21st October, 2019

Good morning <<First Name>>,

We hope you had a wonderful weekend, jam-packed with Autumnal fun.

Last week we saw 12 Democratic presidential candidates ascend the stage in Ohio for the largest and most substantive debate in the primary thus far.

Healthcare has been a key topic of discussion throughout this election cycle, and Wednesday was no exception. But this time around Kamala Harris directed candidates' attention to an area that has been largely ignored in previous debates, an omission she referred to as "outrageous" - women's access to healthcare. “There are states that have passed laws that will virtually prevent women from having access to reproductive health care," she reminded the audience. "And it is not an exaggeration to say women will die.” 

So, we thought this an opportune moment to revisit an important topic we covered in the summer: maternal mortality. It's an issue that has been under-reported for decades, but one that affects hundreds of women across America every year. Finally, it's started to garner the political attention it deserves with several Democratic candidates, including frontrunner Elizabeth Warren, having introduced proposals aimed at tackling poor maternal health outcomes. 

We're republishing summer's newsletter, so if you missed it or want a quick refresh, check out our great selection of podcasts below and learn about the background, the causes, and the potential solutions to America's maternal mortality crisis.

Enjoy the week ahead!

How to access the podcasts:

Option 1: Click the ListenNotes link below for the full easy-to-use playlist.  To learn how to download into your preferred podcast app using the RSS feed follow the tutorial on our Instagram story.  

Option 2:  For those of you who love Spotify, we now have all of our playlists there as well!  If you want to access our full playlist there, click on the link below. 

Option 3: Click on any of the podcast pictures when you scroll down to go to the individual episode on the podcast host's website, or on the app links to take you directly to the episode on Apple Podcasts or Spotify.
Maternal Mortality:

Defined as the death of a mother from pregnancy-related complications while she’s carrying or within 42 days after birth.

The Issue:
  • The United States now has a higher rate of maternal mortality than any other developed country in the world - according to a study by The Lancet, the maternal mortality ratio in the U.S. was 26.4 per 100,000, compared to 7.2 per 100,000 in Western Europe in 2015.
  • While in other countries maternal death rates have been falling consistently, dropping by roughly 48% in developed countries between 2000 and 2014, in the U.S. this number has increased by 27% over the same period. What’s worse, according to recent research by the Centers for Disease Control, 60% of these deaths are preventable. 
  • The problem is worst amongst black women in the U.S. who are three to four times more likely to die from pregnancy-related complications than their white counterparts. This means that for every 100,000 live births, nearly 43 black women will die. This constitutes one of the widest of all racial disparities in women’s health and is an issue that cuts across class, educational and income lines. Think of Serena Williams, the world famous tennis champion whose recent experience of complications after giving birth highlighted the persistence of racial inequalities that haunt the U.S. medical system. 
  • Maternal mortality rates vary from state to state, but according to a recent USA Today investigation, they range from a low of 4.0 deaths per 100,000 births in California to a high of 58.1 deaths per 100,000 births in Louisiana (these numbers are taken over the course of the study period from 2012 to 2016).
  • In December 2018 President Trump signed the “Preventing Maternal Deaths Act”, which will provide federal grants to states to fund investigation into the causes of maternal death.

The Causes:
  • There are a multitude of reasons surrounding America’s increased rate of maternal mortality. For example:
  • There has been a huge rise in medically unnecessary, so-called "elective", C-sections, which can increase the risk of life-threatening complications during childbirth. 
  • More pregnant women in the U.S. have chronic health conditions, such as diabetes and obesity, which puts them at greater risk of pregnancy complications.
  • New mothers are often older than they used to be and have more complex health histories.
  • In states across the country, women are being removed from their Medicaid coverage within 60 days of giving birth, putting new mothers who experience postpartum complications at greater risk.
  • In recent decades, there has been a prevailing assumption that maternal mortality is an issue that’s largely been dealt with, so the healthcare system has shifted focus to fetal and infant safety, and away from maternal health. Under the Title V federal-state program that looks at maternal and infant health, for example, states devoted 78% of their budgets on infants and special-needs children, compared to 6% on maternal health.
What The Candidates Say:
  • Senator Kamala Harris: recently reintroduced a bill called the Maternal Care Access and Reducing Emergencies (CARE) Act, aimed at tackling racial disparities in maternal care.  
  • Senator Cory Booker: alongside Rep. Ayanna Pressley, introduced a bill to expand Medicaid coverage for pregnant women and new mothers. It is called The Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act. 
  • Senator Elizabeth Warren: recently announced plans to hold health systems accountable for protecting black mothers. If health systems are able to reduce maternal death rates for Black women, they will be rewarded a bonus. But if they are unable to decrease the rates, "money will be taken away from them.”


Maternal mortality has been rising in the U.S. for the past 30 years. Yet it is a crisis that’s gone largely under-discussed and under-reported. Pro-Publica and NPR’s collaborative series “Lost Mothers” sought to change that, covering the stories of those who have been affected by complications surrounding childbirth and pregnancy, and investigating the myriad failures of the U.S. healthcare system in perpetuating this issue. In this episode, we hear from ProPublica reporter, Nina Martin, on what prompted her to start this landmark investigation into America’s maternal mortality crisis and what she discovered in the process.

*Unfortunately this podcast is not available on Spotify, so you won't be able to find this episode on your playlist there.



You are three times less likely to die giving birth in California than in the rest of the country. Why? Because of The California Maternal Quality Care Collaborative, which, founded in 2006, set up a review committee to gather data, for the first time, on maternal health and conduct research into tackling preventable causes of pregnancy complications. The organization revolutionized how the state approached maternal health and through rolling out quality improvement toolkits and state-wide outreach collaboratives, has helped drive down California’s maternal mortality rate by 55%.
In this episode, Vox’s ‘The Impact’, examines how this approach has worked, and the bad policy decisions that have been driving up maternal deaths throughout the rest of the country.



We are finally beginning to talk about the racial disparities surrounding pregnancy and childbirth in America. Black mothers are more likely to die from pregnancy-related causes than white women. And black babies are twice as likely to die in their first years as white babies. But what are black mothers supposed to do with this information as they consider pregnancy? In this episode, The Stakes examines what it means to be pregnant and black in America. 


This rounds up our deep dive, but stay tuned as we will return to Healthcare Reform in a few weeks time.

Words by: Emma-Louise Boynton
Editing by: Jim Cowles, Stacy Perez and Emma-Louise Boynton

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