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U.S. women pay more, fare worse during pregnancy and childbirth, global health study finds

Women in the United States are more likely to die during pregnancy and childbirth and to skip care because of costs compared to women in other high-income countries, a new report shows. The U.S. has long lagged behind other nations when it comes to health, life expectancy, and access to medical care, despite spending far more on health care than other countries do.

The report, published by the Commonwealth Fund, compares the experiences of women in the U.S. and 10 other high-income countries, including Norway, Sweden, the U.K., Germany, Switzerland, France, the Netherlands, Canada, Australia and New Zealand. For the study, researchers analyzed data from the Commonwealth Fund International Health Policy Survey and measures from the Organization for Economic Co-operation and Development and UNICEF.

The findings shed light on some bleak realities for American women. In the United States, 14 women die during pregnancy per 100,000 live births. Compare that to Sweden, the country with the lowest maternal mortality rate in the study, where the number is just 4 per 100,000 live births.

"Women in the U.S. have the highest rate of maternal mortality because of complications from pregnancy or childbirth, as well as among the highest rates of caesarean sections," the authors write.

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More than one-third of women in the United States reported skipping needed medical care because of costs — a far higher rate than the other countries in the study. In addition, American women were less likely to rate their quality of care as "excellent" or "very good," compared to women elsewhere.

And when it comes to chronic illness, women in the United States also fare worse. The report found 1 in 5 American women said they have two or more chronic conditions such as joint pain or arthritis, asthma or chronic lung disease, diabetes, heart disease, or high blood pressure — compared to 1 in 10 or less in Germany, the Netherlands, and Australia.

U.S. women also report the highest rates of emotional distress, with German and France reporting the lowest rates. This likely plays a role in the overall poorer health of Americans, the authors note.

"The relationship between emotional distress and health is complex, but some research shows emotional distress can exacerbate physical illness as well as lead to difficulties managing other aspects of life, such as the ability to work," they write.

There were a few bright spots in the report for women in the U.S. They reported quicker access to specialist care, matched only by  Switzerland and the Netherlands. Among those who needed to see a specialist in the past two years, only a quarter of women surveyed in these countries said they had to wait more than four weeks for an appointment. That number is much higher in countries like Canada and Norway.

Women in the United States also reported some of the highest rates of breast cancer screening and have some of the lowest rates of breast cancer-related deaths.

But despite this progress, American women "continue to be disadvantaged by their relatively poorer health status and higher costs of care," the authors write.

The report did not delve into the reasons behind these findings, but the researchers point to lower rates of health insurance coverage, "as well as differences in health care delivery systems and the level of social protection across countries." The United States was the only country in the study without universal health coverage.

The report concludes that getting health care costs under control in the U.S. "must be at the top of the nation's policy agenda." It points out that, for example, a normal delivery or a caesarian section costs about twice as much in the United States as it does in Australia.

"Bringing health costs under control will help improve access to health insurance and health care," the authors write.

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