The U.S. maternal mortality rate is shockingly high—can improved midwife accessibility help?

The maternal mortality rate in the U.S. is bleak, and frankly, unacceptable, especially among Black women, who face increased risk of death due to medical racism. A new report is shedding light on just how bleak the statistics are, and why U.S. women are dying in pregnancy, childbirth, or postpartum at much higher rates than women elsewhere. And yeah, it might make you want to scream into the abyss in anger.

According to a report released by the Commonwealth Fund, there were roughly 22 maternal deaths for every 100,000 live births in the United States in 2022, the most recent year with readily accessible data. Even more frustrating? The researchers note that as many as 80% of those deaths were likely preventable.

When it comes to maternal healthcare and support, the U.S. falls sharply behind other wealthy countries, many of whom report next to no deaths among women during the perinatal period. Researchers looked at data from a slew of countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, Korea, Chile, Japan, and the United Kingdom, along with the many factors that contribute to the U.S. rate being so high. For comparison, our maternal mortality rate is 55% higher than Chile, which is the next-highest nation on the list.

Half of the other high-income countries had fewer than 5 maternal deaths per 100,000 live births in 2022, with Norway reporting zero. For Black women, the stats are even more grim, with the report citing a rate of nearly 50 deaths per 100,000 live births.

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So how and why are we failing women every step of the way during pregnancy and the postpartum period? There are several factors, as Munira Gunja, lead author of the report and senior researcher at the International Program in Health Policy and Practice Innovations at the Commonwealth Fund, told CNN.

She cites the ongoing “maternal care workforce shortage problem” in the U.S., which she says is “only supposed to get worse,” as a global shortage of healthcare workers will mean a shortage of 4.5 million nurses and 0.31 million midwives by the year 2030, according to the World Health Organization (WHO). 

“We have an under-supply of midwives, and midwives are underutilized, whereas in most other countries, midwives greatly outnumber OB-GYNs. They’re part of their health care systems. Midwifery care is not integrated enough into our system,” Gunja said.

In the United States, “there are several barriers to getting midwifery care, and other countries just don’t have that. They’re able to make sure that every woman has access to care, whether it be in some cases an OB-GYN and in most cases a midwife,” she said. “In the U.S., we’re the only country in this analysis without a universal health system. Nearly eight million women of reproductive age are without health insurance.”

According to a 2021 study published in The Lancet, a substantial increase in coverage of midwife-delivered interventions could avert 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths, equating to 2·2 million deaths averted per year by 2035.

The study found that strengthening the capacity of midwives to deliver high-quality maternal and newborn health services has been highlighted as a priority by global health organizations. To support low-income and middle-income countries in their decisions about investments in health, we aimed to estimate the potential impact of midwives on reducing maternal and neonatal deaths and stillbirths under several intervention coverage scenarios.

According to the 2021 State of the World’s Midwifery report (published in Human Resources for Health), Europe has 2.5 times the amount of midwives compared to the Americas, and the new report from the Commonwealth Fund notes that in most other countries, midwife care is the standard. The U.S. and Canada have the lowest overall supply of midwives and OB-GYNs—16 and 13 providers per thousand live births, respectively. That’s without mentioning that nearly 7 million women in the U.S. currently live in maternal care deserts, making access to any sort of healthcare challenging and/or cost-prohibitive.

In all the wealthy countries analyzed, universal healthcare covers the cost of midwife and/or OB-GYN visits, with the U.S. being the sole exception. We’re also the only high-income country without a federally mandated paid leave policy, contributing to our increased maternal mortality rate. Paired with the racial inequities faced by Black women and other women of color, and it’s clear why we fall so short when it comes to protecting women during the pregnancy and postpartum periods.

“Maternal deaths are a preventable problem, and this problem can be solved. A lot of countries have been able to figure out ways to make it so that all women are in safe hands when it comes to having a baby and after giving birth. We need to extend that to women in the U.S. as well,” Gunja told CNN.

“We know most deaths are during the postpartum period—so making sure we have federally mandated paid leave, making sure we make it easy for women to get postpartum care, which means having home visits and not making women go to the doctor—all essential factors to lowering the mortality rate and keeping moms and babies healthy and safe.”