Turning Our Backs on American Infants and Mothers

American women continue to have the highest rate of death before, during and after childbirth, compared to any other high-income country in the world. The worst part: about 80% of those deaths are likely to be preventable, according to a 2024 brief from The Commonwealth Fund.

This has been a crisis since before the current president came back into power, but with threats to Medicaid looming and some of the structural issues around the problem yet unresolved, it appears the problem is going to get worse.

Here’s an example of how a lack of informed perspective on diversity, equity and inclusion efforts could interrupt efforts to fix this: In the U.S., the maternal death rate in 2023 was highest for Black women, at a rate of 49.5 deaths per 100,000 people. Compare that to 22.3 deaths per 100,000 for white women — or the rate of 8.4 for women in Canada, and 1.2 for Switzerland — and it’s clear there’s a serious problem. Mounting any effort at the federal level to address these racial disparities seems a distant possibility at the present time.

Here are some other things to know:

The U.S. and Canada have some of the lowest rates of midwives and OBGYNs per capita. Currently, downward pressure on people leads to abandonment of the profession here in the U.S., or others choosing not to join, when in states such as Texas and Idaho, some of these providers can be prosecuted for providing life-saving care, and are sometimes targeted with violence.

In countries with less-abysmal rates of maternal death and these types of threats, midwives and home health providers are a big part of the equation.

“Visits by a midwife or a nurse are associated with improved mental health and breastfeeding outcomes as well as reduced health care costs. Home visits give providers an opportunity to address maternal and mental health concerns as well as to assess the mother’s available supports and social drivers of health, including needs for food, housing, financial security and protection from domestic violence,” The Commonwealth Fund’s brief described.

Here in the U.S., much of that vital care is provided to low-income women through Medicaid, a program that the president campaigned on leaving alone. Yet, this past week, he endorsed a budget that would cut Medicaid funding. As of August 2024, some 23% of Oregonians — around 1,427,00 people — were covered by the Oregon Health Plan or CHIP, both health insurance programs funded by the federal government, according to data from the Kaiser Family Foundation. Some 44% of births in Oregon are covered by Medicaid.

Here in our state, paid leave is a bright spot Oregonians enjoy, and one that can have an impact on postpartum outcomes. Oregon recently implemented a state-level version of paid family leave just last year, making it among 13 states, and the District of Columbia, to have such a program in place. Were it to be implemented at the national level, “a federally mandated paid leave policy would be especially beneficial to Black and lower-income women, who are less likely to have a paid leave policy through their employers,” according to The Commonwealth Fund brief.

If Americans are not yet deeply troubled by the rapid slashing of the lifesaving support our country provided through U.S. Agency for International Development; if they’re not ashen at the appalling conditions and treatment of the migrants who are in the process of being deported; our hope is that they’ll draw the line at cutting vital support for infants and their mothers. Inside this Women’s Issue, we can only hope.

A groundswell of concern over potential cuts to Medicaid, directed at members of Congress, would be the ideal place to begin to push back. But funding nonprofits that provide vital medical services — and recognizing the need for more providers in the realm of reproductive health, not fewer — would be another.

This article appears in The Source Weekly February 27, 2025.