Maternal Health: A Persistent Crisis
EPPN Health Care Series Part 2
O gracious God, we give thee humble and hearty thanks that thou hast preserved through the pain and anxiety of childbirth thy servant, who desires now to offer unto thee her praises and thanksgivings. Grant, most merciful Father, that by thy help she may live faithfully according to thy will in this life, and finally partake of everlasting glory in the life to come, through Jesus Christ our Lord. Amen.
-Prayer for a safe delivery, Book of Common Prayer pg. 444
As a Church, we celebrate and honor those who go through pregnancy and childbirth to bring new life into the world. In the U.S. however, pregnancy, childbirth, and the postpartum period present more significant risks than for those who give birth in other developed nations. The U.S. has high rates of maternal mortality, severe medical complications, and perinatal mood disorders. All of these are compounded by the lack of a paid family leave policy.
Those who give birth in the United States die from preventable causes at higher rates than in other developed countries, and indeed, despite impressive medical advances, U.S. maternal deaths rose in the last two decades. The U.S. maternal mortality rate, at 17.4 per 100,000 live births, is twice that of our neighbor Canada, and four times that of Sweden. Maternal mortality and severe morbidity, meaning unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health, have continued to increase. There are also persistent and troubling racial disparities in maternal health outcomes.
What is the cause of these alarming statistics and what can we do to reverse these trends? A recent report by the Aspen Health Strategy Group provides a helpful analysis of the causes, which include lack of data and systemic racism. Often, low-income women lack the means to access high-quality reproductive and prenatal health care. Many states and the federal government under the Trump administration cut funding for family planning services in recent years. Since a great number of family planning clinics also provide health care to those who are pregnant, these funding cuts have reduced the number of clinics available to low-income women.
Black and Indigenous women have significantly worse health outcomes, including death, during pregnancy, and following childbirth. Black women are also substantially more likely to die from pregnancy-related complications such as preeclampsia and postpartum hemorrhage. They often reference instances of medical professionals dismissing their health concerns when they raise them. African Americans also have higher rates of pre-existing conditions like high blood pressure, diabetes, and obesity, which all raise the risks of pregnancy and childbirth. Addressing the maternal mortality crisis in this country means we need to grapple with and develop solutions for racial disparities and health inequities.
The mental health of those who are pregnant and postpartum is another critical aspect of care where the U.S. has a long way to go. Conditions such as poverty, exposure to violence, and low social support can increase the risk of severe depression and anxiety, with worse outcomes for parent and child. Paid family leave is associated with improvements in both the mother’s and child’s physical and mental health, but falls terribly short in the U.S.
These problems are all exacerbated by the incoherence of the American health care system. Women who lack health insurance are less likely to seek preventative care and prenatal care, which can head off a wide variety of pregnancy complications. The U.S. also does not devote enough resources to maternal health, and maternal mental health and substance use treatment must be integrated further into health care during and after pregnancy. Medicaid and federal-state grant programs spend a lot of money on newborn babies, but Medicaid coverage for new parents ends within weeks of the birth and spending on programs targeting health for new moms is limited and spotty.
Much can be done to improve the experience of giving birth in this country. The Momnibus is a suite of legislation designed to address the maternal health crisis. Please take action on the Momnibus Action Alert to urge your member of Congress to support it! This Momnibus legislation would:
- Make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition.
- Provide funding to community-based organizations that are working to improve maternal health outcomes and promote equity.
- Comprehensively study the unique maternal health risks facing pregnant and postpartum veterans and support VA maternity care coordination programs.
- Grow and diversify the perinatal workforce to ensure that every mom in America receives culturally congruent maternity care and support.
- Improve data collection processes and quality measures to better understand the causes of the maternal health crisis in the United States and inform solutions to address it.
- Support moms with maternal mental health conditions and substance use disorders.
- Improve maternal health care and support for incarcerated moms.
- Invest in digital tools like telehealth to improve maternal health outcomes in underserved areas.
- Promote innovative payment models to incentivize high-quality maternity care and non-clinical perinatal support.
- Invest in federal programs to address the unique risks for and effects of COVID-19 during and after pregnancy and to advance respectful maternity care in future public health emergencies.
- Invest in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies.
- Promote maternal vaccinations to protect the health and safety of moms and babies.
- U.S. House of Representatives Black Maternal Health Caucus
- National Birth Equity Collaborative
- Black Mamas Matter Alliance
- Reversing the U.S. Maternal Mortality Crisis: A Report of the Aspen Health Strategy Group
Episcopal Church Resolutions
- 2018-D014: Urge Equitable Access to Prenatal and Maternal Health Care
- 2012-A140: Advocate for Maternal and Infant Health
The Office of Government Relations