Having the Most Advanced Healthcare Doesn’t Equal Lowest Maternal Mortality Rate

In a recent study of the Best and Worst Places in the World to be a Mother, the United States was ranked 28^th out of 160 countries. Now the study based the rankings on several things including government sponsored healthcare and government subsidized maternity leave. However, looking at the maternal mortality rate alone, the U.S. still didn’t rank very well. One in every 4.800 women in the United States dies from pregnancy or birth related issues. 

 “A U.S. woman is more than five times more likely to die from pregnancy-related causes than a woman in Bosnia and Herzegovina, Greece, or Italy, and 10 times more likely than a woman in Ireland, the survey finds.”

 I have a theory, though not based on any empirical research, as to why the United States ranks so poorly in this area. We have some of the most advanced healthcare available in the world. I believe this is actually one of the reasons why we don’t rank as highly as we should. The U.S. Healthcare system may be one of the best in the world, but we also have much higher incidence of medical lawsuits, and very high medical malpractice insurance. Therefore, Doctors, especially in areas like OB/GYN where malpractice insurance rates are the highest, are forced to focus more on protecting themselves from lawsuits, than doing what is best for their patients. I am referring to the increase in unnecessary non-emergency C-Sections and decrease in VBACs. While a C-Section can decrease the chance of infant mortality (though this is not always the case) it actually increases chance of complications or death for the mother. Yet many hospitals and doctors insist on C-Sections for women who 5 or 10 years ago might have had normal vaginal deliveries. Breech births are not even attempted at most hospitals anymore, (medical schools don’t even train doctor’s how to handle them any other way) and some overly cautious doctors opt for C-Sections even when the baby is head down but in the posterior position (emerging face up rather than face down). I have seen no studies on this fact, but I have to believe that the excess number of surgeries being performed every year have to play a role in increasing our maternal mortality rate. Note: these increases are not being seen in countries with national healthcare because of the extreme expense. Women in countries such as Great Britain, who have national healthcare systems, are actually being encouraged to opt for drug free vaginal births as a way to control costs.

I think another aspect is the widespread availability of In Vitro Fertilization for women over 40. In many nations, advanced infertility treatments are just not available. Though these procedures are rarely covered by insurance, even in the United States, the average American family has more expendable income than most other nations, as well as better access to loans that would help to pay for these pricy procedures. However, these treatments are not without risks. There are medical consequences to multiple rounds of fertility treatments and even once the pregnancy is achieved, there are risks to older women having babies. (Yes, I know, some women get pregnant at an older age naturally, but the fact that they were able to get pregnant without medical intervention would seem to indicate that their bodies are more able to handle the process). So we probably have more women in the United States having more babies as a result of fertility treatments later in life. That also has to increase our maternal mortality rate. As a side note, there are still some small medical risks to any fertility treatments at any age, and since wider access is typically available in the United States, I would also suspect that we have more women having babies at any age, that wouldn’t be doing so in a country without access to advanced fertility treatments. More high risk women having babies equals a higher maternal mortality rate.