It’s difficult to reconcile how the richest and most productive country on Earth, home to incredible physicians and scientists, has the highest maternal mortality rate among developed countries. Yet we do. It’s stunning to learn that Black women in the U.S. are three to four times more likely to die from pregnancy-related causes than their white counterparts. And yet they are.
Most tragic of all is that more than 80% of pregnancy-related deaths in the U.S. can be prevented. This situation is not only alarming, it’s intolerable, and that’s why the AMA is committed to addressing this growing crisis and improving maternal health outcomes through policy changes, creative partnerships, and sustained state and federal advocacy.
Numbers reflect crisis
Nationwide, there were about 22 maternal deaths recorded for every 100,000 live births in 2022, according to data compiled by the Centers for Disease Control and Prevention. Compare that with just 1.2 deaths per 100,000 births in Switzerland, or 3.5 deaths per 100,000 births in Germany, or 5.5 deaths per 100,000 births in the United Kingdom. But the figures for Black women in the U.S.—49.5 maternal deaths per 100,000 live births—are simply devastating.
While the factors driving the maternal health crisis are numerous and complex, research shows that social determinants of health play an outsized role. These are the social, environmental and economic factors—poverty, social isolation, discrimination, pollution and others—that create and sustain health inequities across generations. Social determinants of health contribute to maternal mortality and are underlying factors in why Black, Latinx and Indigenous communities confront disproportionately higher rates of diabetes, obesity, certain cancers, hypertension and other chronic ailments.
The AMA and our Center for Health Equity continue to work closely with our partners in the Federation of Medicine, including specialty societies and state medical associations, to make concrete policy recommendations that support state and federal efforts to reduce maternal mortality.
Access to care is essential
A research study conducted by the March of Dimes in 2022 found that more than 2.2 million women of childbearing age lived in maternity care “deserts,” defined as counties that lack hospitals or birth centers offering obstetric care, and that have no ob-gyns.
In the AMA’s home city of Chicago, the unequal distribution of maternal care across the South and West sides of the city—where most residents are Black—is directly correlated with higher maternal mortality rates, more preterm births and lower birth weights, as documented in a study (PDF) the AMA conducted with the Sinai Urban Health Institute and with support from the March of Dimes.
The closure of hospitals and maternity units in Black neighborhoods has exacerbated the problem in Chicago, just as it has in other under-resourced communities nationwide. The AMA believes greater support and funding for telehealth obstetrical services and remote patient monitoring to bridge in-person visits will improve outcomes and overcome maternity health deserts when provided as an option for earlier and more frequent prenatal and postpartum visits.
This is particularly true for Medicaid populations, which have traditionally faced greater obstacles in accessing care than other types of patients. The need is even greater when you consider that more than 40% of all U.S. births are financed by Medicaid, which is why the AMA strongly supports expanded Medicaid coverage of maternal health care services.
Other steps we can take
There are no easy answers to a problem this pervasive and complex. But the AMA and our partners in medicine recently outlined a number of steps that policymakers can take collectively to improve maternal health, such as expanding evidence-based programs for pregnant and postpartum people with substance abuse disorder, promoting telehealth and home monitoring during pregnancy and the postpartum period while addressing barriers to remote care provision, and providing the financial resources needed to implement the Alliance for Innovation on Maternal Health core patient safety bundles, among others.
We will not make meaningful gains in reducing maternal mortality without dealing directly with social determinants of health within the pregnant and postpartum populations. One strategy that has shown positive results involves expanding and strengthening medical-legal partnerships, which offer legal assistance to pregnant and postpartum individuals coping with housing issues, food insecurity, structural racism, a lack of insurance and related issues that all lead to poorer outcomes. The AMA continues its longstanding support for medical-legal partnerships such as the Georgetown University Perinatal LAW Project to promote maternal health and improve outcomes.
While pregnancy, childbirth and the postpartum period will always carry some degree of health risks, we must do everything within our power to reduce our nation’s unacceptably high rates of maternal mortality and severe maternal morbidity. Hospitals and health systems, payers, employers, physicians and other health professionals, philanthropic and community groups and medical researchers all have roles to play in resolving this crisis. The AMA is committed to helping mothers and their babies thrive throughout pregnancy, childbirth and the rest of their lives.
