It’s Spring 2021. We’ve been at this pandemic thing for well over a year and there are finally signs of hope in the US. Mask mandates are easing and hospital ICUs are seeing a fraction of the occupancy rates that they did last year. We’re all anxious about getting back to “normal.” But that, of course, means revisiting the many unresolved problems that we faced pre-pandemic. In this case, the state of maternal health.
For decades, the US has seen a steady decline among developed nations when it comes to maternal mortality. For a country where some healthcare facilities and services are unparalleled, the solution to this national crisis remains elusive largely due to a lack of a national policy on maternal health.
A Bleak Landscape
In January of 2020, the CDC released the first national data on maternal mortality in over a decade from the National Center for Health Statistics.
The numbers weren’t good.
After making adjustments in recording methods and implementing new systems to capture more accurate data from hospitals the report stated that in the US:
17.4 maternal deaths occur per 100,000 live births.
Approx. 700 mothers die per year in pregnancy, birth, or postpartum.
The number of deaths increased from the previous decade’s 12.7 deaths per 100,000.
Black, Indigenous, and LatinX mothers die at a rate of almost three times that of white mothers.
Prior to the new release of data, hospitals were not uniformly collecting data on maternal mortality. It was optional to record such data but has since come under better regulation. To emphasize, we are 20 years into the 21st century and have only recently begun accurately recording maternal mortality.
Yet even those numbers may not be an accurate reflection. Maternal death, according to the CDC, is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy.” Yet, according to a Pew Trust Report, almost a quarter of maternal deaths occur between 6-week and 1 year postpartum. So it can be assumed the number of actual maternal deaths skews conservative.
Unsurprisingly, maternal mortality statistics did not improve during Covid.
Global maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. It’s estimated that there was a ⅓ increase in maternal deaths during the past year, according to a study from The Lancet from March 2021. It goes on to say that “there is an urgent need to prioritize safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises.”
Ample research shows that the majority of these deaths are preventable and often correlate to a lack of access to nutrition, insurance, doctors, and pre/postnatal education. And the disparity between BIPOC and white maternal deaths is a vital area where resources need to be allocated.
Trust Science
This year gave us the famous slogan. As so many tried to dispel medical and political misinformation, a certain portion of the educated public joined in the chorus to #TrustScience. So what happens when the science is there but the policy lags far behind?
Many pregnant and new mothers in the US work right up to their due dates, sometimes having little to no workplace protections, and return to work in as few as two weeks postpartum. They receive little (if any) postpartum care, and are responsible for making arrangements to travel to postnatal pediatric and OB-GYN appointments. This alone may be a barrier to care. Lifting heavy baby carriers and strollers into cars and onto public transportation, while still healing from c sections, vaginal tears, and uterine bleeding (a conservative list) takes a toll on mothers who should be afforded time to heal at home.
In contrast, new mothers in The Netherlands, Sweden, and France receive home visits from nurses prior to, and after, birth for several weeks. Mothers may choose to stop working, sometimes, months before their due date depending on the specifications of their plans. Many new mothers in these countries still carry private insurance but a foundation of support remains in place. These countries see better retention rates in the workplace as well as higher birth rates and parental satisfaction.
One of the benefits of studies is that they give rise to better policy. The studies confirm (or refute) practices so that institutions and governments may improve health outcomes. National and hospital policies do not uniformly support practices despite having sufficient science to back them up.
When Will The US Do Right By Mothers?
Currently, the Biden administration is proposing legislation to support families with up to $4,000 a month in paid leave for up to twelve weeks. The administration seeks to provide direct support to families to ensure that low- and middle-income families spend no more than seven percent of their income on child care.
Currently, nine states (California, Colorado, Connecticut, Massachusetts, New Jersey, New York, Oregon, Washington, Rhode Island, and the District of Columbia) have sponsored maternity leave. A huge step forward yet many are still tethered to a minimum duration with an employer.
Legislation has also been introduced to extend Medicaid to postpartum mothers for up to one year. This could have a huge impact on the maternal mortality rate since mothers could rely on continuous care during this tenuous time. In the short term, The American Families Rescue Act was signed into law on March 11, 2021, and provides Medicaid coverage to mothers for 60 days postpartum. However, this is an optional pathway for states to adopt and does not go into effect until 2022.
A country that does not afford mothers the appropriate amount of time, financial support, medical care, emotional care, nutritional counseling, lactation support, or physical therapy in the prenatal and postpartum time will see no other outcome than the one we face today. There is a solution to this crisis but will politicians finally act on behalf of mothers and families to make meaningful change?