Oct 7, 2018 3 min read

Wander through any old cemetery and you’ll probably come across weather-battered, hard-to-read stones from the 1800s memorializing young women who died in their 20s or 30s, just as their lives should have been hitting full stride.

The ways one could die in 19th-century America were many and varied, given the hazards of living in an unsettled land, the prevailing obliviousness to sanitation, the primitive state of medicine and the cornucopia of diseases one could contract. But it’s a good bet that many of those women who perished in the prime of their lives were claimed by childbirth.

Though we now widely perceive childbirth as being a joyous event, for much of human history it has been a notably dangerous enterprise. It still is in many parts of the world, particularly in undeveloped outposts like Sierra Leone, South Sudan and Chad. The United States obviously does much better, but we don’t have reason to crow – compared to our industrialized peers, we have a higher maternal mortality rate. Even more worrying, the rate has been rising in recent years.

To put this in perspective, the United States’ rate of maternal deaths per 100,000 live births in 2015 was 26.4. In the same year, Britain’s rate was 9.2, Canada’s was 7.3 and Japan’s was 6.4. The rate of maternal mortality varies by state, with Pennsylvania experiencing 18.6 maternal deaths per 100,000 live births, which is better than two of our neighbors, Ohio and Maryland, but considerably worse than West Virginia, which has a rate of 12.9. The national “leader” in maternal mortality is Louisiana, followed by Georgia, Indiana and Arkansas. Overall, the rate of maternal mortality increased more than 25 percent in the United states between 2000 and 2014.

Experts have zeroed in on a number of factors, such as increasingly older mothers who might have pre-existing medical conditions before they deliver, or mothers who are obese, have diabetes or high blood pressure. Caesarean deliveries can cause excess bleeding, and the opioid epidemic is also thought to be a contributor.

Blame must also inevitably be placed on America’s health care system. Though the Affordable Care Act has expanded coverage, there are still many less well-off Americans who cannot afford health insurance, don’t receive it from their employer and are ineligible to receive Medicaid. This means crucial prenatal care, along with care after delivery, ends up being deferred or sought after it is too late.

Reproductive health programs have also been cut in some states by lawmakers eager to take a stand against Planned Parenthood, abortion or contraception.

On Tuesday, Gov. Tom Wolf announced the formation of a committee of medical professionals from across the commonwealth that will be exploring how to reduce the incidence of maternal deaths in Pennsylvania. That’s a good first step, but the state and the country’s rates of maternal mortality remain sobering reminders of the flaws in our health care system.

Let’s put it this way: The case for American greatness is wobbly when countries like Romania and Iran are seeing their rates of maternal mortality head downward, while ours is inching up.