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Commonwealth Fund Maternal Health Study Unveils Dismal Conditions of the United States’ Maternal Health Landscape

Bintou Diarra | Editorial Lead | MS1: Alpert Medical School of Brown University | June 24, 2024

The United States is among the worst high-income nations to give birth. Not only is our maternal mortality rate higher than that of similarly-positioned nations despite advances in medical technology and healthcare access, but the burden is not evenly distributed. When compared to their white counterparts, Black birthing people are three to four times more likely to die of pregnancy and childbirth related complications, with this number representing the baseline. The Commonwealth Fund is among the organizations leading the effort to evaluate conditions of maternal health in the United States, and their recent study paints a glaring picture; when it comes to establishing conditions of optimal maternal health, the United States has a ways to go.

Among the significant findings is that the United States continues to have the highest maternal death rate, even with improvements from the COVID-19 spike. In 2022, there were 22 maternal deaths for every 100,000 live births, with Black women representing the majority. It’s important to note that this deviates from the norm. According to the study, this number sat at less than 5 for half the countries in the study, and the United States’ number is double, and in some cases, triple that of some of the countries centered in the study. Researchers attribute the disproportionate burden on Black women to longstanding inequities in care access, discrimination and clinician bias. 

Another important finding speaks to the significance of longitudinal care. According to the study, the majority of maternal deaths in the United States occur during the postpartum period, which they define as from one day after giving birth to a full year after childbirth. This calls for a solution that challenges deeply-entrenched frameworks of maternal care that center survival through childbirth alone. Making it through the event of childbirth does not ensure the livelihood of United States’ mothers and birthing people, and the systems underlying maternity care in the United States must shift to account for this.

In addition to maternal health outcomes, the Commonwealth Fund’s study includes an international analysis and evaluation of said systems. According to their findings, the United States and Canada are among the well-resourced countries without a midwifery-led maternity care system, despite a growing body of evidence of the benefits. In the brief, they cited a research study that found that the integration of a midwife workforce could provide 80% of essential maternity care services around the world, prevent 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths. The optimal conditions seen in a number of nations stand as proof—researchers assert that midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetricians.

The tenets of a midwifery-led care model is likely to improve outcomes, and we are currently lacking in our efforts to honor them. All of the countries centered in the analysis, apart from the United States, have a universal standard that guarantees at least one such home visit within one week postpartum. This is troubling, given the finding that the majority of maternal deaths occur during the postpartum period. In the United States, the postpartum period continues to stand as a woefully neglected one in other ways. Currently, there exists no universal policy that guarantees paid leave for postpartum mothers and birthing people, which undermines the ability of postpartum mothers to meet increasing demands.

The brief includes directives for the future, which are founded on the knowledge that Black and Indigenous mothers are particularly vulnerable. Much like the principles and inner workings of birth work, researchers emphasize the importance of centering equity above all in our efforts to improve the maternal health crisis. Regardless, an intensive, worthwhile solution is one that acknowledges the dimensions of the longstanding maternal health crisis at the root.

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