In 2024, the maternal mortality ratio (MMR) in the US and UK will increase, even though post-mortem reviews conclude that 80% of maternal deaths in high-income countries are preventable. Rates in high-income countries in Western Europe and Asia declined between 1990 and 2010, but in some of these countries, such as the United Kingdom, MMRs have increased over the past decade. The US MMR has always been an outlier, nearly doubling in the first decades of the 21st century.
Reasons for predicting an increase in MMR include the ongoing consequences of the Covid-19 pandemic. However, MMR vaccine increases in the US and UK preceded Covid, suggesting the pandemic has exacerbated deeper problems.
Systematic negligence and bias in medical care systems is one of them. In the United States, crucial challenges for improvement include the lack of universal health insurance and an increasingly competitive healthcare system: the United States has hemorrhaged maternity providers to the point that 36% of American counties , mostly rural, have none. In the UK, healthcare is theoretically available to all, but the NHS has suffered from underinvestment in its facilities and equipment. Half of NHS maternity units are now rated sub-standard; the shortage of midwives has reached crisis proportions. Obstetricians and midwives in both countries are suffering from burnout and choosing to go on strike, practice abroad, retire or change professions.
Racial and class inequality is entrenched. The highest MMR rates and greatest increases are seen in minority, working-class, or poor populations. As devastating as inadequate health systems are for these groups, the fundamental causes of their health inequalities are the adverse living conditions, including the stigma and discrimination they face. Solid scientific evidence demonstrates that the multiple systemic assaults they must contend with on a daily basis – material hardship, environmental toxicity, decaying municipal infrastructure, and structurally entrenched psychosocial stressors – chronically activate their human physiological stress response.
Combined, stressors and the tenacious ability to cope with them cumulatively damage health down to the cellular level, effectively accelerating biological aging. This erosion, called “weathering,” leaves the marginalized, vilified, or exploited to suffer from multiple infectious and chronic diseases, functional limitations, and even death, long before they are chronologically elderly. In populations subject to more severe weather conditions, the growing tendency to have children at older ages increases the risk of adverse maternal and child outcomes. Maternal mortality is a barometer of the contribution of weathering to excess deaths, as the physical stress of pregnancy is more difficult for a body exposed to the elements to bear, while other manifestations of weathering often become life-threatening only after pregnancy reproductive age.
In 2024, the deterioration will continue to be fueled by racism, classism, xenophobia, political polarization, resentment, white nationalism and budget austerity. Brexit, a consequence of this resentment, now exacerbates UK labor shortages, supply chain bottlenecks, inflation and a reduction in gross domestic product. Neither the United States nor Western Europe fully embrace their minority or immigrant populations.
In 2024, this problem will intensify as wars and climate change increase the flow of immigrants of color. Despite the facts, the official position of the British Equalities Minister is dismissive of systemic racism as a cause of health inequality. The 2021 Report of the UK Commission on Racial and Ethnic Disparities is based on an unfounded victim-blaming shibboleth, inferring that inequity arises from the inability of minority populations to exercise agency and take advantage of seemingly abundant opportunities to promote Health. In the politically polarized United States, active and influential populist movements seek to whitewash American history.
In 2024, counter-movements to take racist and classist history seriously will continue to clash with strong undercurrents of political scapegoating and zero-sum thinking in both countries, increasing the severity and scope of weathering.