Trump’s second presidency will be even worse for maternal health
In the United States, the state of pregnancy and childbirth has been in a bad shape for the past few decades. We have some of highest maternal mortality rates among countries with similar resources, and we also face some of the most expensive costs associated with childbirth. The nation saw some positive changes under the Joe Biden administration. This included a decline in maternal mortality. With Donald Trump in the White House, it is likely that pregnant women will face worsening health conditions, leading to more complications, harm and even death. Some clues could be found in his first term, recent election promises, and the first month of office. The maternal mortality rate in the U.S. rose dramatically under the first Trump administration. It went from 17.4 deaths per 100,000 births in 2018, to 32.9 deaths in 2021. In this same timeframe, Black women died at more than double the rate of their white counterparts.
Improvements that came after Biden took office brought the maternal mortality rates back down. In 2022, the maternal mortality rate for all races dropped significantly, reaching an average of 22.3 deaths out of 100,000 live births. In 2023, the maternal mortality rate dropped even further, to an overall rate 18.6 deaths for every 100,000 live births. It should be noted, however, that the maternal death rate for Black women has increased, increasing disparity. While these rates are still far above the global average among our peers, the fact that maternal mortality rates have slowly started to lower is promising, and is a real start to tackling other issues impacting pregnancy and birth in this country.
However, combined with the fallout from Dobbs v. Jackson Women’s Health Organization, a second Trump administration will likely result in a deterioration of access to and quality of reproductive care that could cause mortality rates to spike again.
Insurance coverage is also likely to take a hit. The Affordable Care Act subsidies are due to expire in 2025. It is unlikely that Trump or a Republican Senate would extend them. This will make health insurance unaffordable. Trump will also likely cut Medicaid, which currently covers about 40 percent of births in this country. These two insurance issues will have devastating effects. Some low-income pregnant women may not be able afford insurance. Even those with expensive or limited coverage may be unable to pay their medical bills. Patients may cancel prenatal appointments or recommended medical tests in order to save money. In a recent statement, the American College of Obstetricians and Gynecologists urged the protection of Medicaid. They stated that “cuts in Medicaid will result to preventable deaths.”
But sadly, the threat against the government program is very real.
We also know that women who receive little or no prenatal care have a higher risk of pregnancy and birth complications. Expectant parents who can’t access prenatal care have a three-to-four times higher risk of experiencing pregnancy complications. In addition, the report found that babies whose parents did not receive prenatal care had a five-fold higher risk of dying than those whose parents received prenatal treatment. A lack of affordable insurance means less consistent care. Combined with an expanding epidemic of maternal care deserts, this will increase risks during and after pregnancy.
We’ve also seen a rise in complications and death in pregnant people directly related to abortion restrictions that have cropped up across various states in the wake of a Trump-stacked Supreme Court overturning Roe v. Wade. The Gender Equity Policy Institute published a report in 2023 that showed that women living in states where abortions are banned or restricted have worse outcomes. Like most prenatal and birth complications, these risks impact people of color at higher rates.
And it’s not just mothers: A new study published in the Journal of the American Medical Association found infant mortality rates were 5.6 percent higher than expected in states with abortion bans.
Abortion bans are also contributing to the rising maternal care deserts as doctors flee to practice in places where they can’t be sued or prosecuted for providing the appropriate care. Many expectant mothers in anti-choice state are left with little or no care. While some states have tried to incorporate reproductive health care in their laws, others restrict the rights of their residents, causing deteriorating conditions among pregnant women. A Texas teenager named Neaveah died last year after doctors repeatedly delayed life-saving treatment. ProPublica reported just this month that sepsis rates skyrocketed after Texas’ abortion ban. ProPublica reported just this month that sepsis cases increased after Texas’s abortion ban. Kennedy is a danger to reproductive rights and has flipped flopped in the past on abortion. How can we ensure that risks related to pregnancy and childbirth do not increase? We will have to protect ourselves, our families and communities while also advocating on a state and local basis. Currently, each state must take action to extend Medicaid coverage after childbirth. You can also ask them to support the Momnibus Act, a comprehensive set of bills aimed at addressing our maternal health crisis by expanding Medicaid coverage, improving maternal health data and increasing support for mental healthcare services. You can also push them to support the Momnibus Act, a comprehensive set of bills aimed at addressing our maternal health crisis by expanding Medicaid coverage, improving maternal health data, and increasing support for mental health services.
When it comes to navigating maternal care deserts, expand your idea of what kind of providers can offer care. You may be able get quality care if you are pregnant with a low-risk pregnancy from a provider that is not an OB/GYN. Family medicine doctors are able to provide high-quality prenatal and postpartum health care. Patients will be more likely to attend appointments that are easily accessible. Midwives can be an excellent fit for you, especially if your situation is low-risk. That might mean overhauling how you envisioned your birth, but depending on your health and needs, you can receive excellent, individualized care at a freestanding birth center or with midwives who attend home births.
Fourth, advocate for your state to expand what kinds of health-care providers can do work legally. Each state has its own rules for midwifery. Check if there are any bills to expand midwifery care and reach out to your local representatives to encourage their support. Check if there are any existing bills to expand midwifery care and reach out to your local representatives to encourage their support.
Lastly, push your lawmakers to vote in favor of legislation that makes your state more abortion-friendly. The right to abortion would ease some of the difficulties pregnant women face in certain states. Support shield laws to protect abortion providers. This will help keep experienced and skilled doctors in your state. We know that despite Trump’s claim that he won’t make abortion illegal at the federal level, he doesn’t keep his word. Reach out to your representatives in Congress and impress upon them the importance of holding Trump to his word if the federal right to abortion is ever threatened.
We’ve seen the harm that Trump’s first term took on maternal health in this country. We cannot wait to see the results of Trump’s next administration.
