The rate at which women die during pregnancy or shortly after childbirth has fallen sharply in many nations as maternal care has improved. The United States — and particularly Texas — is a glaring exception.
In Texas, for instance, according to a study in the journal Obstetrics & Gynecology, the maternal mortality ratio — maternal deaths per 100,000 live births — doubled to 35.8 in 2014 from 17.7 in 2000. Compare that with Germany, which had 4.1 deaths per 100,000 live births in 2014.
In California, that figure fell from 21.5 in 2003 to 15.1 in 2014, but in the remaining 48 states and the District of Columbia it increased from 18.8 in 2000 to 23.8 in 2014. The United States as a whole had the second-highest maternal mortality ratio among 31 members of the Organization for Economic Cooperation and Development. Only Mexico had a higher figure.
A big part of the problem is the inequality embedded in America’s health care system. The 2010 Affordable Care Act made health insurance more available, but millions of families still cannot afford the care they need. And lawmakers in many states and many Republicans in Congress have repeatedly shortchanged reproductive health programs because of ideological opposition to contraception and abortion.
The surge in maternal mortality in Texas defies easy explanation. Such increases typically happen during war, natural disasters and severe economic distress. State Republican lawmakers sharply reduced spending on women’s health care in 2011 in an effort to eliminate government funding of Planned Parenthood. The cuts, which took effect at the end of that year, don’t account for all of the increase, but they certainly don’t aid maternal health.
The biggest killers during and after pregnancy in Texas are cardiac problems and overdoses involving prescription opioids and illegal drugs, according to a recent report by a task force created by the Texas Legislature. It also found that maternal mortality was much higher for black women in Texas than for white and Hispanic women.
Researchers estimated maternal mortality trends in the United States, accounting for gaps in data collection. In Texas, the rate spiked after 2010, while it fell in California.
Texas lawmakers could address some of these problems by investing more in health clinics in minority communities and in mental health and addiction treatment. Expanding Medicaid to cover 1.2 million more poor people would also be very helpful. Texas is one of 19 states that have refused to expand Medicaid under the Affordable Care Act, despite the law’s generous terms, with the federal government picking up nearly all of the cost for low-income families.
Texas can also learn from California, which has organized doctors, hospitals, insurance companies and public interest groups in a collaborative to focus on maternal mortality. The group has developed state-of-the-art treatments for causes of maternal death like hemorrhages and pre-eclampsia, a condition characterized by high blood pressure and organ damage.
But even California could go further. Despite some improvement, its maternal mortality ratio far surpasses that in nations like Germany and Britain, where it is 6.7 per 100,000. One reason for Britain’s low figure is a mandatory system of confidential reviews, in place since 1954, of every maternal, newborn and infant death to determine what went wrong and how doctors and hospitals can improve. That’s easier in Britain’s single-payer, government-run health system, but it should not be impossible for state governments to develop something along these lines.
One of the United Nations’ Millennium Development Goals was to reduce global maternal mortality by three-fourths between 1990 and 2015. The world missed that target but still reduced maternal mortality by 45 percent. Set against that progress, America’s record is unconscionable.
Correction: September 6, 2016
An earlier version of this editorial incorrectly referred to maternal deaths per 100,000 live births as the maternal mortality rate. It is the maternal mortality ratio.