An American disgrace: For babies and mothers, lower quality care and more injuries and deaths than other affluent countries.

Too many women in this country suffer serious health harms or even die during pregnancy and just after. Too many infants in this country suffer serious health harms or die in the first year after they are born.

There is no getting around it: Maternal and infant “morbidity and mortality” are a disgrace of the U.S. health care system.

The unacceptable injury to and deaths of infants, statistically speaking, are not declining. The debilitation and death for moms, especially for those of color, already has become a public health crisis. And it is worsening.

It is hard to fathom how this nation has allowed the dismal treatment of women and infants to go on. The challenges of childbirth and early life, and the safeguarding of women and babies, are hardly new. The way to start reversing this national embarrassment is for more of us to know about it and to demand changes, so here are five key points to consider:

Long before the coronavirus pandemic began, journalists and health advocacy organizations raised alarms about the atrocious data on pregnant women and their increasingly awful care. That’s because hundreds of women in this country die each year — needlessly — due to maternity-related causes.

National Public Radio and Pro Publica, a Pulitzer Prize-winning investigative website, just a few years ago dug deep and found that the spiking U.S. maternal mortality and morbidity put this country in the same neighborhood as Afghanistan, Lesotho, and Swaziland. The reporters also found this:

“In the course of our reporting, another disturbing statistic [besides that of maternal mortality] emerged: For every American woman who dies from childbirth, 70 nearly die. That adds up to more than 50,000 women who suffer ‘severe maternal morbidity’ from childbirth each year, according to the Centers for Disease Control and Prevention. A patient safety group, the Alliance for Innovation on Maternal Health, came up with an even higher figure … around 80,000.”

The independent, nonprofit Commonwealth Fund and its analysts in April examined data from the Organisation for Economic Co-operation and Development (OECD), reporting these distressing maternal mortality rankings for this country versus those for its highly industrialized peer nations in Scandinavia,  Canada, Australia, Britain, Germany, and France:

“The U.S. has long had the highest rate of maternal mortality related to complications of pregnancy and childbirth. In 2020, there were 24 maternal deaths for every 100,000 live births in the U.S., more than three times the rate in the 10 other high-income countries studied. In Norway, no women died from maternal complications in 2019, the year with the latest available data.”

The CDC in September reported that it studied 1,000 maternity-related deaths that occurred in 2017-19 and were reported to state groups that examine such cases to understand their causes and recommend steps to avert them. The federal experts reached this major finding:

More than 80% of pregnancy-related deaths were preventable.

Dr. Allison Bryant, an obstetrician and the senior medical director for health equity at Massachusetts General Hospital, told USA Today this of the CDC findings:

“It’s significant. It’s staggering. It’s heartbreaking. It just means that we have so much work to do.”

As for this country’s infant mortality rate, it is not as grim as that of pregnant moms. But the numbers are appalling for the richest country in the world, which spends more on health care than any nation on the planet. Consider what America’s Health Rankings, a project of the United Health Foundation, reported in 2019:

“Over the past 50 years, improvements in the U.S. infant mortality rate have not kept pace with improvements in other OECD countries. Today, the average rate of infant mortality among OECD countries is 3.8 deaths per 1,000 live births. At 5.8 deaths per 1,000 live births, the United States ranks No. 33 out of 36 OECD countries.”
 

Commonwealth Fund chart (shown above) illustrates how the U.S. is an outlier among advanced OECD nations no matter the comparison for Hispanic, white, total, or black women.

There is plenty of information, and no mystery, about what harms the well-being of pregnant moms and infants.

ProPublica and NPR provided one summary of some major causes of maternal mortality and morbidity:

“Women develop pregnancy-induced high blood pressure known as pre-eclampsia, which can lead to a stroke and organ failure; parts of the placenta can be left behind, which can lead to infection; and a woman giving birth is more prone to blood clots that can be life-threatening … The treatment for these complications can become an ongoing financial burden, and the trauma suffered from physical complications can lead to persistent emotional and psychological pain.”

The journalists also found experts pointing to these issues:

“In the U.S., the rate of severe complications from childbirth has been rising faster than the rate of women who died. The rate of women nearly dying almost tripled between 1993 and 2014, according to the CDC. To help explain those dire statistics, experts point to risk factors that have increased in recent years: American women are giving birth at older ages and are more likely to have problematic conditions like obesity, high blood pressure, and diabetes.”

The nonprofit, congressionally chartered Wilson Center and its researchers offered these insights on pregnant moms’ health menaces:

“The three leading medical causes of preventable maternal mortality in the United States are blood clots in the lung, hypertension (high blood pressure), and blood loss. But why more women are dying because of them is unclear, according to a panel of experts.”

The most recent CDC analysis offered a list of too prevalent medical conditions that contribute to maternal mortality: excessive bleeding, cardiac and coronary conditions, infection, thrombotic embolism, cardiomyopathy (a disease of the heart muscle) and hypertensive disorders of pregnancy (relating to high blood pressure).

With infants, a tracker researched by the Peterson and Kaiser Family Foundation finds these leading medical causes for high mortality: congenital malformations, deformations, and chromosomal abnormalities; short gestation and low birth-weight disorders; sudden infant death syndrome; accidents; complications of placenta, cord, and membranes; and bacterial sepsis.

Maternal pregnancy complications are listed as a major cause of infant mortality, underscoring, of course, how inter-related are the health issues of moms and tots.

The CDC list also has a major cause of maternal mortality that emphasizes the broader complications in dealing with this health nightmare — the significant percentage of fatalities of pregnant women due to mental health conditions, including deaths to suicide and overdose-poisoning related to substance abuse.

The coronavirus pandemic made it glaringly clear: The U.S. health care system is rife with inequities, and these inflict grievous harms on expectant mothers and infants, especially for women and children of color, and especially for black women.

Here is what the independent, progressive Century Foundation reported in reaction to 2020 CDC data on maternal mortality:

“[T]he overall maternal mortality rate masks stark disparities by race and ethnicity … Black women bear the brunt of this horrific burden. Due to systemic racism and discrimination at the individual level, black women …  face unacceptable (and mostly preventable) risk during childbirth and throughout and after pregnancy. It must also be noted that Hispanic women saw the largest maternal mortality increase of any racial or ethnic demographic group in the study, rising by a staggering 44% in just one year.”

The Biden Administration has published its blueprint to battle the injuries to and deaths of women during pregnancy and just after, focusing on racial and economic injustice as a key and underlying issue and affecting not only black women but many others, too:

“Black women are more than three times as likely as white women to die from pregnancy-related causes, while American Indian/Alaska Native (AI/AN) are more than twice as likely. These disparities persist regardless of income, education, geography, and other socioeconomic factors. Systemic barriers and the failure to recognize, respect and listen to patients of color when they express concerns continues to contribute to unequal outcomes for black and AI/AN people in our health system. Considerable disparities have also been reported for rural women and for women with disabilities.”

The White House describes one of the confounding outrages of black maternal mortality, which the Kaiser Family Foundation has reported on:

“[R]acial disparities [in the death of those pregnant and black] persist across education levels. Among women with a college education or higher, black women have an over five times higher pregnancy-related mortality rate compared to white women. Notably, the pregnancy-related mortality rate for black women with a completed college education or higher is 1.6 times higher than the rate for white women with less than a high school diploma.”

U.S. society may celebrate black women celebrities. But many of them have spoken out about their own experiences with pregnancies that became problematic, the inattentive care they received, and their too-close brushes with maternal mortality or morbidity. The public reaction has been shock and dismay to such first-hand accounts by pop diva Beyonce, tennis hall-of-famer Serena Williams, six-time Olympic gold medal-winner Allyson Felix, and TV star Tatyana Ali.

Race and other social determinants of health also loom large in infant harms and deaths, as the Kaiser Family Foundation has reported:

“There are significant racial disparities in infant mortality rates in the United States. Non-Hispanic black mothers experience the highest infant mortality rate among all racial and ethnic groups … as well as the highest rates of preterm birth (delivery before 37 weeks of gestation) and low birth weight, both of which are leading causes of infant death. Mothers who are American Indian or Alaska Native and Native Hawaiian or other Pacific Islander also experience a higher-than-average infant mortality rate … The infant mortality rate among Hispanic mothers is similar to the national average … while rates among White and Asian mothers are lower than average …

“Researchers have long considered a variety of complex factors …to better understand racial disparities in infant mortality, including infant health; maternal demographics, health, and behavior; medical care before, during, and after birth; and home and social environments before and after birth. Studies consistently indicate that socioeconomic disadvantage is linked to higher risk of adverse birth outcomes both in the U.S. and other highly industrialized countries, with substantial variation in how socioeconomic factors impact birth outcomes for different racial and ethnic groups.

“However, studies also increasingly note that socioeconomic disadvantages alone may not fully account for why black mothers and their infants face such a disparity in adverse maternal and infant health outcomes in the U.S. … Researchers focusing on the substantial black-white infant mortality gap have generally found that controlling for maternal background factors also does not fully explain the disparity. Notably, recent research exploring U.S. maternal and infant health disparities discusses structural racism as a primary risk factor for African-American mothers and their infants, largely due to the complex stress it places on mothers throughout their life.”

What’s to be done to better safeguard infants and expectant moms? Experts say the responses must occur at all levels: national, state, local and individual.

Segregated hospitals, for example, bear some of the blame, with this concern hot in Washington, D.C., where maternal mortality rates are unacceptably high.

More study may be needed to assist black women. But experts have looked at state-by-state statistics and have examined the better outcomes in spots like California. Unlike many other parts of the nation, the Golden State has reduced risks for its mothers by committing public resources to provide prenatal care and assistance for moms, with follow-up after their children are born. Further, as the Washington Post reported, public health officials, doctors, and hospitals have zeroed in on “problems that arise during labor and delivery, using data collection to quickly identify deficiencies (such as failing to have the right supplies on hand or performing unnecessary Caesarean sections) and training nurses and doctors to overcome them.”

The Commonwealth Fund has offered a list of policy options to battle maternal mortality and morbidity problems, including a redoubled commitment to taking better care of women and expectant moms:

“In the U.S., which on a per capita basis has among the fewest maternal health providers overall and among the fewest midwives, most women see an obstetrician in a hospital. Top-performing health systems like those of Norway, the Netherlands, and Australia are better at preventing maternal deaths for several reasons, including the wide use of alternate models of care. In the U.S., expanding the maternal care workforce to include more nurses, midwives, and doulas could improve perinatal and postpartum outcomes, particularly for people experiencing significant inequities in birth outcomes.

“Greater investment in the U.S. primary health care workforce and an expansion of the medical home model to include women-centered primary health care could also have a significant impact on maternal health. One bill introduced in Congress, the Midwives for MOMS Act, aims to provide targeted grant funding for accredited midwifery education programs. Additional efforts to incentivize medical residents to work in rural or other underserved areas could increase the overall supply of maternal health providers.”

The Wilson Center has reported that its researchers and experts they interviewed have found that modern medicine — familiar as it may be with childbirth, dating into antiquity — can be slapdash in its formalized practices to protect infants and expectant moms. The center quoted Dr. Michael C. Lu, associate administrator of the U.S. Department of Health and Human Services’ Health Resources and Services Administration, reporting:

“Until recently in the United States, there were no standardized medical protocols to deal with maternal health emergencies, said Lu. California implemented its own protocol in 2008 which has resulted in a considerable reduction in maternal mortality below the national average. This model of best practices and standardized protocols ‘needs to be replicated nationally,’ he said. One way to introduce and standardize protocols in health facilities are ‘patient safety bundles’ – consistent guidelines, protocols, and best practices that can be replicated in many different settings, said Lu. The goal is to ensure consistent care in hospitals, clinics, and among private providers for conditions such as preeclampsia and obstetric hemorrhage, and to prevent unnecessary Cesarean sections.”

For doctors, the tragedy of infant and maternal mortality and morbidity should be, experts say, a “sentinel event” — a loud alarm of preventable injury and death that cannot be ignored.

Research shows that, sadly, doctors fail to listen to and heed what black women patients are telling them, as experts like Dr. Ana Langer, a pediatrics and neonatology specialist at the Harvard T. H. Chan School of Public Health, have warned:

“Basically, black women are undervalued,” she said. “They are not monitored as carefully as white women are. When they do present with symptoms, they are often dismissed.”

With the U.S. birth rate declining for seven of the last eight years, demographers have warned that our already graying nation faces serious challenges ahead in maintaining its global dominance with shrinking numbers of young people. So, why isn’t the country also doing everything it can to safeguard and support its infants and expectant moms?

That giant public policy question has been part and parcel of the furious political combat over health care for more than a decade. It has centered on the Affordable Care Act, aka Obamacare, and the pitched battles to provide health coverage to tens of millions of poor, working poor, and middle-class Americans.

The ACA, and recently the Biden Administration’s push to provide health benefits to the country during the throes of the miseries of the pandemic, also has led to expansion of public support for the care of infants and expectant mothers, notably via Medicaid programs for the poor.

Medicaid is a life-changing and lifesaving difference-maker for just under half of pregnant moms it covers in many states, paying for medical services that otherwise would be unavailable to those who may need them most.

But politicians have waged war on benefit programs for the needy. Progressives have laid out detailed, expansive plans for federal support for the poor and working poor, notably to improve the well-being of expectant moms and infants. Republicans have argued in almost theocratic fashion that the government, mostly, has no legitimate role in Americans’ health care.

A dozen states have declined to expand Medicaid coverage under the ACA, leaving giant geographic disparities in medical care — particularly in the South. As Democrats expanded Medicaid postpartum coverages, with clear and proven support for expectant moms and infants, new partisan wrangling has erupted over how much the nation should spend on such efforts and how long they should last.

Let’s also not forget that Democrats and the current administration briefly got Congress to approve an expanded child tax credit program, which, for poor families, meant many received U.S. checks with money they could spend on necessities like more and better food, as well as medical care. The program benefited 65 million children and boosted 3.7 million of them out of poverty, researchers say. This was one of the largest and most successful anti-poverty efforts in recent memory.

The program has expired. Its prospective resurrection is stuck in the politically riven Congress, notably because GOP opponents insist that it can return only if it contains work requirements for poor recipients, including already overwhelmed single mothers.