The good news is that infant mortality rates in the United States — while still too high — are going down, having reached the lowest point in American history. But a massive investigation from NPR and ProPublica published Friday shows that, despite this positive trajectory for babies, it's also moms who are in danger during childbirth, as well as before and afterwards — at least, much more than they should be based on maternal mortality rates in other countries and the tools and knowledge at medical professionals' disposal. Currently, the news outlets reported, pregnancy- or childbirth-related causes account for between 700 and 900 maternal deaths in the United States annually, and another 65,000 women come close to meeting that same fate.
In 2014, 23,000 babies died in this country, a sobering statistic that seems to indicate that the younger patient in that delivery room is the one who requires more care and attention. But that's not necessarily true. Unlike infant mortality, maternal deaths are on the rise: Between 2000 and 2014, the rate jumped from 18.8 deaths out of every 100,000 women to 23.8 per 100,000 in each state excluding Texas and California. And the reasons for this shocking uptick that Bo Erickson of NPR and ProPublica's Derek Kravitz and Adrianna Gallardo uncovered are both excruciatingly simple and frustratingly complicated.
In general, they found, the American medical establishment largely believes that it has conquered maternal mortality. As a result, the focus for care is primarily on babies, who are perceived as having more urgent needs during childbirth and beyond, too. For example, the NPR and ProPublica team reported that there's a major disparity within Title V, which is a federal-state program charged with supporting the wellbeing of mothers and children. In 2016, the program allocated 78 percent of its block grants to infants and special needs children; only 6 percent helped mothers.
And the issue extends into hospitals, too: In 2012, students of maternal-fetal medicine weren't even required to learn how to care for birthing mothers. And maternal health advocates told NPR and ProPublica that medical professionals are simply more attuned to babies' needs as they monitor babies and moms postpartum.
There's also the problem of oversight and allocating resources to fixing this problem. There's no federal effort to track or review maternal deaths in the United States; In the United Kingdom, by contrast, a national committee of experts "scrutinizes every death of a woman from pregnancy or childbirth complications, collecting medical records and assessments from caregivers, conducting rigorous analyses of the data, and publishing reports that help set policy for hospitals throughout the country."
As a result, deaths from a pregnancy-related high blood pressure called preeclampsia have dropped dramatically in Britain.
Other reasons for the climbing infant mortality rate include the fact that women today tend to have babies later in life than they did previously, and that more women are having c-sections, increasing their risk of complications and infections, according to the NPR/ProPublica report. Additionally, almost half of all pregnancies in the United States are unintended, which means that unaddressed chronic health issues can affect those pregnancies.
All of these myriad factors contribute to the awful realization that mothers who give birth in the United State are three times more likely to die than those who do so in Canada, and outpace Scandinavians in this respect by six times. Worse still, 60 percent of these deaths — which occur as the result of complications like preeclampsia as well as heart problems, massive hemorrhage, blood clots, infections, and more — are preventable.
The NPR/ProPublica investigation is as illuminating as it is heartbreaking, and all Americans should read it in full. Understanding the country's nuanced roadblocks to providing the safest pregnancy, childbirth, and postpartum experience possible for moms is among the first steps in improving these outcomes.
