A social law lens on maternal mortality in the U.S.: Lessons from Germany and the Netherlands

• Published in: European journal of public health Vol. 30; no. Supplement_5
• Main Author: Tonti, L
• Format: Journal Article
• Language: English
• Published: Oxford Oxford Publishing Limited (England) 01.09.2020
• Subjects: Access; Appeals; Birth; Births; Codification; Compensation; Developed countries; Fatalities; Insurance; Law; Legislation; Maternal mortality; Midwifery; Mortality; Mortality rates; Policy making; Postpartum period; Pregnancy; Public health; Race factors; Racial inequality; Social security; Statistics; United States > US; Netherlands; Germany
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckaa165.1123

Abstract The United States has one of the worst maternal mortality rates among developed nations. American mothers are three times more likely than Canadian mothers and six times more likely than Scandinavian mothers to die from pregnancy-related deaths. Currently, for every 100,000 live births, 26.4 mothers are dying in the U.S, with significant disparities between White mothers and mothers of color. Projections indicate that by 2030, the maternal mortality rate will rise to 45 maternal deaths out of 100,000 live births. In direct contrast, most other similarly situated high-income nations have decreased their maternal mortality rates in recent years, evidencing only single-digit mortality per 100,000 mothers. This research examines how social protection measures afforded by the law can facilitate differences in these rates. Specifically, this presentation compares legal interventions enshrined in social law that impact maternal health in the United States, Germany, and the Netherlands, including mandated access to prenatal care, midwifery reimbursement, and obligatory duration of postnatal care. Compared to the United States, both Germany and the Netherlands enshrine more comprehensively midwifery compensation and access to postnatal care in their social legal codes and insurance benefit schemes. Evidence accumulated by comparing these interventions with maternal mortality statistics suggests that legal interventions that spur extra attention to mothers during and after birth may help prevent pregnancy-related deaths. It also opens a discussion about how policymakers can use legal interventions to help eliminate racial disparities in maternity practice. Key messages Codified legal interventions that mandate extra attention to mothers during and after birth may help prevent pregnancy-related deaths. Compared to the U.S., both Germany and the Netherlands better enshrine midwifery compensation and access to postnatal care in their social legal codes and insurance benefit schemes.