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Nearly 84 million people live in areas with shortages of healthcare providers, mostly in rural or under-resourced urban communities.

Shortages of obstetricians, midwives, hospitals, and birth centers mean that some people, especially in rural areas, have to travel an hour or more to get basic prenatal and delivery care. For women with complications who need to see a specialist, the drive can be prohibitive – as long as 5 hours round trip – leading some women to go without the level of care they need for the best chance at a healthy birth.

Every Mother Counts is supporting the Improving Access to Maternity Care Act to identify maternity care shortage areas and fill those gaps. The bill is currently before the United States Senate.

The countries with the best maternal health outcomes also have universal health coverage.

America’s healthcare system is the most complicated and expensive in the world. This means that many people go without the care they need. Uninsured women are more likely to forego preventive care, such as annual gynecological exams, which is important for a healthy pregnancy and can help identify problems early. In 2016, approximately 11% of adult women (not including the elderly) were uninsured. People of color are more likely to remain without coverage; among low-income women, Latinas and Black women have significantly higher uninsured rates (32% and 16%, respectively) compared with white women (12%).

Many states have expanded the number of people eligible for Medicaid resulting in 11 million more people being insured.

When women are unable to access affordable health insurance or a regular provider, they are more likely to enter into pregnancy with chronic conditions.

Some of the most common chronic health conditions — high blood pressure, diabetes, and obesity – contribute to higher risk in pregnancy and birth. Following the Affordable Care Act, 19 states, mostly concentrated in the South, decided not to expand Medicaid. As a result, 3.1 million poor, uninsured adults fall into a “coverage gap” — they earn too much to qualify for Medicaid but not enough to purchase insurance on the Marketplace.

Women with consistent access to a healthcare provider throughout their lifetimes are more likely to manage or address risks or complications early and maximize the chances of a healthy pregnancy and birth.

The United States’s national cesarean section rate is nearly 32%.

The WHO has found that rates higher than 10% do not offer benefits to mothers or babies. In addition to C-sections, overused procedures include: inducing labor early, requiring women to stay in bed, and restricting food and drink. Because all medical procedures come with risks as well as benefits, procedures should not be used for the convenience of maternity care providers or facilities and should always be performed with the mother’s consent. For example, if a mother does not want to be induced, she should not be induced.

Many hospitals and provider practices are committing to improving maternal healthcare by revising OB and hospital practice guidelines to prevent C-sections and premature deliveries and to allow women to labor longer. Additionally, midwifery care results in lower rates of interventions, such as induction of labor, epidural use, and continuous fetal heart monitoring, and leads to higher rates of normal vaginal delivery.

Chronic stress related to racism and social inequities contribute to a higher risk of complications and death for women of color.

The differences in maternal outcomes based on race, ethnicity, socioeconomic status, and indigenous status are stark and are among the most extreme in any area of health in the United States. For the last 60 years, Black women have consistently been 3 to 4 times as likely to die from a complication of pregnancy or childbirth. Maternal mortality rates are two times as high for women living in counties with high poverty rates, compared with women living in counties with low rates of poverty.

Community-based organizations, including Commonsense Childbirth, offer proven solutions that can be expanded into more communities.

Pregnant women need more than a 10-minute visit with a doctor once a month to have a healthy childbirth.

Many pregnant people, especially those enrolled in Medicaid, see different care providers at each of their prenatal visits and meet the physician or midwife attending their birth for the first time when arriving at the hospital in labor. Without providers who collaborate to function as a care team, information often falls through the cracks. In addition, many women don’t know about available support services or have difficulty navigating a complex health system.

An integrated and comprehensive approach to care can have a powerful beneficial impact, especially for those at the greatest risk of poor health outcomes. Addressing the pregnant person’s individual needs, whether for nutrition and exercise counseling, childbirth education, breastmilk feeding support, home visits, or assistance coordinating and following up to receive needed care and services. A comprehensive, coordinated approach to care can make a difference in achieving a safe and healthy birth.

Community-based doula programs and maternity care homes offer the kind of coordinated and comprehensive approach that meets women’s needs and puts them at the center of their care.

Many women report feeling that their concerns, values, preferences, and voices are disregarded in care related to pregnancy and childbirth.

In the U.S., women have reported a range of disrespectful, coercive, and abusive behaviors. Women relate that they have been ignored, shouted at, or threatened (including with coerced or withheld treatment or with calling child protective services), having their physical privacy violated, and, more rarely, experiencing physical abuse. A disturbing number of cases have been documented where women with a life-threatening complication know something is wrong, but their requests for help went unheeded.

The midwifery model, doula support, maternity care homes, and other patient-centered models of care emphasize the value of respectful, equitable treatment and focus on engaging women in decisions and putting the woman at the center of their care. When women develop a trusting relationship with their providers, they are more likely to share relevant health information, which can make the difference in their getting the help they need.

Organizations like Every Mother Counts and our partners work with communities to expand access to care models that prioritize respectful treatment and trusting relationships, such as the midwifery model and doula support. We help raise awareness about women’s rights regarding pregnancy and childbirth care.