America is the most dangerous place to give birth in the developed world — it’s only getting worse
Earlier this month, the Texas Department of State Health Services missed the deadline to publish the 2019 data on maternal mortality rates in the state, announcing instead that this data will be made available only in mid-2023. What may seem like a piece of administrative incompetence could instead be an attempt to hide a damning state- and nationwide statistic from public view until after the 2022 midterms.
Maternal mortality rate (MMR) is defined as the number of mothers dying during childbirth or because of other pregnancy-related causes. Typically expressed in numbers of such deaths per 100,000 live births, MMR is a measure of country’s development and the ability of its citizens to access health care. Indirectly, it also measures gender equality — fathers do not die in childbirth, and a goal of an equitable society should be to eliminate this risk for mothers as well. Caring for expectant mothers costs money, and richer countries understandably have lower MMRs.
According to 2017 data, Norway and Italy recorded just two maternal deaths per 100,000 live births. Sweden and Spain had four, Japan five, France and Singapore eight. The U.S., in contrast, stood at 19 maternal deaths per 100,000 live births, on par with the poorest European country — Moldova, and faring a bit worse than Russia or Iran. America is the most dangerous place to give birth in the developed world.
It is getting worse. A report by the World Health Organization (WHO) found that all world regions experienced significant drops in the MMR between 2000 and 2017: the European rate went down by 53 percent, sub-Saharan Africa improved by 38 percent, Latin America by 23 percent and the global average decreased by 38 percent. The only region that saw a sharp rise is North America, whose maternal mortality increased by 52 percent. Don’t blame Canada — their MMR stayed roughly the same during the past two decades.
Breaking down the U.S. data by race or by state reveals even more abysmal numbers. For non-Hispanic Black women, maternal mortality rate is whopping 55 deaths per 100,000 live births — worse than in e.g. Jordan or Panama!
Louisiana, Indiana and Georgia all recorded more than 40 deaths per 100,000 live births between 2011 and 2015. The last time Texas reported its numbers, MMR stood at 34.5 deaths per 100,000 live births. These numbers are really, really bad. Texas is on par with Syria. Indiana is comparable to El Salvador. Louisiana is as bad as Kyrgyzstan. For a Black woman in Louisiana, chances of dying of pregnancy-related causes are the same as in Libya.
But it will get even worse: 13 states banned essentially all forms of abortion and 10 more are considering similar moves. Many of these states are already having the highest MMRs in the U.S., and they will get higher still.
Banning abortions does not eliminate them: it simply pushes them underground, where they will be unsafe, leading to further deaths.
Even the rare legal exceptions to anti-abortion statutes will have negative consequences on maternal mortality. While new laws still allow legal abortions when mother’s life is at risk, they simultaneously threaten providers with draconian punishments in all other cases. The fear of making such a costly mistake will make many health care providers understandably reluctant to intervene except in the most clear-cut cases. More deaths will ensue.
The Supreme Court’s recent reversal of Roe vs. Wade was a big political win for the religious right, aligning the U.S. (or at least half of it) with other highly religious countries where abortion is banned, such as Malta or Poland. But Malta and Poland follow the Christian logic in caring for their mothers, with some of the lowest MMRs in the world: The countries have just six and two deaths per 100,000 live births, respectively. Texas and other red states should perhaps do the same, rather than hide the data on maternal mortality.
Ognjen Miljanić is a professor at the University of Houston, where he teaches on sustainability, including sustainable development metrics like gender equity and maternal health. He is the author of “Introduction to Energy and Sustainability,” published by Wiley. Follow him on Twitter: @MiljanicGroup