Report Finds Pregnancy & Childbirth More Dangerous For Women In America Than Other High Income Countries

For decades the disparities between women in the United States has led to maternal mortality rates that vary greatly by income, insurance type, race, ethnicity and geographic location. While rising rates of severe complications and death during pregnancy and childbirth underscored the shortcomings of the U.S. health system since 2000, the Covid-19 pandemic has exacerbated our failings at a rapid rate.

According to a new report published by the Commonwealth Fund, Maternal Mortality and Maternity Care in the U.S. Compared to 10 Other Developed Countries, among high-income countries, the United States has the highest maternal mortality rates. In fact, a woman giving birth in the U.S. is about 10 times more likely to die than a woman giving birth in New Zealand (17.4 and 1.7 deaths per 100,000 live births, respectively). 

The international comparison looks at the U.S., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the U.K., concluding that pregnancy and childbirth are more dangerous for American women than their 10 counterparts. Further, the study suggests health workforce shortages are current pain points that may be worsened by the coronavirus – further undermining an already faulty system.

But there is much to learn from our understanding of what makes the American health system – and women’s access to care – different from the countries of comparison. Given that the U.S. has the highest maternal mortality rate among developed countries suggests there are a number of contributing factors, and that the issues run deep throughout our system. Further, that we have deficiencies from beginning to end of the birthing process. 

Here are the most important conclusions for consideration in America:

– U.S. women have the highest death rate from complications of pregnancy and childbirth. In 2018 there were 17 deaths per 100,000 live births – a maternal mortality rate that is more than double the rates of most other high-income countries. In comparison, the Netherlands, Norway and New Zealand experience three maternal deaths (or less) per 100,000 live births.

– 17% of maternal deaths in America occur on the day of delivery.

– A shocking 52% (more than half) of maternal deaths in the U.S. occur after birth. A period of time often referred to as the fourth trimester – usually ranging from one week to one year postpartum – is when a majority of postpartum deaths occur. 

– In 2018, the death rate for Black mothers was more than two times that for white mothers. As Covid-19 has widened disparities through the pandemic’s disproportionate health and economic burdens on Black people, racial and ethnic gaps are not only likely to persist, but potentially deteriorate for Black mothers. 

– The U.S. and Canada have the lowest overall supply of OB-GYNs and midwives, having only 12 and 15 providers per 1,000 live births, respectively. In contrast, the nine other countries in the study have a proportion two to six times greater.

– Midwives are in far lower supply in the U.S. than other high-income countries. 

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Spanish women fight for control of childbirth as COVID-19 curbs rights

MADRID (Thomson Reuters Foundation) – As she struggled through painful labour contractions, Spanish nurse Teresa pleaded with doctors not to perform a caesarean section on her. But offering no explanation, they did it anyway.

Teresa, 40, who asked not to give her real name, found out later they had operated because she had COVID-19 – triggering a hospital protocol that said most women who had tested positive for the disease should have caesareans.

Traumatised and suffering nightmares, Teresa has sought psychological help and feels unable to return to her job at the public hospital in northern Spain where she gave birth seven months ago.

“I only realised what was happening when they put up a blue sheet to block my view and gave me an anaesthetic,” she said.

“I begged them not to cut me open and said I wanted to push, but no one spoke to me or even looked me in the eye. It was like I was nothing.”

There has been a spike in complaints about medical interventions and violations of patient rights since the pandemic hit Spain, one of Europe’s worst-affected countries, said lawyer Francisca Fernandez Guillen.

Fernandez specialises in obstetric violence cases – in which mothers are mistreated during or around childbirth – and is preparing legal action on Teresa’s behalf.

Every week, she said she gets calls from women who had been separated from their babies or forced to give birth unaccompanied due to hospital protocols, as well as from concerned midwives.

The health crisis has exacerbated long-standing problems with the treatment of women during childbirth in Spain, Fernandez said, describing a culture of excessive procedures, poor communication and a lack of accountability.

“In general, women aren’t being given explanations or options that relate to their situation. They’re simply told what’s going to happen and it happens,” she said.

Because Teresa was in the pushing stage of labour, she should have been spared a caesarean under the terms of the protocol issued by her particular hospital, which was seen by the Thomson Reuters Foundation.

The document describes caesarean delivery as the best way to protect staff safety.

But Fernandez said such edicts rode roughshod over patients’ rights: “A professional can protect themselves, but never at the cost of doing damage to a woman or baby.”

‘WHAT I LOST’

A study of more than 17,000 Spanish women conducted in 2018 and 2019, published in the International Journal of Environmental Research and Public Health in October this year, found 38% “perceived having suffered obstetric violence”.

“Offering information to women and requesting their informed consent are barely practised in the healthcare system,” the study said.

It is an issue that goes far beyond Spain.

The United Nations and the Council of Europe recognised last year that gynaecological and obstetric violence was widespread, attributing the problem to institutionalised factors, from under-resourced health services to patriarchal attitudes.

As the pandemic puts further strain on healthcare services, the World Health Organisation (WHO) has emphasised that, whether or not they have

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