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Shameful Outcomes

— Abortion is today's hot topic in women's health, but we're overlooking an equally important one

by David Nash, MD, MBA, FACP, Contributing Writer, MedPage Today

MedpageToday
A black and white portrait of a pregnant black woman holding her belly.
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    David Nash is the Founding Dean Emeritus and Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at the Jefferson College of Population Health. He is a board-certified internist. Follow

Once again, history repeats itself. From our "grass roots" to our legislatures and courts, the U.S. is caught up in a heated debate about women's access to abortion. Every American with a car radio, TV, or electronic device is made aware of the issue as it evolves.

But there is an equally important story that is largely overlooked -- alarmingly high national rates for maternal and infant mortality. In particular, the persistent rise in maternal mortality should be spurring public advocacy and urgent action from the healthcare community, professional organizations, and regulatory agencies.

In 2021, pregnancy and its complications

Since the 1990's, maternal mortality has been rising in the U.S. at a higher rate than other developed countries, and racial disparities are a major factor. An analysis looking at specific populations over the period between 2016 and 2020 found that maternal mortality was highest among Black mothers (52.0 deaths per 100,000) compared with Hispanic mothers (13.4 deaths per 100,000), American Indian/Alaska Native mothers (39.4 deaths per 100,000), and White mothers (20.1 per 100,000). Social determinants appeared to play a role as well, with maternal mortality among mothers with a high school education than college graduate mothers.

Disparities associated with the COVID pandemic were reflected in the maternal mortality rates for 2021. There were 69.9 deaths per 100,000 for non-Hispanic Black mothers in comparison with 26.6 deaths per 100,000 for the non-Hispanic white population.

Rising rates of severe maternal morbidity are an additional challenge, particularly among women of color and those with lower educational attainment. Severe maternal morbidity increased 5% nationally between 2018 and 2019; and, (126.1 complications per 10,000 hospital deliveries) compared with White mothers (66.2). Interestingly, the increase was : Nevada (29%), Pennsylvania (14%), Florida (11%), and Texas (9%).

What can we do and where do we start?

In many cases, opportunities for improvement are within the realm of possibility.

  • We can ensure that all women in the U.S. have free/affordable access to comprehensive reproductive healthcare (prenatal care, delivery and postpartum support) in addition to primary care services.
  • Insurance coverage can be assured for the nearly 8 million uninsured women of reproductive age. Every state should expand its Medicaid program to adequately support thousands of women (of reproductive age and disproportionately Black) who would otherwise be vulnerable to losing coverage 60 days postpartum.
  • The maternal healthcare workforce (including midwives) can be equitably compensated for providing a consistently high standard of care.
  • The Biden administration's proposed Medicaid extension to cover mothers for one year postpartum can be expedited. This would provide the care necessary to and complications, reduce racial and ethnic inequality, and -- importantly -- improve the health outcomes of the infants born in this country.

Shouldn't the world's wealthiest and most influential nation also have some of the best health outcomes for its mothers and infants?