Updated | Washington, D.C., is one of the worst places in America to be a mother, and it has the highest infant mortality rate of any capital city in the developed world, according to new study.
Disturbing data about persistent health care gaps in the United States are detailed in State of the World’s Mothers 2015: An Urban Disadvantage, a new report from humanitarian relief organization, Save the Children. The report, which looks at the situation for maternal and infant health across 179 countries and focuses on the urban poor, found that mothers in the U.S. are more likely to die than those in other high-income countries.
"In some U.S. cities, urban child survival gaps between rich and poor are greater than those found in developing countries," according to the report.
The national infant mortality rate, or deaths of children under 1-year-old, for the U.S. is 6.1 deaths per 1,000 live births. But in Washington, where the infant mortality rate is slightly higher than the national average at 6.6, infants born into the city’s poorest area, Ward 8 in the southeast, are 10 times more likely to die than children in Ward 3, Washington’s affluent northwest. Women of color bear the brunt of these deaths; Ward 8, where half of children live in poverty, is 93.5 percent black.
“If you go to those places [in Washington], there’s a dramatic difference between the way mothers are living in the same city,” said Carolyn Miles, president and CEO of Save the Children. Prague, in the Czech Republic, is the high-income capital with the lowest infant mortality rate, having less than two infant deaths per 1,000 live births.
“The knowledge of health care [in Washington] is extremely low. The knowledge of why it’s important for a pregnant mom to access prenatal care is just very low. It’s low in terms of the knowledge of it, it’s low in terms of the value that’s seen in accessing that care,” said Miles.
“There’s a big education issue here in the United States generally and Washington’s a horrible example of why that’s so important,” said Miles.
Poor, unmarried and young African-American mothers lose their babies at much higher rates than the U.S. average in many cities: A black mother in San Francisco is six times as likely as a white mother to lose her child before its first birthday, according to the report.
“It’s important to think about how we use language. It is very common for people to say ‘race plays a factor,’ and in fact it’s not race so much as racism and the experience of being a black women or a person of color in this society,” says Linda Goler Blount, president and CEO of the Washington-based Black Women’s Health Imperative.
“Race implies there’s some kind of biologic determinant and there isn’t,” said Blount. “There’s nothing unique about black women that would cause them to have higher infant mortality rates or maternal mortality rates.”
The twin forces of racism and poverty, which both put a great deal of stress on pregnant women, are the causes of poor maternal health among black women, says Blount. Women of color often face a lack of access to health care and prenatal care, while higher obesity rates can lead to diabetes and preeclampsia, conditions that complicate the health of mothers and their unborn children.
Physicians in the U.S. can help women of color in the U.S. by asking questions about their home life, like whether they had breakfast that morning, or where they live and how many people they live with. Currently, the U.S. health care system doesn’t do enough to recognize and help care for poverty-related health issues, says Blount.
“It would be a huge benefit if the provider community could embrace the whole life of a woman, or a patient, because if they’re trained to take into consideration the social factors [it would] help improve health outcomes and pregnancy outcomes,” says Blount.
For all women, repeated births are a huge stressor on the body, which leads to children being born premature and dying earlier, says Robert Clay, vice president of global health at Save the Children. Lack of access to maternity leave is another risk factor for poor maternal and infant health. The U.S. is the only high-income country that doesn’t guarantee paid parental leave. Ten weeks of paid maternity leave leads to a 1 to 2 percent reduction in infant mortality, according to a 2011 study by Future of Children.
Some of the highest rates of infant mortality are found in the American South, including Mississippi (7.2 deaths per 1,000 live births) and in West Virginia (which sees 7.6 deaths per 1,000 live births), according to the Kaiser Family Foundation. Washington dramatically cut its infant mortality rate, from 7.9 in 2012 to 6.6 deaths in 2013, by bringing more pregnant women into community-based health care systems, said Clay.
The U.S. needs to increase awareness of what health care is accessible for mothers and make sure the resources for mothers and babies are getting properly distributed, said Miles.
“If you look at the way in which the United States spends its money, it’s not generally in poor communities. Are you getting resources to those who are suffering the most?” said Miles.
The U.S. dropped from 31st in 2014 to 33rd out of 179 countries in the report’s 2015 Mothers’ Index, which looks at countries’ maternal health records, children’s well-being, educational opportunities for children, the economy and participation of women in the national government. Norway is the top-ranked country, with high ratings on all factors.
Somalia was ranked at the bottom of the Mothers’ Index for a second year in a row and the ten worst-ranked countries are in Sub-Saharan Africa and Haiti. While progress has been made in ending child mortality around the world, enormous gaps in wealth disparity still exist in some countries, which continues to put the poorest children at risk.
By 2050, an estimated 66 percent of the world’s population will live in an urban area, an increase on the 54 percent of city dwellers in 2015. Most of the growth will be seen in Asia and Africa, two continents that already suffer from high rates of infant mortality and risk of maternal death.
Correction: This article originally said a Future of Children study was published in 2013. The article has been updated to reflect the correct publication year, 2011.