More mothers are dying in America. Why?

Throughout the developed world, the number of women dying in pregnancy or childbirth is going down.

The big drop happened in the 20th century, but even in the last 20 years, it’s continued to fall. Except, that is, in America.

A striking graphic in the Economist shows how, on average in developed countries, the rate has halved between 1990 and 2013 from 25 maternal deaths per 100,000 live births to 12. (In some countries, the rate is even lower: in Britain, there are six maternal deaths for every 100,000 live births.)

But in the US the reverse has happened. In the same 23 years the rate increased from 12 to 18.5.

Why? The Economist article posits various explanations: one is that the country has got better at counting the data, though it says that this can account for only a small part of the increase.

Another is that women are having their first child at an older age, which increases risk. But this also applies in other developed countries, where rates are falling.

It also considers that possibility that a rise in caesarean sections is to blame. Although caesareans are risky, again it seems unlikely that this accounts for such a dramatic rise.

The explanation favoured by the Economist is that American women are in poorer health when they become pregnant:

“Chronic health conditions, such as obesity, hypertension, diabetes and heart disease, are increasingly common among pregnant women, and they make delivery more dangerous.”

Shockingly, the maternal mortality rate among black women is roughly three times that of white women, because black women on average are more likely to suffer from these health conditions.

Chronic health conditions on their own don’t account for the difference between the US and other countries – British women also have problems of obesity, diabetes and so on but Britain has a much lower maternal mortality rate.

Perhaps the biggest problem still is the historic lack of universal healthcare.

“Medicaid already pays for almost half of all births in America, but millions of new mothers lost coverage 60 days after delivery, with the result that many entered their next pregnancy in bad shape,” the article says.

Obama’s Affordable Care Act may help to change things. But it’s scandalous that, in one of the richest countries in the world, pregnant and labouring women are still dying unnecessarily.

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