives as an evidence-based approach to reducing maternal mortality.10 Several systematic reviews have found that midwifery-led care for women with healthy pregnancies is comparable or preferable to physician-led care in terms of11: Some experts note that “high-income countries with the lowest intervention rates, best outcomes, and lowest costs have integrated midwifery-led care” into their health care systems. Donna L. Hoyert and Arialdi M. Miniño, “Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release,” National Vital Statistics Report 69, no. American College of Nurse-Midwives, Ensuring Access to High Value Providers: ACNM Survey of Marketplace Insurers Regarding Coverage of Midwifery Services (ANCM, Sept. 2014); Marian F. MacDorman and Eugene Declercq, “Trends and Characteristics of United States Out-of-Hospital Births 2004–2014: New Information on Risk Status and Access to Care,” Birth 43, no. 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