Last month, we sat with the truth that the U.S. has the highest maternal mortality rate among high-income countries.⁰ We looked at the racial, geographic, and systemic disparities that drive that outcome — especially for Black and Brown women.
This month, we ask the harder question:
What will it take to fix it?
Because other countries have.
Because it’s not inevitable.
Because we can choose better.
The U.S. vs. the World: A Stark Contrast
Let’s start with the numbers:
- United States (2021): 32.9 maternal deaths per 100,000 live births
- United Kingdom: 3.6 deaths
- Germany: 3.2 deaths
- Canada: 8.4 deaths
- Japan: 3.4 deaths
- Sweden: 2.0 deaths¹
Not only is the U.S. rate more than 10x higher than countries like Sweden — it’s getting worse, not better. Much of that increase came after 2020, and disproportionately affects Black women, low-income patients, and people living in maternity care deserts.²
So What Are Other Countries Doing Right?
- Midwifery-Integrated Models: In places like the Netherlands and New Zealand, midwives are not only trusted providers — they’re central to the maternity care model. Care is collaborative, home births are supported with backup hospital plans, and patients receive longer prenatal appointments.
- Universal Health Coverage: In the U.K., Sweden, and Japan, pregnancy-related care is free at the point of service. No insurance gaps, no billing departments sending stress-inducing invoices while someone recovers from birth trauma. That financial consistency means more checkups, more continuity, more prevention.
- Paid Parental Leave: The U.S. is 1 of 6 countries in the world with no national paid parental leave.³ Meanwhile, Sweden offers 480 days. Canada offers 40+ weeks. And the result? More time to heal. Less postpartum depression. More consistent follow-up care.
- Data Systems That Center Equity: Countries like the U.K. and Australia publicly track and report maternal outcomes by ethnicity, location, and income. This transparency forces accountability. The U.S. still has patchy, siloed data systems — and most state maternal review boards lack real enforcement power.
- Trauma-Informed Postpartum Support: Some countries offer at-home nurse visits within 48 hours of delivery — a model shown to reduce ER visits and detect postpartum complications early. In the U.S., many new parents are told, “See you in six weeks,” even after C-sections or high-risk births.
What the U.S. Could (and Should) Do
Here are actionable, evidence-based steps the U.S. can take — tomorrow — if the will exists:
| Policy Recommendation | Modeled After | Why It Works |
|---|---|---|
| Medicaid extension to 12 months postpartum 4 | Already adopted in 44 U.S. states | Reduces maternal deaths |
| National midwifery integration standards | New Zealand, U.K. | Improves continuity and lowers C-section rates |
| Universal paid parental leave 3 | Sweden, Canada | Improves recovery, bonding, mental health |
| Community-based perinatal health workers | NYC, Baltimore, national pilots | Builds trust and bridges care access gaps |
| Required hospital reporting of maternal outcomes | U.K., Australia | Increases transparency and accountability |
| Expanded telehealth & mobile maternity clinics | Rwanda, India (rural models) | Reduces rural access barriers |
| Fund culturally competent postpartum mental health | Multinational best practices | Reduces depression, improves outcomes |
Sources:
- CDC: Maternal Mortality Rates
- March of Dimes: Maternity Care Deserts
- OECD: Parental Leave Systems
- KFF: Medicaid Postpartum Extension Tracker
What You Can Do (Even If You’re Not a Legislator)
- Support organizations like Black Mamas Matter Alliance
- Ask your representatives to support bills like the Momnibus Act
- Advocate for hospital review boards with patient representation
- Normalize postpartum mental health screening and support
- Be the friend who checks in on new parents — not just the baby
From Advocacy to Action
You don’t have to be a lawmaker to change outcomes. You can be a medical student who learns to listen more than speak. A clinician who pauses before rushing. A future SAFE who understands that childbirth and assault survival sometimes intersect. A public health writer who chooses to keep saying the hard things.
And if you’re one of the newly matched residents from last month — you are the future this system needs. Learn from the countries that do better. Then fight for something even better here.
We don’t have to settle for the highest death rate.
We don’t have to normalize suffering.
We can build the fix.
— Advocate in Scrubs
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