The birth of a new royal baby is all the buzz: Prince Harry and Meghan, Duchess of Sussex welcomed a son this week who will now be seventh in line for the British throne. The story has once again piqued interest in maternal mortality rates, which have been rising in the U.S.
While the rate has “more than doubled” over 30 years, it’s important to keep in mind that this is easy to do. The rate has gone from about 9 in 100,000 women to 18 in 100,000 women. The chances of dying in childbirth, on average, are still lower than the chance of being killed in a car crash or even being struck by lightning.
Still, the trend is in the wrong direction. With medical advancements, we should expect maternal mortality to be going down, not up. There is one piece of maternal mortality stats in the U.S. that is particularly troubling: The disparity between white women and black women, with the latter group facing a chance three times higher of maternal death.
Meghan, an American, has a white father and a black mother. Some of the media reports have focused on comparing the maternal mortality rates of the U.K. and the U.S.,showing that overall, the U.K. has a lower rate. But the underreported reality is that the racial disparity is actually worse in the U.K., a country with nationalized healthcare. Black women are five times more likely than white women to die during or following childbirth there, compared to three times here.
If the push for government-run healthcare is focused on equality for everyone, why the greater racial disparity in the U.K., a country with one of the world’s most government-controlled systems? This is bound to be a disappointment to those who believe government-run healthcare would be a great equalizer.
To be fair, the rate at which black mothers die in the U.K. and the U.S. is about the same: 40 deaths in 100,000. The disparity actually lies in the lower rates for white women in the U.K. (8 in 100,000 compared with 12 in 100,000 in the U.S.).
Does this mean white women are better off in the U.K.? Well, as with any international comparison, we should also note that healthcare metrics may be measured differently and data may not be exactly consistent. Even within the U.S., we often rely on state-level death certificate data on maternal mortality, and states may measure this differently and possibly dramatically overstate the problem. For example, should a postpartum mom killed in a car crash count as maternal death? I think not, but some states include that in their maternal mortality statistics.
We must acknowledge that maternal mortality can be related to many factors, sometimes cultural factors outside of the scope of medical care, such as poverty. Women with poor housing and poor nutrition are at higher risk of maternal death, as well as myriad other bad outcomes. It also could very well be that American women more often carry risky pregnancies (for example, in mothers who abuse drugs, are obese, or are very young or old), which may contribute to our higher mortality rate.
As far as the racial gap, we should not discount the possibility that discrimination may play a role, both here and in other countries. Also, black patients have less trust in the medical system, at least in the U.S., and may be less likely to speak up if they fear they won’t be taken seriously. In fact, mortality rates are higher for black patients in a variety of situations, not just pregnancy and childbirth. Addressing these cultural issues will take time and effort from the medical community, and it is already a focus.
Even so, there are health policy changes we can make to reduce maternal mortality: Planned pregnancies are generally safer than unplanned pregnancies (likely due to the earlier prenatal care pursued by the former group). Making birth control available over the counter, as the Independent Women's Forum has suggested, would reduce the rate of unplanned pregnancies.
Perhaps most importantly, we can continue to focus on getting every woman access to the highest quality healthcare available. As the Centers for Disease Control and Prevention says in its website, a healthy pregnancy starts even before conception. Private insurance provides the best access to the largest networks of doctors with the shortest waiting times, so our focus should be on getting as many women of childbearing age (and other patients of course) into private insurance coverage, rather than Medicaid or no insurance.
As the nonpartisan Congressional Budget Office recently reported, moving to a "Medicare for all" or single-payer, government-funded healthcare system could expand coverage for preventive care and other benefits that may improve people’s health, but it also said that extending coverage to more Americans could produce longer wait times and reduced access to care.
One thing we can say looking across the pond is that socialized medicine certainly doesn’t reduce racial inequality in outcomes, as much as we might wish that were true.