Maternal mortality in the United States: a human rights failure.

With 99% of maternal deaths occurring in developing countries, it is too often assumed that maternal mortality is not a problem in wealthier countries. Yet, statistics released in September of 2010 by the United Nations place the United States 50th in the world for maternal mortality — with maternal mortality ratios higher than almost all European countries, as well as several countries in Asia and the Middle East [1,2]. Even more troubling, the United Nations data show that between 1990 and 2008, while the vast majority of countries reduced their maternal mortality ratios for a global decrease of 34%, maternal mortality nearly doubled in the United States [1]. For a country that spends more than any other country on health care and more on childbirth-related care than any other area of hospitalization — US$86 billion a year — this is a shockingly poor return on investment [3,4]. Given that at least half of maternal deaths in the United States are preventable [5], this is not just a matter of public health, but a human rights failure [6]. The Universal Declaration of Human Rights states that “every human being has the right to a standard of living adequate for the health and well-being of himself and his family, including medical care and necessary social services” [7]. This means that the United States health care system must provide health care services that are available, accessible, acceptable and of good quality [8]. In addition, the health care system must be free from discrimination, must be accountable and must ensure the active participation of women in decision-making. Yet, instead, too many women in the United States face shortages of providers and facilities and inadequate staffing; financial, bureaucratic, transport and language barriers; care that is not culturally appropriate or respectful; a lack of opportunity for informed decision-making and the lack of a system to ensure that all women receive high-quality, evidence-based care. The comparatively high rates of maternal deaths in the United States is an indicator of the failure to ensure that women have guaranteed lifelong access to equitable, quality health care, including reproductive health services. Indeed, in countries such as Canada and the United Kingdom where maternal deaths are reviewed and universal access to health care is guaranteed, fewer women die of preventable causes during childbirth than in the United States.