Forty-five years after the U.S. Supreme Court handed down its landmark decision in Roe v. Wade, ending safe and legal abortion in the United States remains an obsession of the Republican Party, far-right Christian fundamentalists and the so-called pro-life movement. But their opposition to universal health care and attacks on everything from Medicare to school lunch programs demonstrate that their concern for human life ends once a baby is born. If the GOP and its evangelical base truly were pro-life, they might object to the fact the U.S. now has the highest maternal death rate in the developed world—a figure that is especially pronounced in Republican-dominated red states.
In 2016, The Lancet published the results of an international study on maternal mortality that found U.S. women were almost three times as likely to die from pregnancy-related complications as their counterparts in Germany or the U.K., and almost seven times as likely as women in Finland. According to the medical journal, maternal mortality in the U.S. increased from 16.9 per 100,000 live births in 1990 to 26.4 per 100,000 live births in 2015.
Meanwhile pregnancy-related deaths have steadily decreased across the developed world. They now stand at 4.2 per 100,000 in Italy, 9.2 per 100,000 in the U.K., 5.6 per 100,000 in Spain, 5.5 per 100,000 in and Australia, 9 per 100,000 in Germany and Portugal, 7.8 per 100,000 in France, 7.3 per 100,000 in Canada and 6.7 per 100,000 in the Netherlands. Scandinavian countries also fared much better than the U.S. in The Lancet’s study, with maternal mortality rates of 4.4 per 100,000 in Sweden, 4.2 per 100,000 in Denmark and 3.8 per 100,000 in Finland. Maternal death rates in 2015 for Japan and Poland were 5 and 3 per 100,000 respectively, according to a separate study conducted by UNICEF.
Piggybacking on the Lancet's report, National Public Radio and ProPublica recently teamed up for a six-month investigation into maternal mortality in the U.S. They discovered that hospitals are grossly ill-prepared for maternal emergencies, and that only 6 percent of federal and state block grants for maternal and child health actually finds its way to these women. In other words, 94 percent of the funds have been directed to children rather than to their mothers.
Dr. Priya Agrawal, in a 2015 article for the World Health Organization’s website, cited three major reasons for the increase in pregnancy-related deaths in the U.S.: inconsistent obstetric practice at hospitals, insufficient care for pregnant women with chronic conditions like high blood pressure, diabetes and obesity, and a lack of quality data at the state level on maternal health outcomes. As Agrawal notes, only half of the states in the U.S. have maternal mortality review boards.
Agrawal also pointed out that women who lack health insurance are three to four times more likely to die from pregnancy-related complications than women who have health insurance. She praised the Affordable Care Act for listing maternal care among the Essential Health Benefits a health insurance plan must cover. “By extending insurance coverage to pregnant women with low incomes, many states have lowered the economic hurdles that limit access to antenatal care for millions of women,” she wrote at the time.
The Guttmacher Institute, which has devoted itself to advancing sexual and reproductive health rights across the U.S., reports that thanks to Obamacare, the number of reproductive-age women in the U.S. lacking health insurance fell from 12.5 million in 2013 to 7.4 million in 2016, good for a 40 percent decrease. The organization has been especially critical of the Trump administration’s attacks on the ACA and Medicaid, which it describes as “crucial for pregnancy-related care." Guttmacher reports the government-sponsored program covered 68 percent of unplanned U.S. births as of March 2017.
In the U.S., there is a strong correlation between maternal mortality and poverty. African-American women are more likely to be poor than white women; they're also three times more likely to die in childbirth. As many as 60 percent of the maternal deaths that occurred in the U.S. between 2004-2014 were preventable, per the CDC Foundation.
Although deaths from pregnancy-related complications are generally higher in Democrat-leaning states than in Europe, Japan or Australia, they are soaring in states dominated by Republicans. One of the worst offenders is Texas, which had a maternal mortality rate of 35.8 per 100,000 live births in 2014, well above the national average according to a study by the medical journal Obstetrics and Gynecology. That makes the Lone Star state, where Medicaid and family planning services have been severely defunded by the GOP, one of the deadliest places for women to give birth in the developed world.
In 2016, maternal death rates cited by the United Health Foundation ranged from 39.3 per 100,000 in Georgia, 35 per 100,000 in Louisiana, 27.1 per 100,000 in South Carolina and 26 per 100,000 in Oklahoma to 14.1 per 100,000 in Connecticut, 13.9 per 100,000 in Minnesota, 8.2 per 100,000 in Maine, 13.9 per 100,000 in Delaware, 6.8 per 100,000 in Nevada and 13.2 per 100,000 in Oregon. Some of the lowest rates can be found in the Democratic strongholds of California (5.9 per 100,000) and Massachusetts (5.8 per 100,000).
Red states have been hit especially hard by hospital closures. Of the 83 rural hospitals that have closed since 2010, about 75 percent were in states that refused to expand Medicaid under the ACA due to Republican intransigence.
Maternal mortality is also likely to be higher in states where family planning has come under attack from the GOP. When Republicans undermine Planned Parenthood, which offers a variety of services including prenatal care, they not only limit access to birth control, cancer screenings and STD tests but endanger the health of pregnant women. In Texas, where women are eight times more likely to die from pregnancy-related complications than they are in Sweden, Republicans have slashed funding for family planning services by 67 percent since 2011, causing 80 clinics to close—11 from Planned Parenthood alone.
As the Trump administration ramps up its war on reproductive rights, expect these numbers to climb.