We like to think that medicine is moving toward eternal forward progress. As in, medicine is always advancing and getting better. We like to think that cancer rates are always falling, that heart disease numbers are always dropping, that diabetics are getting better care and Alzheimer’s patients are ever-closer to a cure. We like to think this.
According to Bradley University, between 2000 and 2015, the global maternal mortality rate plummeted 36.6%. That’s almost a third fewer mothers who died in childbirth, an amazing accomplishment. In the US? Not so much. We not only didn’t share in the enormous decrease, the United States saw a 16% leap in maternal mortality during the same period. That’s right, mothers are 16% more likely to die in childbirth in the United States today than they were in 2000. So much for onward and upward.
In 2000, we lost 12 women per 1,000 — an unacceptable number by the standards of any Westernized country, but on par with the United Kingdom. According to UNICEF, at the same time, Australia was seeing 9. So was Belgium, Denmark, and Canada. Croatia was experiencing 11 maternal deaths per 1,000; the Czech Republic 7. Finland had 5; Germany 8; and Iceland 5. So the United States was already considerably behind the curve when it came to maternal mortality.
Well, many of those countries improved, UNICEF shows. Iceland and Finland squelched maternal mortality to an unheard of 3 women per 1,000. Australia, Germany, and Denmark brought it to 6; Belgium and Canada to 7; Croatia to 8. The Czech Republic came down to a staggering 4. The UK brought their number down from 12 to 9.
But the United States? Our number bucked the trend and rose from 12 to 14 deaths per 1,000 births.
Part of reason? We have somewhat different causes of death, according to Bradley University. In most of the world, you’re more likely to die of hemorrhage, hypertensive disorders, sepsis, other direct causes, abortion, miscarriage, or ectopic pregnancy, or embolism. In the United States, our leading causes of maternal death include hemorrhage, cardiovascular and coronary conditions, cardiomyopathy, infection, embolism, mental health conditions, and preeclampsia/eclampsia.
These numbers actually tell similar stories, but in different ways. Women in the U.S. die of hemorrhage at a lower rate than other women around the globe; however, other women are more likely to die of “hypertensive disorders,” of which preeclampsia is one. Rates of infection/sepsis are nearly the same. And more US women die of embolism.
So while we have some unique causes, we also have some similar ones, and can’t hide behind a list of different issues.
Keep in mind, and understand it in your gut: every one of these numbers is a woman. Every one of these numbers is a woman, with a child, with a family, likely with a partner, who may or may not leave behind orphaned children, including the one she died bearing. Every one of these women has a story, a terrible one of blood splattered through a birthing room, of tears and lamentations, of a house left empty, of maternity clothes and hopes left behind. We study medicine not so we can analyze the statistics, but we analyze the statistics so we can understand how to help the one particular woman, in one particular room, with one particular big belly, straining to give birth.
If we want to fix this problem, Bradley University recommends, all women in the U.S. need access to care — something, shockingly, they often don’t have. Countries with socialized healthcare, which include all the countries cited above as making strides in maternal mortality, assure every woman comprehensive access to pregnancy care regardless of ability to pay or insurance status.
Second, women need access to information about pregnancy and pregnancy-related diseases — including teenagers. That way, when they start to swell up and get headaches, they know to go to the doctor and make sure their symptoms are taken seriously. We also need to lower our number of C-sections; states with a higher C-section rate had a 21% higher maternal mortality rate.
Pregnant women need complete health work-ups too since many causes of death in the U.S. are caused by pre-existing conditions. Doctors have to use good hygiene and closely monitor patients for signs of infection, or sepsis. We need to prevent severe bleeding, monitor for preemclampsia, and make sure healthcare providers are up-to date in best practices.
Only then can we hope to drop our 14 deaths per thousand down to something even near acceptable — both in the global community, and in our hospitals, our birthing units. With our friends. And perhaps even in our families.