U.S. Healthcare System ‘Consistently Fails’ Women of Reproductive Age

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The U.S. health-care system “consistently fails” to meet the basic needs of reproductive-age women, which may partly explain why women are more than three times as likely to die during pregnancy or shortly after childbirth in the United States compared with other high-income countries, according to new research from the Commonwealth Fund.

The United States has among the highest maternal mortality rates of high-income countries — a well-documented trend that is even worse among people of color and has accelerated during the pandemic. But a new report by the Commonwealth Fund found that U.S. women of reproductive age also fare worse when it comes to their general health and ability to access care.

Compared with women in other high-income countries, women of reproductive age (18-49) in the United States are more likely to be without a primary care doctor, struggle to pay medical bills, skip care because of cost, develop multiple chronic health conditions, and — ultimately — die from avoidable causes, according to the report, which analyzed data from the Commonwealth Fund’s 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development (OECD).

“U.S. women are sicker, more stressed, and die younger compared to women in other countries,” said Munira Gunja, a senior researcher with the Commonwealth Fund and the report’s lead author. “This is largely because so many of them lack access to needed care.”

An inadequate primary and preventive care system may partially explain the high maternal mortality rate in the United States. Women are more than three times as likely to die during pregnancy or shortly after childbirth in this country compared with other high-income countries. Maternal mortality is even higher among Black women.

“When we talk about people of reproductive age, we have to look beyond maternal care,” said Gunja. “It starts with primary care and preventative care.”

Researchers found that not only are women in the United States far more likely to die during pregnancy or childbirth compared with other high-income countries, they also experience higher rates of other health challenges:

  • U.S. women were far more likely to have high out-of-pocket costs for health care. About 27% of U.S. women said they spent more than $2,000 on health care, compared with 13% in Australia and 8% in Canada. Most other high-income countries provide universal health care, which funds health care through tax revenue rather than from patients.

  • U.S. women were also more likely to report problems paying medical bills and skipping needed care because of cost. Even with health insurance, people may find care is too expensive, especially if their plan has a high deductible that requires them to spend thousands of dollars out of pocket before the plan pays a greater portion of bills.

  • One in five U.S. women reported having two or more chronic health conditions. In Switzerland, Germany, Sweden, and France, fewer than one in 10 women had two or more chronic conditions.

  • The United States has the highest rate of avoidable deaths among women, compared with other high-income countries. Avoidable deaths are those that could have been prevented with routine care, such as cancer screenings and vaccinations.

In the report, Gunja and coauthor Laurie Zephyrin, a vice president at the Commonwealth Fund, urged lawmakers to consider how the pandemic has affected women and how to improve health resources.

For instance, Gunja said, midwives and doulas are go-to medical professionals for women in European countries. Midwives and doulas are less common in this country, and those who are available often are not covered by insurance.

“We know that investing in gender-centered care benefits everyone,” Zephyrin said in a statement. “It is time for policymakers to take a lesson from other countries and make these critical investments.”

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