How does infant mortality and maternal mortality in the US compare to countries with universal health care?
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Executive summary
The United States has higher maternal and infant mortality compared with many high‑income peers; maternal death rates are 18–49% higher in states that did not expand Medicaid versus those that did, and infant mortality worsened in 20 states between 2018 and 2022 [1] [2]. Multiple analyses conclude the U.S. performs worse on maternal mortality and other long‑term outcomes than comparable countries, a gap some researchers link to weaker primary care, gaps in insurance coverage, and social safety nets rather than medical technology alone [3] [4].
1. U.S. maternal and infant outcomes: a disturbing pattern
U.S. maternal mortality remains a national crisis: Commonwealth Fund researchers report maternal death rates are substantially higher in states that haven’t expanded Medicaid—18 to 49 percent higher—signaling that coverage gaps drive part of the problem [1]. The same scorecard shows infant mortality trends worsening in many states: infant mortality rose in 20 states between 2018 and 2022, reversing earlier declines and highlighting geographic disparities [2].
2. How the U.S. compares with countries that have universal care
Comparative trackers conclude the U.S. fares worse on maternal mortality and other care‑sensitive outcomes than most peer high‑income countries that feature broader universal access and stronger primary care systems. The Peterson‑KFF Health System Tracker summarizes that the U.S. performs worse on long‑term outcomes including maternal mortality and has higher rates of obstetric trauma and avoidable deaths than comparable nations [3]. MedicalXpress reporting of excess‑death research also points researchers toward policies in peer countries — universal coverage, safety nets and public‑health investments — as protective factors for lower mortality [4].
3. Insurance coverage and Medicaid expansion matter
Empirical U.S. evidence links insurance policy to perinatal outcomes. Commonwealth Fund analysis ties higher maternal mortality rates to states that did not expand Medicaid under the ACA, and advocates and analysts emphasize that expanding postpartum Medicaid coverage and easing eligibility are actionable ways to reduce deaths [1] [5]. The AJMC coverage of the Commonwealth Fund brief stresses that Medicaid gaps, behavioral‑health shortfalls, and structural disparities continue to drive poor maternal and infant outcomes in the U.S. [5].
4. Not just health care — social drivers and system capacity
Authors and analysts warn the mortality gap is not solely a function of hospitals or technology. The U.S. lags on primary care capacity, has fewer general practitioners and weaker social safety nets compared to peers; these deficits amplify risks during pregnancy and infancy and help explain excess deaths even after COVID‑19 [3] [4]. Commonwealth Fund reporting directly connects higher infant and maternal deaths to broader health system dysfunction across states [2] [1].
5. What proponents of universal systems argue (and critics reply)
Researchers cited here argue that universal coverage, robust primary care and social policies explain why peer nations have lower maternal and infant mortality; MedicalXpress recounts researchers urging U.S. policymakers to study those models [4]. Available sources do not present detailed rebuttals from U.S. policymakers defending the current fragmented system on the same metrics; instead, U.S. reports focus on policy levers such as Medicaid expansion and postpartum coverage extensions [1] [5].
6. Measurement, trends and limitations in the reporting
Comparisons across countries and states are complicated by measurement choices, timing and the pandemic’s disruption: Commonwealth Fund notes infant mortality rose in many states after COVID, and measuring maternal mortality has persistent methodological challenges [2] [1]. Comparative trackers and excess‑death studies call for further research to disentangle causes; they nonetheless observe clear, long‑running U.S. disadvantages [3] [4].
7. Bottom line and policy implications
Across the cited reporting, the United States shows worse maternal and infant mortality than peer countries with more universal systems, and within the U.S. Medicaid expansion is associated with markedly lower maternal death rates—concrete evidence that coverage and primary‑care investments change outcomes [3] [1]. Policymakers seeking to reduce these deaths face two linked tasks: expand access and coverage (especially postpartum), and strengthen primary care and social supports that prevent avoidable perinatal harm [5] [4].
Limitations: this analysis is confined to the provided sources; available sources do not mention specific country‑by‑country mortality numbers or alternative methodological critiques beyond those summarized here [3] [2].