The paradox of a country that spends the most on health care but has a higher maternal mortality rate than the EU, Russia, Egypt and Albania. Lockdown, obesity, and economic problems among the causes
It is hard to believe: the United States has the highest maternal mortality rate not only among all the rich countries, but also higher than any country in the European Union except Cyprus, and even higher than those of Albania, the Chile, Russia, Turkey and Egypt. What is worse, while the data of most of the world‘s countries, even the poorest and most heavily afflicted by maternal mortality such as those of sub-Saharan Africa, are improving, those of the USA have continuously worsened from 2000 to today.
33 mothers died in pregnancy for every 100,000 live births
This was revealed on February 23 by the report Trends in maternal mortality 2000 to 2020 by the United Nations Maternal Mortality Estimation Inter-Agency Group (which brings together WHO, Unicef, World Bank and other United Nations agencies); this was confirmed – with even heavier data – by the National Center for Health Statistics of the United States, and the news was relaunched on the front page by Wall Street Journal on March 16. According to this statistic, the deaths of women between the ages of 15 and 49 for reasons related to pregnancy and childbirth were 1,205 in 2021, equal to 33 deaths for every 100,000 live births. This is the worst figure since 1965 and has been steadily worsening since 2000, when 12 women died for every 100,000 deliveries; in 2020 the number had risen to 24 (21 according to the United Nations report), in 2019 it was 20.
The merciless comparison with the big European countries
The comparison with the big European countries is simply impossible. Between 2000 and 2020, Italy decreased from 10 to 5 women who died of causes related to pregnancy and childbirth for every 100,000 births, France from 9 to 8, Germany from 7 to 4, the United Kingdom from 11 to 10.
The comparison with some developing countries and with some post-communist countries is merciless: while in the USA between 2000 and 2020 maternal mortality worsened from 10 to 21 deaths (24 according to the National Center for Health Statistics), in Russia improved from 52 to 14, in Turkey from 32 to 17, in Egypt from 79 to 17, in Albania from 14 to 8, in Chile from 33 to 15. If we take the 2021 figure, US maternal mortality is double that Russian, Turkish, Chilean and Egyptian, quadruple that of Albania.
Among the causes, lockdown, Covid and cardiovascular problems
What are the causes of this situation? According to the explanations of doctors and health managers interviewed by the Wall Street Journal Covid-19 and disruptions to hospital services during the pandemic have added to the pressure of factors such as cardiovascular problems and unequal access to health care that have worsened maternal health in recent years. Pregnant women, as well as the rest of the population, in many cases did not receive the care they needed during the pandemic due to the lockdowns and the fear of contracting the virus by going to the clinic or hospital.
According to the CDC (Centers for Disease Control and Prevention) cardiovascular conditions such as pulmonary embolisms, uncontrolled bleeding and problems resulting from hypertension are the leading causes of pregnancy-related deaths in the United States. Some pregnancy and postpartum complications likely result from rising obesity and declining heart health in the United States. About 42 percent of US adults are considered obese, 47 percent have high blood pressure, about 11 percent have diabetes, and 38 percent have prediabetic conditions.
The weight of economic and territorial factors
Economic and territorial factors have their weight. Until 2000, maternal mortality in rural areas and small cities was lower than in large metropolitan areas, but since 2010 the situation has reversed: maternal mortality in the countryside is now almost double that in large cities. The closure of gynecology and maternity services in about 500 hospitals in the United States between 2005 and 2014 contributed to this, with a prevalence of those located in rural areas: there the offer of maternity services fell by 15 per cent. of course, while in urban areas it has decreased by only 5 percent. In addition, rates of obesity – a risk factor in pregnancy – are higher in rural areas than in cities.
Maternal mortality is related to women’s economic stability and educational attainment. It is no coincidence that 30 percent of all maternal deaths concern African American women (representing 14 percent of the US population), and that their mortality rate is 2.6 times higher than that of Caucasian women, while that of Hispanic women is slightly higher than that of white women.
The heart health of pregnant women deteriorated
According to doctors and health experts, more than 80 percent of pregnancy-related deaths in the United States could be prevented. Thromboses are curable if treated in time, while the prevention of cardiovascular disorders should and could be improved by taking care of heart health before pregnancies. Instead, “the heart health of pregnant women has deteriorated over the past decade,” says Dr. Sadiya Khan, a professor at Northwestern University Feinberg School of Medicine.
The United States is the country in the world that spends the most on health both in absolute figures (4,000 billion dollars) and as a percentage (15.3 percent of its GDP by adding private and public spending). Italian health expenditure, public plus private, is equal to 9 percent of GDP and is approximately 167 billion euros in absolute terms.
Photo on Alexander Grey are Unsplash