In the US, many of us labor under the misconception that the technological advances and extensive training of healthcare professionals in the United States mean that both babies and mothers are safer here than anywhere else in the world. But an examination of statistics from the world’s leading healthcare organizations reveals that the US lags far behind in safety.
While rising affluence and technological advances in healthcare are partly responsible for reducing mortality in mothers and infants over the last century, recent improvements have either slowed or even reversed in some cases, making the act of giving birth potentially deadlier than it was even a generation ago.
Meanwhile, other nations have continued to invest in their overall healthcare systems and have worked to create a holistic approach to pregnancy and postpartum care—not just for the newborn, but also for the mother.
Increasingly, mothers in the US are not getting consistent care, and while more and more attention is being paid to the baby, mortality rates are not dropping the way doctors think they should. Medicine, as it is practiced in the US, is often reactive rather than proactive, but countries that invest in preventive care see the best outcomes for mothers and babies. A single statistic alone doesn’t make one country better than another, but by looking at a series of risk factors and outcomes, it becomes clear that there’s a lot of room for improvement in maternal and neonatal health care.
Rising Rates Of Infant Mortality
The stark fact is that more babies are dying in the US than in most other wealthy, developed countries. In the 1970s the once positive trend of a lowering infant mortality rate first stopped, then began to rise to the rates we have today, according to The Washington Post.
Babies born in the US are 76% more likely to die than in other developed countries before they turn one year old. The picture is almost as grim for young children—far too many never make it to adulthood. One reason why birth outcomes in the US look so grim is the alarming number of babies born prematurely.
C-Section Stats Sour
Despite the fact that bringing C-section rates down to 10% is tied to decreased rates of perinatal and maternal mortality rates, the number of C-sections in the US has steadily climbed for years, now topping out at just under 33%, according to Belly Belly. The global C-section rate is 18.6%.
While the US doesn’t top the list—the Dominican Republic has that dubious honor—the rising Cesarean rate has shown little to no improvement in maternal or neonatal health. In fact, rising C-section rates are also concurrent with rising rates of birth complications and even dangerous hemorrhaging.
The VBAC Prohibition
A vaginal birth after C-section—usually known as a VBAC—is a rare bird in hospitals in the US. Only around 11% of women are able to successfully have a VBAC, despite experts’ assurances that it’s often safe for women who had a prior transverse cut C-section, as per Elle.
It’s not that all of the women are suddenly high risk. Most women, despite a prior C-section, are considered low-risk, yet doctors are still loathed to even contemplate a VBAC. Many hospitals refuse to allow them point-blank, and because of this women often don’t even know they have an option or aren’t able to access a VBAC-friendly facility.
Interpreting Increased Intervention
The most common form of pain relief during birth is the epidural. In fact, epidurals or similar spinal pain relievers are used by women in the US at least 71% of the time as of 2014, according to Scope. That’s a more than 10% increase since 2008, and the rates show no sign of slowing.
What many expectant mothers don’t realize is that researchers know surprisingly little about the effects of epidurals on the birth experience and even on the baby. Essentially epidurals are considered routine despite a clear lack of data as to how often it really affects birth outcomes and neonatal complications.
Prevalence Of Prenatal Care
Not all women in the US get adequate prenatal care. Only around 77% of women begin prenatal care in their first trimester, as per the CDC. Around 17% begin prenatal care during the second trimester, and a staggering 5% don’t begin prenatal care until the third trimester.
More than 25% of teen mothers under the age of 15 in the US receive either late or no prenatal care at all, and more than 10% of teens between 15 and 19 receive late or no care. Worst of all, these percentages don’t adequately reflect the fact that women of color have much higher rates of late or no prenatal care in all age categories.
The Missing Midwives
When it comes to the prevalence of midwives, the US is unique. Midwives attended births only around 12% of the time as of 2014, according to Midwife. Most often when a midwife was used during labor and delivery, it was in a hospital setting. Despite the fact that the vast majority of pregnancies are low-risk, less than 2% of mothers plan to give birth at home, as per Scientific American.
The systematic destruction of the role of midwives—especially the women of color who were overwhelmingly most likely to practice midwifery—decimated the practice in the US. In other countries where midwives are the norm, intervention rates are significantly reduced.
The Color Line
When one in five Hispanic or black mothers reports they received poor treatment because of their cultural background, race, language or ethnicity from hospital staff, there’s a systemic problem. Despite all the improvements in technology, hygiene and medical practice, more than twice as many black babies die than white babies, and the numbers remained disparate even when controlled for similar socioeconomic status or educational level, according to The New York Times.
A growing body of research draws a clear correlation between systemic racism both pervasive within society at large and in healthcare’s approach to the person of color. Healthcare professionals are often not listening to women of color.
Negative Neonatal Numbers
The rate of decline in infant mortality in the United States lags far behind comparable countries, as per Health System Tracker. Because the infant mortality rate—the number of deaths within the first year—of black and Native American women is substantially more than that of white or Asian women, the problem is far more nuanced than a simple rate of six babies who die per 1,000 in the first year of life.
Four babies out of every 1,000 are considered neonatal deaths—that is, the baby did not live past the 28th day of life. The US consistently lags behind in making birth safer for mothers and babies.
While the most life-threatening complications are rare whether a woman gives birth vaginally or via C-section, those women who were classed as low-risk but still underwent a C-section were still three times more likely to suffer a serious side effect, according to Consumer Reports.
These women were more likely to either die or experience a serious complication such as hemorrhage, blood clots or sepsis than a comparable group of women who delivered vaginally. Their babies born via C-section were also more likely to develop potentially lifelong complications such as asthma or obesity. Moms who have had at least one C-section risk additional complications in subsequent pregnancies.
Maternal Mortality Mess
The maternal mortality rate (MMR) for women in the US is increasing again, especially in comparison to other developed countries. The current rate is somewhere between 17 and 28 pregnancy-related deaths per 100,000 women, which is more than six times the rate in Scandinavian countries, as per Berkeley Wellness.
There are a number of factors that experts theorize are contributing to this increasing MMR, including poor or incomplete integration between primary and prenatal care, as well as the lack of a national standard of care and protocol for pregnant women in the US. No national standard means that women don’t all access the same type of care, and doctors and hospitals institute different policies.
The Safest Place To Be Born
Babies are born every minute of every day all around the world, but the likelihood that baby will survive the birth varies widely. The safest country to be born in is Japan, where the rate of infant mortality is only one for every 1,111 births, according to CNN. The United States does not even rank in the top ten safest countries.
Premature birth, birth complications, serious perinatal infection and lack of maternal education are the top reasons for infant mortality, and countries that have invested in maternal education and universal access to care have seen rates of neonatal and infant mortality drop significantly.
Where Moms Do Best
Based on gender equality, maternal mortality rates (MMR) and perceptions of safety and family-friendliness, Sweden wins as the best country for moms, as per US News. Prenatal courses are provided to women free or at subsidized rates to help them prepare for birth and motherhood.
After birth, the government issues each family an allowance to help pay the cost of raising that child. This is in stark contrast with the fact that many women in the US still aren’t even guaranteed any paid maternity leave, as per The Washington Post. The US is the only country in the developed world that doesn’t mandate that employers provide paid leave.
When OBs Have Time For Moms
In the US, women get around 20 minutes with their prenatal care provider on average—not the worst, but nowhere near the best, according to The Bump. Women in Costa Rica may spend over an hour with their provider, including time for the provider to review the chart, discuss symptoms, review the birth plan and also cover family history.
Adequate prenatal care saves the lives of both mothers and babies. When providers are checking in with mothers regularly, they can develop a treatment before the issue becomes life-threatening. While low-risk pregnancies may require little to no intervention, regular care is directly correlated with a significant reduction of risk.
This Country Rarely Sees Preeclampsia
Part of the mystery surrounding preeclampsia is that doctors aren’t sure what causes is, and data regarding the prevalence of preeclampsia is often incomplete. In the US, somewhere between 5% and 8% of pregnancies end up developing preeclampsia, and that’s a big range, as per Preeclampsia. It is thought to range as high as 10% in some countries.
A recent study in Norway indicated that around 3% of expecting mothers develop preeclampsia, as per PLOS. While the same study of Norwegian mothers identified low-dose aspirin as a potential prophylactic for high-risk mothers, there is also emerging evidence that preeclampsia is at least partially genetic.
Less Premature Births Here
More than 12% of all births in the US are pre-term. That puts the United States in the top ten with one of the highest rates of pre-term births in the world, according to the World Health Organization (WHO).
In contrast, countries with some of the lowest numbers of premature births include Japan, Finland, Latvia, and Croatia—but the country with the lowest rate of pre-term births is Belarus. Experts attribute high rates of pre-term birth to an increase in medically unnecessary C-sections, advanced maternal age, and use of fertility medications. Socioeconomic factors and racial issues also factor into the likelihood of pre-term birth.
While the United States’ percentage of C-sections isn’t the highest in the world at 33%—that distinction goes to the Dominican Republic at over 58%—most experts think it is too high and could be endangering some women and babies. On the other extreme is South Sudan—their C-section rate is an astonishing 0.6%, as per CNN.
The WHO believes that a rate higher than 10% is not associated with any reduction in mortality rates for women or babies, and recommend a target rate of 10% or less. Western and Central Africa average a C-section rate of 4% overall.
An Uncomplicated Birth
Complications during labor and delivery are directly responsible for the health outcomes of mothers and babies. UNICEF recommends that countries invest at least 5% of gross domestic product (GDP) on healthcare, but some countries have gone above and beyond, and are seeing a drastic reduction in birth complications, according to CNN.
Japan, Iceland, Singapore, Slovenia, and Finland—the five countries with the lowest newborn mortality rates—all reported a far lower rate of birth complications. The US is currently seeing a rise in the rate of complications during labor and delivery, which has been attributed to various things, including increasing intervention, and racial disparity.
The Lowest Teen Pregnancy Rates Here
The teen birth rate has been directly tied to the health outcomes of mothers and babies. Teen mothers are far more likely to experience birth complications and both maternal and neonatal mortality. Once again, the US isn’t even in the top ten, and once again, Japan has the lowest rates of teen pregnancy, according to UNICEF.
Switzerland and the Netherlands come in right behind Japan. Not only is a teen pregnancy far more dangerous for the mother’s body and the developing baby, but it also has long-term consequences, as it may limit the ability of the mother to continue her education or attain work opportunities to support herself.
Best Access to Healthcare
Access to good healthcare overall is vitally important to the health of a population, including pregnant women and newborns. Japan has the lowest rates of teen pregnancy and is considered the safest place to be born, and ranks fourth amongst the world’s best healthcare systems.
Switzerland and Singapore rank slightly better, but number one is actually Luxembourg, a wealthy but tiny country. Situated in between France, Belgium and Germany—all three of which rank in the top 16—the life expectancy for Luxembourgians is 82 years, as per Business Insider Nordic. Health infrastructure, preventive services and mental and physical health of the population determine overall healthiness.
Best Parental Leave Policy
There are no laws in the US that guarantee any paid maternity leave, and paternity leave is even harder to come by. It’s often left up to the employers to provide maternity leave, and that’s usually limited to a maximum of six weeks after the birth.
The US is the only industrialized country that does not provide any paid parental leave. When all the types of paid maternity leave are factored in, the country with the most paid leave for mothers is Estonia, according to CNN Business. Mothers there can access up to 166 weeks of full or partially-paid maternity leave—that’s over three years of maternity leave in total.
Sources: Belly Belly, Elle, The Washington Post, Scope, CDC, Midwife, Scientific American, The New York Times, Health System Tracker, Consumer Reports, Berkeley Wellness, CNN, US News, The Washington Post, The Bump, Preeclampsia, PLOS, World Health Organization, CNN, CNN, UNICEF, Business Insider, CNN