The United States is one of just eight countries in the world where deaths related to pregnancy and childbirth rose between 2003 and 2013, a new report says. That puts it in the company of countries such as Afghanistan, Belize and El Salvador.
While U.S. maternal mortality rates remain lower than those in many poor countries, they are much higher than those in developed countries ranging from the United Kingdom to Saudi Arabia, says the report, published Friday in the Lancet by researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle.
The maternal death rate per 100,000 U.S. women was 12.4 in 1990, 17.6 in 2003 and 18.5 in 2013, the report says. The global rate per 100,000 was 209 and falling in 2013; the rate in developed countries was 12.1, half the 1990 rate.
The continued rise in the United States may reflect “the performance of the health system as a whole,” and “poorer access to essential health care,” compared with other developed countries, says study author Nicholas Kassebaum. It also may reflect health problems in U.S. women, he says.
The rise has been previously reported by the U.S. Centers for Disease Control and Prevention. The agency has said that better tracking of such deaths may play a role. But CDC also says growing numbers of U.S. women enter pregnancy with conditions such as hypertension, diabetes and heart disease, putting them at higher risk for complications and death. One increase in maternal deaths, in 2009, occurred because of the H1N1 flu pandemic, CDC says. The deaths amount to about 650 women a year.
“It certainly seems plausible that one of the underlying causes is that more mothers are ill when they start their pregnancies,” Kassebaum says.
That’s all the more reason for women planning pregnancies to see their doctors before they conceive, says Siobhan Dolan, a medical adviser to the March of Dimes and professor of obstetrics and gynecology at the Albert Einstein College of Medicine in New York. “So many of these complications are preventable,” she says.
A separate study, also in Lancet, on child deaths finds that 28,000 children younger than 5 died in the United States in 2013. Such deaths declined in the United States and the world between 1990 and 2013, but the pace of the U.S. decline has slowed, the report says.