Amnesty International Condemns U.S. For Soaring Maternal Death Rates

by on Friday, March 12, 2010 at 4:00 pm in Healthcare, Politics

In a scathing new report released today, Amnesty International calls on U.S. President Barack Obama to address its spiraling maternal mortality rates and soaring pregnancy related complications (which disproportionately affects minorities and those living in poverty):

More than two women die every day in the USA from complications of pregnancy and childbirth. Approximately half of these deaths could be prevented if maternal health care were available, accessible and of good quality for all women in the USA.

Maternal mortality ratios have increased from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006. […]

The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 40 other countries, [including nearly all the industrialized countries]. For example, the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. […]

A total of 1.7 million women a year, one-third of all pregnant women in the United States, suffer from pregnancy-related complications.

The report also revealed that severe pregnancy-related complications that nearly cause death — known as “near misses” — are rising at an alarming rate, increasing by 25 percent since 1998.

US Amnesty executive director Larry Cox weighs in:

“This country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful. Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies.” […]

“Mothers die not because the United States can’t provide good care, but because it lacks the political will to make sure good care is available to all women.” […]

The group blasts the U.S. health care system as one that systematically creates barriers to keep pregnant women from getting coverage:

The way in which the health care system is organized and financed fails to ensure that all women have access to affordable, timely and adequate maternal health care. For many women, health care costs are beyond reach.

Half of all births are covered by private insurance. However, policies that exclude maternal care are not uncommon and most insurance companies will not provide coverage for a pregnant woman unless she had insurance before she became pregnant.

Some 42 percent of births are covered by Medicaid, the government-funded program for some people on low incomes. However, complicated bureaucratic requirements mean that eligible women often face significant delays in receiving prenatal care.  […]

Women who do not receive prenatal care are three to four times more likely to die of pregnancy-related complications than women who do. Those with high risk pregnancies are 5.3 times more likely to die if they do not receive prenatal care.

The group pointed out many other systematic failures, including:

  • Nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. Minorities account for just under one-third of all women in the US A (32 percent) but over half (51 percent) of uninsured women.
  • One in four women do not receive adequate prenatal care, starting in the first trimester. The number rises to about one in three for African American and Native American women.
  • A shortage of health care professionals is a serious obstacle to timely and adequate care, especially in rural areas and inner cities. In 2008, 64 million people were living in “shortage areas” for primary care (which includes maternal care).
  • Many women are not given a say in decisions about their care and the risks of interventions such as inducing labor or cesarean sections. Cesarean sections make up nearly one-third of all deliveries in the US A – twice as high as recommended by the World Health Organization.
  • The number of maternal deaths is significantly understated because of a lack of effective data collection in the USA.

Here’s a bird’s eye view of how countries rank on lifetime risk of death from pregnancy related causes (as reported by the World Health Organization:

1. Ireland 1 in 47,600

2. Bosnia and Herzegovina 1 in 29,000

3. Italy 1 in 26,000

4. Greece 1 in 25,900

5. Austria 1 in 21,500

6. Germany 1 in 19,200

7. Czech Republic 1 in 18,100

8. Denmark 1 in 17,800

9. Sweden 1 in 17,400

10. Spain 1 in 16,400

26. United Kingdom 1 in 8,200

41. United States 1 in 4,800

In its new report, Amnesty disclosed maternal mortality ratios (per 100,000 live births) for each of the 50 states, and the nation’s capitol:

51 — Washington, DC (34.9 deaths per 100,000 live births)
50 — Georgia (20.5)
49 — New Mexico (16.9)
48 — Maryland (16.5)
47 — New York (16.0)
46 — Louisiana (15.9)
45 — Mississippi (15.2)
44 — Arkansas (14.6)
42 — Delaware, Michigan (13.6)
41 — Florida (13.1)
40 — Nebraska (12.6)
39 — Oklahoma (12.3)
38 — Tennessee (11.7)
37 — North Carolina (11.4)
35 — New Jersey, California (11.3)
34 — W. Virginia (11.2)
32 — South Carolina, Idaho (11.1)
31 — Colorado (11.0)
30 — North Dakota (10.7)
28 — Missouri, Montana (10.5)
26 — Nevada, New Hampshire (10.4)
25 — Alabama (9.6)
24 — Rhode Island (9.2)
23 — Illinois (9.1)
22 — Kentucky (8.8)
20 — Texas, Utah (8.6)
19 — Pennsylvania (8.5)
18 — Ohio (8.4)
17 — Virginia (8.0)
16 — Wyoming (7.8)
15 — Washington (7.5)
13 — Arizona, Wisconsin (7.2)
12 — Iowa (7.0)
10 — Oregon, South Dakota (6.2)
9 — Kansas (5.9)
8 — Connecticut (5.1)
7 — Alaska (5.0)
6 — Hawaii (4.7)
5 — Minnesota (3.7)
4 — Indiana (3.3)
3 — Massachusetts (2.7)
2 — Vermont (2.6)
1 — Maine (1.2)

To put this in perspective, a pregnant woman in our nation’s capitol is fifteen times more likely to die from childbirth than a pregnant woman in Greece, twelve times more likely to die than a pregnant woman in Germany, and nine times more likely to die than her counterpart in Spain.  And yet, ironically many of our politicians who live and work in that very same city, continue to tout U.S. health care as the “best in the world.”


Generate an instant email (c/o Amnesty International) to Kathleen Sebelius @ the US Department of Heath and Human Services demanding immediate action.



  • Mar 13th, 2010 at 2:55 am is the website created for the Safe Motherhood Quilt Project. Go there if you want to read some of the local news stories about maternal deaths. You’ll see that bad things happen to well-insured women too often as well. Too many c-sections, not enough nurses to look after women after birth, too many medical errors, no postpartum home visits like those most European countries provide for and consider necessary, too many nasty (MRSA) infections, not enough midwives and family docs doing obstetrics——it’s a long list.

    • | 183#
      Mar 13th, 2010 at 8:34 am

      I’ll be sure to check out that site.

      It’s disgraceful what our health care system has become — one of the greediest and most immoral industries on the planet.

  • | 185#
    Gilbert Hall
    Mar 15th, 2010 at 11:05 am

    The international figures from the WHO are weird. Forget the United States for a moment, why is Ireland so good? How come Bosnia and Herzegovina is so much better than Germany or Denmark? Then look at the US: how come Maine is so amazingly good? Instead of the usual US bashing (I’m English and it’s common knowledge outside the US that US health care is inferior with the UK being bad but not so bad) I’d welcome some calm analysis of why the results are all over the place. I can’t believe the numbers at present.

    Is there a wonderful respect for human rights in Maine (and Bosnia)? Is that really what it’s all about?

    • | 186#
      Mar 15th, 2010 at 12:35 pm

      You make some very good points.

      As far as the US is concerned, I’m going to assume that Amnesty’s in-depth report probably correctly underscores the WHY with regards to its soaring maternal mortality rate — (as usual, with US health care it’s all about the lack of access).

      As far as the WHY with regards to Ireland being at the top and Bosnia being second, I would only be speculating since the WHO didn’t summarize their findings with explanations for each country’s numbers. Here are just a few guesses as to the WHY:

      1. They both offer Universal Health Insurance coverage.

      2. They are small in population, so perhaps they are better equipped to provide superior health care (at least for certain types of care).

      3. Ireland is predominantly Catholic, and therefore pro-life. I’m going out on a limb here, but maybe they prioritize maternal care more so than other countries.

      4. Despite Bosnia having experienced horrible human rights violations between Bosnian Serbs and Muslims and Croatians during the 1990s, ones engaged in genocide/ethnic cleansing are not necessarily derelict from providing superior health care to their own.

      There was a study on Bosnian immigrants who came to the United States to escape the Balkan wars and here’s a brief summary into their impressions of US health care:

      During the 1990s, approximately 300,000 Bosnian immigrants came to the United States as a result of the Balkan wars. In contrast to immigrants from less developed countries, Bosnian refugees were typically older, had experienced significant war related trauma, and were accustomed to universal health insurance coverage. There is little information about Bosnian immigrants’ transition to the U.S. health care system.

      As part of a related project, 12 Bosnian immigrants were interviewed about their perceptions of the U.S. health care system and their experiences as patients. Participants were universally critical of the U.S. system and described several core issues: confusion about insurance coverage, personalized quality of care, access to primary and specialty care; and a perception of U.S. health care as bureaucratic. Participants compared their experience with prewar Bosnian health care along these dimensions. Implications of the findings and suggestions for improving care to the Bosnian immigrant population are provided.

      So, anyways, I’m just throwing some ideas around. Perhaps other groups have conducted studies into some of these countries’ maternal care to better identify what they are doing right versus what others are doing wrong. I suspect Amnesty did some of that in their attempt to identify what the US needs to do to improve their numbers.

      I took a second look at the Amnesty report to compare individual states, I just arbitrarily selected Maine (the best) versus Georgia (the worst), and one difference between the two is the existence of a Maternal Mortality Review Board. Maine has one, Georgia doesn’t. But then I noticed Vermont (the second best state) doesn’t have one either.

      If you compare the number of uninsured, you find that Georgia has 1,682,400 uninsured versus Maine’s 126,000 uninsured. Maine is a far smaller state.

      Another HUGE discrepancy between the two states is that the Medicaid eligibility level for working parents in dollars (for a family of three) is $36,276 for residents of Maine versus $9,072 for comparable residents in Georgia. So Maine makes its Medicaid (government insurance for poor) available to its residents making as much as $36,276. That ensures better access to many more people who otherwise couldn’t afford insurance on their own.

      Accessibility to health care, as you see, differs from state to state. But to throw yet another monkey wrench into that “reason,” Washington, DC — which has a worse ranking than Georgia — allows families of three making $36,396 to qualify for Medicaid.

      This might be a good study for the Freakonomics guys. 🙂 They love dissecting piles of raw data to unearth overlooked patterns/consistencies.

  • | 189#
    Gilbert Hall
    Mar 16th, 2010 at 6:48 am

    I think the disparity between the numbers is too big for the sort of explanations you’re thinking of to be credible. For example Washington DC would have to prevent 28 out of every 29 maternal deaths to get up to Maine’s performance!

    I oppose Amnesty International involving itself in what seems to me a political issue. The direction they’re argument’s heading in is that someone’s human rights are being denied if they do not get equal access to medical care as the most privileged. Therefore private health care should be banned. This is a reasonable, socialist, position. A lot of people in Europe support this sort of view. But it’s also valid to argue that people should be allowed to set up private health facilities if they want to even if only the rich can afford them. That’s the American way. Maybe the American way doesn’t work well for health care. Maybe it can be made to work well. Maybe there are advantages to the American way of doing things that make it worth putting up with bad health care for the poor. For example the US hasn’t become a dictatorship at any point in its history, whereas as most of the “better” countries have.

    There is a fundamentalist view around that a more equal society is unequivocally a better one, that there can be no argument about this and that any policies that aren’t in line with this are actually against international law! Amnesty International appears to be using this sort of argument. It may be calling for a ban on Capitalism soon. Capitalism creates inequality. The poor have inferior health in all countries. Therefore Capitalism denies the fundamental human rights of the poor.

    • | 190#
      Mar 16th, 2010 at 8:18 am

      I respectfully disagree. In my opinion Health care is a human right. In the US there are over 50 million people with no health insurance. A recent Harvard Medical Study found that over 45,000 Americans die each year due to a lack of health insurance. 45,000! Under 4,000 people died in 9-11 and look at the wars launched and trillions spent in knee jerk reaction to that.

      No one has advocated that private health care should be banned. People are advocating for a public health care option to coincide with private health insurance. That way people have a choice.

      If you look at the economics of health care in this country you have health insurance corporations that increase their profits by doing two things: denying coverage to high risk people, and denying claims of high cost procedures. Essentially, they profit from denying people medical care. They have financial incentive to deny medical care to people who need it. They are also exempt from anti-trust laws that every other corporation in the United States is governed by.

      Even those insured in the US have to pull teeth to get the health insurers just to deliver on what they are required to. I’ve had surgery before and had the health insurer try to get out of paying the claims — leaving me on the hook for $13k. They contended that I didn’t get proper referrals through each of the steps to surgery — although I did. They pretended to never get the claims that my doctors, hospital, etc. sent them, faxed them, and fed ex’d them.

      This went on for two years, and before long collection agencies were coming after me threatening me on behalf of the hospitals, doctors, etc. And eventually — after two years — the insurer finally paid them. I’d been paying the insurer over $5k per year in premiums, and the minute they had to deliver, they tried to weasel out of it. This is a common scenario in the US. And I wondered how many old people would probably have just sent the check themselves (if they had the money) just to get the collection agencies off their backs.

      No one has ever proposed that private health care facilities should be taken over by the state. In fact, that’s never been propositioned by anyone. The only changes that anyone has proposed in the US is to offer a public health insurance option to compete with the private ‘for profit’ ones that exists, and to impose fairer legal restrictions on pharmaceutical companies (ones that limit their excessive monopolies — in the form of patents which often exists for many many years, ensuring millions of people cannot afford essential medicines that are affordable in every other country outside of the US). So essentially you would still have private hospitals, private doctor’s offices, with both private and public insurers.

      In America we pay twice what every other industrialized nation pays for health care, and in study after study our health care gets lower ratings across the board, not to mention the quality of service itself even gets low ratings from patients. AND then consider we have 50 million uninsured who are forced to go to the ER for everything — common colds, etc. — which costs a fortune, and thereby ensures their costs get passed on to everyone else who needs to go to ER for legitimate reasons.

      So, it is definitely a broken, corrupt system we have — which results in tens of thousands of unnecessary deaths each year. I applaud Amnesty International for bringing that into the public light.

  • | 191#
    Gilbert Hall
    Mar 16th, 2010 at 8:49 am

    I’m sure you’re right about US health care being a corrupt, broken system. My vote goes to the European model or the British model, though we don’t seem to have got things quite right in the UK yet. Perhaps maladministration has reached an extreme in the US where it has become a human rights issue. I’m much happier reading your arguments though. Even if Amnesty’s arguments are sensible on this issue, I’d keep them out of it. US democracy and freedom of speech will solve this issue if anything does. I’m an Amnesty member of 33 years standing.

    Thank you for an interesting exchange of views.

    • | 193#
      Mar 17th, 2010 at 1:55 am

      Thanks, Gilbert. I enjoyed the discussion as well.

  • | 203#
    May 5th, 2010 at 2:43 pm

    Something doesn’t add up. The U.S. has a lifetime risk of death from pregnancy related causes of 1 in 4800. But if you look at Georgia the lowest ranking state, they have a 20.5 in 100,000 maternal mortality ratio. That works out to 1 in 4878. Now I realize this are slightly different statistics they are comparing but come on.

    This is just another attempt by the WHO to socialize U.S. medicine.

  • Jun 18th, 2010 at 9:44 pm

    Thank you Stan for writing this article! I am currently in Midwifery school and have been studying the health disparities of women, particularly African American women within the U.S. So not only is the U.S. doing a terrible job providing for all women, it’s doing an even worse job for women of minority. Black women for example, are almost 3 times more likely to experience infant mortality than white women. Further, black women are much more susceptible to preterm labor (which is the leading cause of infant mortality) and new research is looking to stress caused by racism on a day-to-day basis as a primary reason for this. I also wanted to point out that the U.S. along with Swaziland, Liberia and Papau New Guinea are the only countries in the world that do not have a national policy when it comes to paid maternity leave…another unbelievable fact for a country with the “best health care in the world.”

  • Oct 18th, 2010 at 11:04 pm

    The following was a fantastic

  • | 405#
    Dec 5th, 2010 at 6:45 pm

    Where are the mortality rates for CALIFORNIA?

    • | 406#
      Dec 5th, 2010 at 10:23 pm

      35 — New Jersey, California (11.3)

  • Dec 18th, 2010 at 3:15 pm

    I usually insisting my dad that not all headlines posted on the internet are original but this post is surely an exceptional to my rule.

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