Maternal deaths on the rise in the United States

The United States is among just eight countries in the world to experience an increase in maternal mortality since 2003 - joining Afghanistan and countries in Africa and Central America, according to a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The study, "Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013," published May 2 in The Lancet, ranked the United States number 60 in the list of 180 countries on maternal deaths, compared to its rank of 22 in 1990, demonstrating how it has fallen behind globally. By contrast, China rose to number 57, up from number 116 in 1990.

In the US, 18.5 mothers died for every 100,000 live births in 2013, more than double the figures for maternal mortality in Saudi Arabia (7) and Canada (8.2), and more than triple that for the United Kingdom (6.1).

The biggest increase in maternal mortality by age group occurred in women 20-24. In 1990, 7.2 women in this age group died for every 100,000 live births and in 2013, 14 died for every 100,000 live births.

The study findings focus on measuring the trends in maternal mortality, but the researchers offer a range of possible explanations for the disparities between the US and other countries, including lack of access to prenatal care and other health services, high rates of caesarian section deliveries, and pregnancies complicated by obesity, diabetes, and other conditions.

"For American women, high-risk pregnancies and the number of women with inadequate access to preventive and maternal health care are just two potential causes of this trend," said study author Dr. Nicholas Kassebaum, Assistant Professor at IHME. "The good news is that most maternal deaths are preventable, and we can do better."

The first installment in IHME's new updates to the Global Burden of Disease (GBD) study finds that globally, maternal deaths fell significantly between 1990 and 2013, but 293,000 women still died in 2013 from pregnancy-related causes. In the US, 796 women died in 2013.

The vast majority of countries have seen accelerated reductions in maternal mortality - with maternal deaths declining by 2.7% per year since 2003.

The leading cause of maternal death globally is medical complications of childbirth and the period post-delivery. Approximately one-quarter of maternal deaths were found to occur during childbirth and the 24 hours following. Another quarter happen during pregnancy, and the remaining deaths occur up to one year after delivery.

A separate study also released on May 2 in The Lancet examined child survival rates and found that 28,000 children under age 5 died in the United States in 2013. Child death rates in the US declined throughout 1990-2013, but the pace of the declines has slowed. During the 1990s, child mortality declined 3.2% annually, and after 2000, the rate slowed to 1.7%.