By 1987, fewer than eight women died for every 100,000 live births. Over the past quarter of a century, however, America’s maternal-mortality rate has been creeping back up (see chart).
By 2013 the rate had ticked up to 18.5 women for every 100,000 births (these numbers include women who die within 42 days of childbirth). This makes America an international outlier. Between 2003 and 2013 it was one of only eight countries, including Afghanistan and South Sudan, to see its maternal-death rate move in the wrong direction. American women are now more than three times as likely to die from pregnancy-related complications as their counterparts in Britain, the Czech Republic, Germany or Japan.
American women are in poorer health when they become pregnant, and are failing to get proper care. Chronic health conditions, such as obesity, hypertension, diabetes and heart disease, are increasingly common among pregnant women, and they make delivery more dangerous. Indeed the traditional causes of pregnancy-related deaths, such as haemorrhage, thromboembolism and hypertensive disorders, have been declining in recent years, whereas fatalities from cardiovascular conditions and other chronic problems have been on the rise.
These health conditions are more common among black women, 40% of whom qualify as obese, compared with 22% of whites. African-Americans are also more likely to be poor, have limited access to health care and have higher rates of unexpected pregnancies: this may explain why they are nearly four times more likely to die from pregnancy-related complications than white women, almost double the discrepancy that existed 100 years ago.Remember that many states refused to accept federal Medicaid expansion. The health conditions that cause high maternal morbidity and mortality are often results of poverty. Good health services could ameliorate the risk, but you need health insurance to get those services if you are poor. The governors who turned down added medicaid for their states are guilty.