By Rose Morrison, managing editor of Renovated
Maternal mortality is unacceptably high, even in developed countries. Women often receive inadequate care before, during and after pregnancy. Making maternity care sustainable is key to saving millions of lives, mitigating the effects of climate change and giving future generations the tools they need to succeed. What can providers do to make this possibility a reality?
Why Maternal Health Care Must Be Improved
Women’s health care — particularly maternity care — has been historically overlooked. An unacceptably high number of women who have been in a delivery room can share their experiences with medical malpractice or a doctor’s dismissiveness.
Kimberly Turbin knows the reality of medical mistreatment all too well. She was mid-contraction when her doctor announced he was going to perform an episiotomy — an incision made to the vaginal area to ease delivery. As she questioned the need for one, he made 12 cuts with surgical scissors. Afterward, Turbin visited 80 attorneys for help. None would take her case.
Unfortunately, Turbin isn’t alone. One study revealed that 13.4% of birthing people have reported experiencing mistreatment during childbirth. Those who were unmarried, obese, queer or insured by Medicaid had a higher risk of being treated poorly, suggesting widespread social stigmas influence providers’ quality of care.
Legal cases like Turbin’s are often challenging and expensive to litigate. As a result, many women remain silent. Many mothers who share their experiences feel a sense of guilt or anxiety for publicly condemning the professionals who helped them deliver a healthy baby.
Tragically, many never even get to share their stories. According to the World Health Organization (WHO), a maternal death occurred, on average, around every two minutes in 2020. Even though developed nations have made significant strides in modern medicine, the current state of maternal health care remains unacceptable.
Whether the birthing experience is traumatic or blissful, new mothers are often underserved. For many, motherhood triggers postpartum mental health issues. Research shows around one in seven will develop postpartum depression. However, few receive adequate postnatal care unless they select a health care facility offering post-delivery support and assistance.
Lastly, maternal health doesn’t just impact the mother — it has lasting effects on a child’s development. Poor maternal health during early pregnancy has been linked to congenital anomalies, which are structural or functional conditions present at birth.
One example is microtia, a condition where the outer ear is underdeveloped, often due to disruptions in fetal development during the first trimester. These anomalies can result from factors such as malnutrition, infections, or exposure to harmful substances during pregnancy. Strengthening maternal care and ensuring prenatal support can reduce such risks, making quality maternity services even more essential.
Photo by Evie S. on Unsplash
What Makes Maternal Health Care Sustainable?
Sustainability is defined as the ability to support a process over time without compromising the environment, society or economy. Here is what that looks like in maternity care.
The Environment
Improved access to women’s health services can help countries achieve sustainable development goals. Since the United Nations Environment Programme reports that gender inequality can compound climate change’s effects, enriching care for pregnant people should be a top priority.
People deserve access to high-quality, affordable support with a minimal environmental impact. Well-equipped local hospitals are ideal because they support patient-provider relationships. Moreover, they reduce transportation-related greenhouse gases and minimize waste, meeting the needs of current and future generations.
Society
Addressing the needs of pregnant, birthing and postpartum individuals is fundamental to improving society. The more a country invests in women’s health, the more it contributes to the well-being and functionality of communities nationwide. Moreover, it ensures future generations will enter the world with much-needed support.
The Economy
Patients often must pay out of pocket in countries without universal health care. The cost of childbirth in the United States was around $13,400 on average. This expense makes motherhood economically unsustainable — many simply cannot afford to have children. Going into debt to start a family unnecessarily contributes to poverty and gender inequality.
Moreover, although women tend to live longer than men, they spend 25% more of their lives in poorer health — the equivalent of 75 million years of life lost each year. The McKinsey Health Institute estimates addressing this disparity would boost the global economy by at least $1 trillion yearly by 2040, contributing to sustainable economic growth.
How Can Health Care Sustainability Be Measured?
Health care sustainability is somewhat subjective. However, while standardizing measurements is challenging, it is not impossible. Doing so would be time-consuming and resource-intensive, but establishing a data-driven baseline is essential for identifying and addressing the causes of mistreatment, inequalities and fatalities in hospitals and birth centers.
Gauging the Environmental Impact
Calculating the difference sustainable maternity care would have on climate change is challenging because there are so many variables to consider. Instead, hospitals should measure how fostering patient-provider relationships and utilizing resources reduces their direct and indirect greenhouse gas contributions.
Measuring the Economic Impact
To measure the economic impact of sustainability efforts, individuals can evaluate how maternal and gynecological conditions affect women’s impact on the gross domestic product (GDP) — their contributions to the value of goods and services produced in the U.S. Metrics like sick days, disability benefits and fatalities can help them arrive at an exact figure.
From there, data scientists can see how funding maternity care would increase women’s average per capita GDP. Alternatively, economists could calculate the economic impact of making pregnancy, childbirth and postpartum care affordable. Many people would feel empowered to give birth if they knew they’d receive support throughout their journey.
Evaluating the Societal Impact
Measuring maternal care sustainability through the lens of societal growth is possible. Researchers must establish a baseline for inequalities in sex-specific health care and then follow its changes after solutions are implemented. For example, they could track fatalities by ethnicity to determine if mothers belonging to minority groups are receiving equal care.
Why Better Maternal Health Datasets Are Needed
Measuring the effects of sustainability efforts is only possible with an accurate, agreed-upon baseline. Unfortunately, in the U.S., each state has its own system for collecting data on maternal health and mortality. The collection methods — and the information quality — vary dramatically from state to state.
Some maternal mortality experts say figures are often over- or underreported due to unreliable reporting. For example, if no autopsy is performed to verify whether someone was pregnant before their passing, they will not be included in the database — even if a pregnancy-related condition contributed to their death.
When clerical issues like these happen, women fall through the gaps. Telling their stories is an integral part of shaping care for future parents, ensuring preventable complications and treatable conditions are taken seriously.
Crucially, unreliable datasets and historical underreporting are not issues of the past. For instance, in September 2024, the Texas committee that examines pregnancy-related deaths announced it would not review cases from 2022 and 2023. Several committee members expressed concern over the decision since it comes in light of a near-total abortion ban.
In 2023, Idaho lawmakers disbanded the maternal mortality board by tabling the bill that would renew it — even though it received federal funding and required no state funds. For a time, it was the only state without one. While policymakers voted to reestablish the review committee, their initial short-sighted dismissal demonstrated the necessity of standardization.
5 Key Factors for Maternal Health Sustainability
Although the state of women’s health care is, in many ways, lacking, implementing a handful of changes would almost immediately right an enormous number of inequalities. Here are five key factors required to make maternal care sustainable.
- Expand Prenatal Education
Pregnant women should know more about their options so they can make informed decisions during pregnancy and exercise their autonomy in the delivery room. In nearly 48% of cases, this information gap is the leading barrier to the utilization of maternity services in low- and lower-middle-income countries.
- Enhance Information Collection
Improving the collection and auditing processes for maternal mortality data will lead to more accurate, actionable insights. States can then work to address the root cause of fatalities, saving lives and fostering a more sustainable system for future generations.
- Remove For-Profit Incentives
For-profit incentives can compel doctors to rush births so they can fill operating rooms, leading to lower-quality care. This trend disproportionately impacts marginalized groups. According to the National Bureau of Economic Research (NBER), black mothers are around 25% more likely to deliver by cesarean section (C-section) than white mothers.
NBER’s research revealed this gap disappeared when the cost of ordering an unscheduled C-section was higher than vaginal delivery, suggesting the decisions were made at the provider’s discretion rather than to ease childbirth or save the mother’s life. Removing for-profit incentives may be essential for improving patient outcomes and the birthing experience.
- Improve Access to Midwifery
So-called “maternity care deserts” in the U.S. affect up to 6.9 million people and impact nearly 500,000 births. Improving access to midwifery by expanding private health care coverage or offering federal grants would drastically improve care in underserved areas.
- Expand Medicaid Coverage
Federal law requires states to provide Medicaid coverage for pregnancy up until 60 days postpartum for those who earn up to 138% above the federal poverty level. If a couple earns a few dollars over $28,200 a year — 138% above the $20,440 poverty line — they may have to pay out of pocket.
While access to adequate care is a global issue, the U.S. is among the worst-ranked developed countries for maternal mortality rates. Having Medicaid cover individuals at 250% of the federal poverty level — and extending the postpartum coverage period to 12 months — could improve the lives of millions of new parents.
Sustainable Solutions to Maternal Health Care
Carrying a pregnancy to term is inherently risky. Rapid hormonal and physical changes can trigger or exacerbate health conditions. Moreover, complications during childbirth are common. Frankly, whether or not a pregnant woman will receive equitable care should be the last thing on their mind. Sustainable solutions are crucial for supporting the well-being of millions of women.
About the Author
Rose is the managing editor of Renovated and has been writing in the construction industry for over five years. She’s most passionate about sustainable building and incorporating similar resourceful methods into our world. For more from Rose, you can follow her on Twitter.