U.S. Has Highest Maternal Death Rate Among High-Income Countries, Experts Cite Funding Gaps

The United States has the highest maternal death rate of any high-income country, largely due to a lack of federal funding for pregnancy research, according to a review published today in JAMA Health Forum by a panel of women’s health experts, including Andrea G. Edlow, M.D., MSc, Vincent Center for Reproductive Biology, Massachusetts General Hospital.

In 2022, there was an average of 22 deaths per 100,000 live births, according to The Commonwealth Fund. By comparison, in 2021 there was an average of 3 maternal deaths per 100,000 live births in Japan and Sweden.

“If we are to improve pregnancy outcomes in the US and promote women’s health in general, it is critical to ensure that research dollars and decisions about funding priorities reflect the views of those who are on the front line and are most familiar with the issues and what is at stake: obstetrician-gynecologist physician-scientists,” Edlow and her colleagues wrote.

The panel specifically called for:

1) Increased spending on women’s health research to reflect that the benefits gained from this research affect half the population.

(2) Engagement of obstetrician-gynecologist physician-scientists to set funding priorities.

(3) A whole-of-the-NIH approach alongside engagement of other key funders and stakeholders.

In the last decade, the National Institutes of Health (NIH) spending on women’s health research has averaged just 8.8% of the total budget—only a fraction of this went to pregnancy research.

Most of the pregnancy research is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) because of the societal focus on the child as the center of perinatal research. However, NICHD’s proportion of funded grants is lower than nearly every other NIH institute. The NICHD also limits funds per investigator to distribute funds more broadly.

New efforts, including the NIH’s Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative, haven’t been enough to support needed research. As a result, many maternal health researchers must rely on philanthropic or industry-sponsored funding, which is also limited.

“The conversation needs to encompass not one institute, but the whole of the NIH—because all the Institutes and Centers have a role to play in optimizing the health of US women,” the authors write. “At a time when care by gender is under attack,⁴ now is precisely the time to rethink how funding should most efficiently be deployed for women across the NIH and beyond to support the health of half the US population.”

For example, a 2023 study found that maternal mortality was 62% higher in states with abortion bans than in states with greater access to abortion.

Additionally, in February, the Centers for Disease Control and Prevention were instructed to remove or edit references to transgender people, gender identity and equity from its website to comply with an order from the federal Office of Personnel Management.

“The universality of women’s health is even more salient for pregnancy, as pregnancy affects nearly everyone in the US—men and women—and optimizing the health of pregnant women is essential to a productive and healthy society. And it is only through research that we can establish the root causes of—and find and test evidence-based solutions for—the country’s severe maternal morbidity and mortality crisis,” the authors said.