The US falls behind other countries on maternal health

For the report, researchers analyzed health data from the Organisation for Economic Co-operation and Development for 14 high-income countries. They also used data from CDC's National Vital Statistics Systems, and the agency's Maternal Mortality Review Committees in 36 states.

In 2022, the United States had 22.3 maternal deaths for every 100,000 live births — significantly higher than most other high-income countries. Several countries, including Germany, Australia, and Japan had fewer than five maternal deaths per 100,000 live births.

In the United States, Black women had the worst maternal mortality rates, eclipsing all other groups at 49.5 deaths per 100,000 live births. In comparison, white women had 19 deaths per 100,000 live births, Hispanic women had 16.9 deaths, and Asian women had 13.2 deaths.

Around two-thirds (65%) of U.S. maternal deaths occur in the postpartum period, which ranges from one day to one year after giving birth. In the first week after giving birth, the most common contributors to maternal deaths are severe bleeding, high blood pressure, and infection. On the other hand, cardiomyopathy is the leading cause of late postpartum deaths (43-365 days).

Although most U.S. maternal deaths occur postpartum, 22% of deaths occur during the pregnancy itself, with stroke and heart conditions being the leading causes.

According to the report, the United States and Canada have the lowest number of midwives and ob/gyns at 16 and 13 providers per 1,000 live births, respectively. Currently, almost 7 million women in the United States live in counties without hospitals or birth centers providing obstetric care and no obstetric providers.

In many countries, midwives are key providers of reproductive healthcare. In addition, a recent study found that a midwife workforce, when integrated into healthcare delivery, could provide 80% of essential maternal care worldwide and potentially prevent 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths.

The United States also doesn't guarantee at least one home visit from a healthcare provider, such as a midwife or nurse, within one week postpartum like many other countries. Some countries, such as Switzerland and New Zealand, also offer several weeks of postpartum home visits. Although some state Medicaid programs and health insurers cover postpartum visits, this varies by state and the individual's health plan.

The United States also doesn't have a federally mandated paid leave policy. All other countries in the report mandate at least 14 weeks of paid leave from work, and several countries provide a year or more of parental or home care leave.

Currently, only around 25% of American workers have access to paid parental leave either through their employer or the state where they live. In the United States, white women and those with higher incomes are more likely to take paid leave than Black women.

More needs to be done to improve US maternal health

According to Laurie Zephyrin, SVP for advancing health equity at the Commonwealth Fund, the report's findings present a stark picture of U.S. healthcare.

To improve U.S. maternal health, Zephyrin called for an increased focus on community-led investments, including birth centers and healthcare teams that work with patients, in the weeks before and after delivery. She also said that health systems should have incentives and be held accountable for providing equitable quality of care, especially for communities of color.

"We want this to be the cultural norm. We want this to be federal policy. We want there to be a big change because we know that we can completely minimize the rate of maternal deaths in this country," said Munira Gunja, a senior researcher at the Commonwealth Fund and the report's lead author.

"We can't just think of reproductive health at the time of pregnancy because a lot happens after the baby is born," Gunja added. "If we're not supporting women during this crucial time period, we're never going to solve this problem."

Health experts have also expressed concerns about how new abortion restrictions have impacted broader healthcare services, especially obstetric care. In states with abortion restrictions, many clinics offering a variety of healthcare services, including reproductive healthcare, cancer screenings, and more, have closed. As a result, people living in these states have faced increased health disparities.

"We are setting ourselves up for an absolute reproductive health provider shortage, and contributing to that is this interference into the patient-provider relationship and the restrictions that are being placed on us," said Tamika Auguste, chair of the American College of Obstetricians and Gynecologists Foundation Board.

Advisory Board's maternal health and health equity resources

For more insights on maternal health and health equity, check out these Advisory Board resources:

Read our take on how to address the root causes of maternal health inequity. Similarly, this research outlines five steps to take to improve women's health and well-being.

Health plans are also making efforts to improve maternal health and reduce disparities. This research outlines health plans' top three maternal health priorities, including expanding reimbursement for midwives and doulas, increasing postpartum coverage, and implementing new technological tools.

Organizations interested in launching their own midwifery programs can also use this white paper, which outlines key tactics and explains how to overcome common implementation challenges. We also offer a cheat sheet on postpartum depression care.

For a broader look at maternal health in America, this Radio Advisory episode discusses key drivers of poor maternal health outcomes and explains why there needs to be a massive shift in how the healthcare industry thinks about maternal health going forward. (Gunja et al., Commonwealth Fund, 6/4; Malhi, Washington Post, 6/4;)