The United States continues to have the highest rate of women dying during pregnancy, childbirth, or postpartum among high-income countries, despite recent declines, according to a new report from the Commonwealth Fund.
The 2022 data shows that there were approximately 22 maternal deaths for every 100,000 live births in the U.S., more than double or triple the rates in most other high-income countries. Notably, Black women in the U.S. face even higher risks, with nearly 50 deaths per 100,000 live births.
In stark contrast, half of the high-income nations reported fewer than 5 maternal deaths per 100,000 live births, with Norway recording zero maternal deaths.
“The U.S. has a maternal care workforce shortage problem, which is only supposed to get worse,” said Munira Gunja, lead author of the report and senior researcher at the International Program in Health Policy and Practice Innovations at the Commonwealth Fund. “We have an under-supply of midwives, and midwives are underutilized, whereas in most other countries, midwives greatly outnumber ob-gyns.”
The report highlights significant disparities in access to maternal care in the U.S., noting that nearly 8 million women of reproductive age lack health insurance. Additionally, more than 2.2 million women live in maternity care deserts, areas with limited or no access to maternal health care.
Researchers analyzed maternal mortality data from 14 high-income countries, including Australia, Canada, France, Germany, Japan, and the UK. The U.S., Chile, and New Zealand had the highest maternal death rates, with Chile and New Zealand each recording about 14 deaths per 100,000 live births. Norway, Switzerland, and Sweden had the lowest rates, with zero, 1, and 3 deaths per 100,000 live births, respectively.
Despite a decrease from 32.9 maternal deaths per 100,000 live births in 2021 to 22.3 in 2022, the U.S. still stands out as an outlier. “It is encouraging to see fewer maternal deaths in the U.S. in 2022; however, the U.S. is still such an outlier, and the racial disparities are profoundly disturbing,” said Dr. Laurie Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund.
The report points to policy differences and the lack of a universal health system as major factors contributing to the high U.S. maternal mortality rate. Unlike other high-income nations, the U.S. does not guarantee paid maternity leave, and its healthcare system does not ensure comprehensive postpartum support.
“Maternal deaths are a preventable problem, and this problem can be solved,” Gunja emphasized. “A lot of countries have been able to figure out ways to make it so that all women are in safe hands when it comes to having a baby and after giving birth. We need to extend that to women in the U.S. as well.”
The report also underscores the need for enhanced maternal health equity. “Our findings suggest that an undersupply of maternity providers, especially midwives, and lack of access to comprehensive postpartum support are contributing factors,” the researchers wrote. “Because both these factors disproportionately affect women of color, centering equity in any future policy changes will be key to addressing the crisis.”
Dr. Tochi Iroku-Malize, board chair of the American Academy of Family Physicians, called for a greater focus on maternal health equity. “Maternal health care cannot stop after a patient gives birth,” she said, urging her colleagues to monitor postpartum patients closely for complications.
The report concludes that a multifaceted approach is needed to address the U.S. maternal mortality crisis, including expanding health insurance coverage, integrating midwifery care, and implementing federally mandated paid maternity leave.
“Timely diagnosis and treatment of complications are essential to ensuring the overall health and safety of our mothers and their children,” said Dr. Michelle Owens, an obstetrician-gynecologist in Jackson, Mississippi. “We need systems in place to facilitate escalation of care when needed so that each birthing person has access to the appropriate care in a timely manner.”
