Today, maternal health outcomes are as disturbing and inequitable as they were more than a decade ago. This isn’t for lack of effort from advocates or providers, but because the American maternity care system is inherently flawed. Corporations and profits are prioritized over individuals’ healthcare experiences and outcomes.
The United States needs a new system that prioritizes people and guarantees moms and families easily accessible, affordable, high-quality maternal healthcare. The good news is that the majority of Americans support a universal maternal health care system that would guarantee every pregnant person access to maternity care at no out-of-pocket cost.
This piece will explore what it might take to shift from our current profit-driven reality to achieve universal access to high-quality maternity care.
Little has changed in the past decade.
American families continue to experience problems with financial access, physical access, and care quality. Early prenatal care is on the decline; race-based differences in health outcomes persist; and maternal mortality continues to rise.
If every family told their birthing story, the data would show that many women are grateful to be alive after a harrowing experience in a deeply flawed system.
Care is especially a concern for Black women, who report mistreatment and neglect from healthcare providers. Videos have surfaced showing some of the mistreatment Black women experience, illustrating what so many have refused to meaningfully acknowledge for decades. If every family told their birthing story, the data would show that many women are grateful to be alive after a harrowing experience in a deeply flawed system. For each maternal death, there are 70 to 80 maternal near-misses—where someone survives a life-threatening complication but suffers nonetheless. High rates of maternal mortality, morbidity, and severe maternal morbidity reflect how many people must contend with limited access to high-quality healthcare and coverage, both in general and throughout the perinatal period.
Simultaneously, healthcare costs continue to rise. Although different data sets show different dollar amounts, on average, hospital charges for labor and delivery increased 2.5 times from 2000 to 2020. More recent data indicate that the average cost for a vaginal delivery without complications is $15,712 overall, with about $2,563 paid out-of-pocket. Complications, cesarean section, and intensive care are more likely to result in greater out-of-pocket expenses for families. These rising healthcare costs are not necessarily tied to enhanced medical technology or better quality care that improves outcomes. A 2023 assessment by the Commonwealth Fund found that increases were attributed to administrative costs (30 percent), care provider salaries (15 percent), and prescription drugs (10 percent).
The profit motive and maternity care are in conflict.
Childbirth and all the risks that come with it are simply unaffordable.
Within the current health system model, which prioritizes profitability over care, families are subject to the whims of health insurance companies, private equity, and consolidated hospital systems, with many families ending up responsible for large hospital bills. A 2021 study found that 24 percent of perinatal women reported having an unmet healthcare need due to cost, and 60 percent reported not being able to afford healthcare. Researchers in that study also noted an affordability gap among women with private health insurance who had low incomes, but who did not qualify for Medicaid. In another study published in 2024, researchers found that when there are out-of-pocket costs for childbirth, both Medicaid-insured and commercially insured families are more likely to report medical debt, even up to one year postpartum.
More than four in ten Americans (41 percent) are in medical debt, with postpartum women being 1.5 times more likely than other women to have medical debt. This debt is unsurprising when labor and delivery bills can easily exceed $40,000. Even with health insurance coverage, out-of-pocket costs for labor and delivery alone can range from $1,000 to $5,000 or more, with out-of-pocket expenses being higher for women who experience severe maternal morbidity.
The healthcare industry’s focus on profit ultimately reduces access to care.
The United States’ health system, which assumes healthcare is a commodity rather than a common good, has resulted in reduced access to healthcare overall and the closures of hospitals and labor and delivery units that are not profitable enough. High fixed costs, high liability insurance costs, and low reimbursement rates for perinatal care has led corporations to close labor and delivery units time and again. Recently, the rate of obstetric units and hospital closures has accelerated, mostly in rural areas, but urban areas are also at risk. In Los Angeles, for example, thirteen of the seventeen hospitals that stopped delivering babies since 2012 were run by for-profit companies.
For-profit companies employ specific practices that result in closures. In order to maximize profits, they implement cost-cutting measures such as closing units that aren’t profitable. Within an acquisition, large hospital systems may consolidate care to specific sites and close sites that are in debt and or financial distress, regardless of whether they are meeting a critical need in an underserved area.
This isn’t surprising: after all, private equity demands a return on their financial investment, so hospital corporations that accept these funds must implement cost-saving measures in the most profitable way possible. As researchers have observed, “The substantial increase of private equity investment in healthcare has accelerated consolidation, decreased competition, and made little to no difference and sometimes even decreased quality of care for some patients.”
Private-sector medicine has benefited immensely from this status quo. Over the past two decades, hospital assets doubled from $750 million to $1.6 billion. Wealthy hospitals have grown their assets, while there has been no significant change for low-asset hospitals. In practice, this may show up as wealthy hospital systems acquiring those that are struggling, thus subjecting them to the business decisions described above. Similarly, asset-rich hospitals had relatively high profit margins when compared to lower-resourced and rural hospitals.
Financial pressure has also led to the closure of freestanding birth centers. A freestanding birth center is defined as “a facility where birth is planned to take place away from the hospital and away from the person’s residence, where care is provided in the midwifery and wellness model, with birth center care integrated into the healthcare system.” Freestanding birth centers would provide families with another option for prenatal care and childbirth, expanding patient choice. However, in spite of growing investments in birth centers, since 2023, twenty-four have closed. The oldest freestanding birth center in Georgia closed in February 2026, leaving Savannah with one less option for maternal healthcare. The birth center was part of Lilac Health, which also operates birth centers in other cities, “where the [birth center] model is better supported,” meaning where birth centers are more profitable. Financial issues, such as low reimbursement rates from insurance companies that do not cover the cost of care, and systemic regulations that favor hospitals, have impeded freestanding birth centers’ success.
Over one-third of U.S. counties have no obstetric care providers or facilities.
As a result of corporate management of healthcare, among other factors, over one-third of U.S. counties have no obstetric care providers or facilities.
There are not enough healthcare providers to meet the demand.
The profit motive in healthcare has also contributed to a growing shortage of healthcare providers. Like hospital closures, provider shortages are accelerating: more people are leaving the healthcare workforce than are joining it.
Record numbers of care providers are leaving their profession because of extreme stress and exhaustion, administrative burdens, and inadequate pay. Hospitals and health systems appear to value their bottom lines more than they do their employees, which exacerbates shortages and leads to increased workloads on those who stay. Certainly, the COVID-19 pandemic had an impact, but it only exacerbated a preexisting problem.
Nurses, who have been historically undervalued, are the most affected by corporate rollbacks, because they generate less revenue than physicians. Physicians order tests, prescribe medications, and determine treatments, all of which have a price tag, and which generate upwards of $1.3 trillion in revenue for hospitals. More than 78 percent of U.S. physicians are employed by hospitals or corporations. For-profit healthcare systems may prioritize physicians at the expense of nurses, which leads to high patient-to-nurse ratios and contributes to burnout.
Beyond profit-driven provider shortages, the healthcare provider population is also aging. For example, many clinical physicians are retiring or are expected to do so over the next decade, and there are few people ready or willing to replace them. Maternal healthcare workforce shortages are expected to continue, with the proportion of childbearing individuals outpacing the number of workers.
Furthermore, many Americans who would become healthcare providers simply cannot afford the cost of medical school, midwifery school, or nursing programs. The consequences of the profit motive driven by capitalism shows up not just in how hospitals operate and pay their workers, but also in the cost of education and the student loan debt required to pay for it. Understandably, this is a cost that many are unwilling to bear in order to enter a stressful career where their work may be undervalued.
Aspiring to universal maternal healthcare can help solve these challenges.
Something needs to change. It is imperative to create a new maternity care system where moms get the care they need, free from corporate interests.
Universal maternal healthcare is most simply defined as easy physical access to no-cost, comprehensive, high quality perinatal healthcare for every birthing person. To refine our vision for such a system, The Century Foundation led a conversation with maternal health stakeholders at the 2026 Association of Maternal and Child Health Programs (AMCHP) Annual Conference. Participants identified four key pillars of universal maternal healthcare:
- Accessibility for All
- Appropriate Scope and Duration
- Holistic, Person-Centered Care
- Coordinated Care and Infrastructure
Working towards universal maternal healthcare provides an opportunity to address the variety of challenges described above. First, it would eliminate the profit motive from the equation and shift the cost of care to the federal government, thereby eliminating out-of-pocket expenses for new moms and growing families so they can utilize their resources where they are needed. Second, working towards universal maternal healthcare would require an investment in new and innovative points of service. If every person is to access timely prenatal care and labor and delivery, then more birthing facilities are needed. Finally, achieving universal maternity care would necessitate government investment in the maternity care workforce and provider pipeline.
What’s more, the idea of universal maternal healthcare is popular among Americans of all backgrounds. New polling of 2,002 registered voters conducted by Morning Consult on behalf of The Century Foundation finds that nearly seven in ten voters—69 percent—support a universal maternal health care system that would guarantee every pregnant person access to maternity care at no out-of-pocket cost, with 38 percent of voters strongly supportive. This includes 83 percent of Democrats, 68 percent of independents, and 57 percent of Republicans who support universal maternal healthcare. Only 21 percent of voters oppose the idea.
Here we present a core framework for a new system that builds on these four pillars.
Pillar 1: Accessibility for All
Remove Financial Barriers
A central theme of the AMCHP convening was the total removal of systemic, financial, and logistical barriers to healthcare for every person. Care must be provided regardless of income, age, education, or insurance status, with several participants advocating for free services and the elimination of income limits on government-funded health programs. To achieve universal financial access to maternity care, the healthcare landscape must shift from a fragmented, profit-driven model to one characterized by unconditional, zero-cost coverage at the point of service.
- Eliminate deductibles, co-pays, and surprise bills from out-of-network specialists (like anesthesiologists).
- Eliminate income-based eligibility limits and insurance-related gatekeeping, ensuring that care is not dictated by a patient’s employment status.
- Ensure that coverage and access remain constant regardless of job changes or income fluctuations, ensuring no gaps in care during the critical post-partum and pre-conception pregnancy periods.
- Create a government-backed universal maternal benefit package that includes services such as doulas, home visits, mental health assessment and treatment, and lactation support as standard, rather than as optional add-ons.
- Compensate hospitals, birth centers, and care providers at a fair rate through the elimination of a fee-for-service payment model.
Increase Physical Availability of Care
So far, no effort has successfully replaced all of the hospitals and obstetric units that are closing. Advocates like Birth Center Equity are working to change that by expanding access to high-quality maternity care through the development of birth centers that prioritize midwifery care. As explained above, freestanding birth centers would provide families with another option for prenatal care and childbirth, expanding patient choice. In rural areas, where care shortages are the most extreme, a freestanding birth center might be the only option for obstetric care.
- Restrict private equity and corporate involvement in maternal healthcare to stop hospital mergers and closures.
- Invest in freestanding birth centers to increase physical access to care, beginning with areas that are defined as maternity care target areas (MCTAs) and health professional shortage areas (HPSAs).
- Provide free undergraduate, graduate, and speciality education to grow the pipeline of providers across care specialties, including nurses, nurse midwives, traditional midwives, and physicians, etc.
Appropriate Scope and Duration of Coverage
AMCHP conference attendees defined universality as a continuous model of care extending beyond labor and delivery. One proposed framework for the duration of coverage under a universal maternal health program is the first 1,000 days, which covers all of pregnancy up to a child’s second birthday. This framework covers the post-partum period, in which risk of maternal mortality and morbidity remains high, and the eighteen months in which one in three women will become pregnant again. It also covers the most critical period of child development.
- Ensure healthcare access across the reproductive continuum, covering preconception, perinatal care, and two years post-partum.
- Emphasize robust post-partum care, including wraparound support, dental care, mental health services, and nutrition.
- Integrate community-based services, such as home visiting, to ensure that the birthing person has support within the broader context of their daily life.
Holistic, Person-Centered Care
In the conference session, definitions of universal maternal healthcare focused on dignity, respect, and autonomy, and the specific environment in which care is delivered. Quality of care across the United States is inconsistent and inequitable, varying from hospital to hospital, provider to provider, and between insurance companies. A new maternity care approach must shift toward a holistic, culturally affirming, person-centered standard of care. The people seeking healthcare must matter more than profit.
In 2018, Black Mamas Matter Alliance (BMMA) defined holistic care as addressing the physical, emotional, and social needs of women throughout pregnancy and postpartum. Other guides, such as the midwives model of care, the Black Birthing Bill of Rights, and the birth justice framework, all provide standards of care that enhance the pregnancy and birthing experience and improve health and wellness outcomes for all people, not just Black women.
- Eliminate capitalist and corporate interests that conflict with the provision of holistic, respectful, person-centered care.
- Create a comprehensive national standard of care that includes metrics for thriving, such as wellness, dignity, experience, and quality of life as measures of success.
- Transition to a collaborative care model that integrates midwives, doulas, mental health specialists, and community-based health workers as essential members of the clinical team.
- Emphasize the importance of empathy, bedside manners, trauma-informed care, and culturally affirming care in healthcare worker education, annual training, and accountability.
Coordinated Care and Infrastructure
Conference attendees noted that universal maternal healthcare requires a coordinated effort across all levels of society to address systems and structures that conflict with quality and equitable care. One such system is the corporatization of healthcare. A healthcare system that focuses on money first will never prioritize the best interest of patients. Attendees acknowledged that the “dollars first” mentality requires a deep structural overhaul.
Additionally, maximizing the potential of a new system will involve connecting hospitals, communities, workplaces, and schools to coordinate research and care. This acknowledges the social and structural determinants of health, where health or illness is created as much outside of the clinical setting as in it.
- In addition to improving individual clinical encounters through holistic, person-centered care, assess and improve the web of interconnected factors—social, economic, and institutional—that influence outcomes.
- Integrate community-based resources like home visitation, peer support, and navigator or case manager roles for families within the first 1,000 days into the maternity care benefit package.
- Establish fully functional coordinating mechanisms that allow for smooth referrals to wraparound support, such as nutrition, housing, and specialty care.
Building a new maternity care system is possible.
The list above is not by any means exhaustive. More pillars and facets of universal maternal healthcare will emerge as experts and advocates develop a complete framework and roadmap. Certainly, a maternity care system overhaul will cost money and require a substantial implementation effort, but it is absolutely worth whatever investment it takes. The only alternative is a worsening healthcare system and maternal health crisis, all at the cost of lives and well-being.
Globally, there are a number of countries that do maternity care well. Norway, for example, has universal healthcare, which includes comprehensive maternity care through the Norwegian Maternal Health Service. Interestingly, while physicians were the primary providers of maternal health services in Norway historically, a 1995 law required that midwifery services be offered. Now, most women choose to receive care from midwives at community health centers. As a result of their reforms, Norway has one of the world’s lowest maternal mortality rates—effectively zero.
Where there is political will, there is a way forward. Universal maternal healthcare requires a shift in priorities, from corporate concerns to care for the health and well-being of the American populace. As other countries have demonstrated, universal maternal healthcare is possible and the money for it exists. It is just that American policymakers, to date, have refused to prioritize the health of its people over corporate profit. The government can and should regulate corporations involved in healthcare, just as it can and should fund a national maternal healthcare system.
Tags: universal healthcare, maternal health, maternalhealthcare
Americans support universal maternal healthcare. Here’s what it could look like.
Today, maternal health outcomes are as disturbing and inequitable as they were more than a decade ago. This isn’t for lack of effort from advocates or providers, but because the American maternity care system is inherently flawed. Corporations and profits are prioritized over individuals’ healthcare experiences and outcomes.
The United States needs a new system that prioritizes people and guarantees moms and families easily accessible, affordable, high-quality maternal healthcare. The good news is that the majority of Americans support a universal maternal health care system that would guarantee every pregnant person access to maternity care at no out-of-pocket cost.
This piece will explore what it might take to shift from our current profit-driven reality to achieve universal access to high-quality maternity care.
Little has changed in the past decade.
American families continue to experience problems with financial access, physical access, and care quality. Early prenatal care is on the decline; race-based differences in health outcomes persist; and maternal mortality continues to rise.
Care is especially a concern for Black women, who report mistreatment and neglect from healthcare providers. Videos have surfaced showing some of the mistreatment Black women experience, illustrating what so many have refused to meaningfully acknowledge for decades. If every family told their birthing story, the data would show that many women are grateful to be alive after a harrowing experience in a deeply flawed system. For each maternal death, there are 70 to 80 maternal near-misses—where someone survives a life-threatening complication but suffers nonetheless. High rates of maternal mortality, morbidity, and severe maternal morbidity reflect how many people must contend with limited access to high-quality healthcare and coverage, both in general and throughout the perinatal period.
Simultaneously, healthcare costs continue to rise. Although different data sets show different dollar amounts, on average, hospital charges for labor and delivery increased 2.5 times from 2000 to 2020. More recent data indicate that the average cost for a vaginal delivery without complications is $15,712 overall, with about $2,563 paid out-of-pocket. Complications, cesarean section, and intensive care are more likely to result in greater out-of-pocket expenses for families. These rising healthcare costs are not necessarily tied to enhanced medical technology or better quality care that improves outcomes. A 2023 assessment by the Commonwealth Fund found that increases were attributed to administrative costs (30 percent), care provider salaries (15 percent), and prescription drugs (10 percent).
The profit motive and maternity care are in conflict.
Childbirth and all the risks that come with it are simply unaffordable.
Within the current health system model, which prioritizes profitability over care, families are subject to the whims of health insurance companies, private equity, and consolidated hospital systems, with many families ending up responsible for large hospital bills. A 2021 study found that 24 percent of perinatal women reported having an unmet healthcare need due to cost, and 60 percent reported not being able to afford healthcare. Researchers in that study also noted an affordability gap among women with private health insurance who had low incomes, but who did not qualify for Medicaid. In another study published in 2024, researchers found that when there are out-of-pocket costs for childbirth, both Medicaid-insured and commercially insured families are more likely to report medical debt, even up to one year postpartum.
More than four in ten Americans (41 percent) are in medical debt, with postpartum women being 1.5 times more likely than other women to have medical debt. This debt is unsurprising when labor and delivery bills can easily exceed $40,000. Even with health insurance coverage, out-of-pocket costs for labor and delivery alone can range from $1,000 to $5,000 or more, with out-of-pocket expenses being higher for women who experience severe maternal morbidity.
The healthcare industry’s focus on profit ultimately reduces access to care.
The United States’ health system, which assumes healthcare is a commodity rather than a common good, has resulted in reduced access to healthcare overall and the closures of hospitals and labor and delivery units that are not profitable enough. High fixed costs, high liability insurance costs, and low reimbursement rates for perinatal care has led corporations to close labor and delivery units time and again. Recently, the rate of obstetric units and hospital closures has accelerated, mostly in rural areas, but urban areas are also at risk. In Los Angeles, for example, thirteen of the seventeen hospitals that stopped delivering babies since 2012 were run by for-profit companies.
For-profit companies employ specific practices that result in closures. In order to maximize profits, they implement cost-cutting measures such as closing units that aren’t profitable. Within an acquisition, large hospital systems may consolidate care to specific sites and close sites that are in debt and or financial distress, regardless of whether they are meeting a critical need in an underserved area.
This isn’t surprising: after all, private equity demands a return on their financial investment, so hospital corporations that accept these funds must implement cost-saving measures in the most profitable way possible. As researchers have observed, “The substantial increase of private equity investment in healthcare has accelerated consolidation, decreased competition, and made little to no difference and sometimes even decreased quality of care for some patients.”
Private-sector medicine has benefited immensely from this status quo. Over the past two decades, hospital assets doubled from $750 million to $1.6 billion. Wealthy hospitals have grown their assets, while there has been no significant change for low-asset hospitals. In practice, this may show up as wealthy hospital systems acquiring those that are struggling, thus subjecting them to the business decisions described above. Similarly, asset-rich hospitals had relatively high profit margins when compared to lower-resourced and rural hospitals.
Financial pressure has also led to the closure of freestanding birth centers. A freestanding birth center is defined as “a facility where birth is planned to take place away from the hospital and away from the person’s residence, where care is provided in the midwifery and wellness model, with birth center care integrated into the healthcare system.” Freestanding birth centers would provide families with another option for prenatal care and childbirth, expanding patient choice. However, in spite of growing investments in birth centers, since 2023, twenty-four have closed. The oldest freestanding birth center in Georgia closed in February 2026, leaving Savannah with one less option for maternal healthcare. The birth center was part of Lilac Health, which also operates birth centers in other cities, “where the [birth center] model is better supported,” meaning where birth centers are more profitable. Financial issues, such as low reimbursement rates from insurance companies that do not cover the cost of care, and systemic regulations that favor hospitals, have impeded freestanding birth centers’ success.
As a result of corporate management of healthcare, among other factors, over one-third of U.S. counties have no obstetric care providers or facilities.
There are not enough healthcare providers to meet the demand.
The profit motive in healthcare has also contributed to a growing shortage of healthcare providers. Like hospital closures, provider shortages are accelerating: more people are leaving the healthcare workforce than are joining it.
Record numbers of care providers are leaving their profession because of extreme stress and exhaustion, administrative burdens, and inadequate pay. Hospitals and health systems appear to value their bottom lines more than they do their employees, which exacerbates shortages and leads to increased workloads on those who stay. Certainly, the COVID-19 pandemic had an impact, but it only exacerbated a preexisting problem.
Nurses, who have been historically undervalued, are the most affected by corporate rollbacks, because they generate less revenue than physicians. Physicians order tests, prescribe medications, and determine treatments, all of which have a price tag, and which generate upwards of $1.3 trillion in revenue for hospitals. More than 78 percent of U.S. physicians are employed by hospitals or corporations. For-profit healthcare systems may prioritize physicians at the expense of nurses, which leads to high patient-to-nurse ratios and contributes to burnout.
Beyond profit-driven provider shortages, the healthcare provider population is also aging. For example, many clinical physicians are retiring or are expected to do so over the next decade, and there are few people ready or willing to replace them. Maternal healthcare workforce shortages are expected to continue, with the proportion of childbearing individuals outpacing the number of workers.
Furthermore, many Americans who would become healthcare providers simply cannot afford the cost of medical school, midwifery school, or nursing programs. The consequences of the profit motive driven by capitalism shows up not just in how hospitals operate and pay their workers, but also in the cost of education and the student loan debt required to pay for it. Understandably, this is a cost that many are unwilling to bear in order to enter a stressful career where their work may be undervalued.
Aspiring to universal maternal healthcare can help solve these challenges.
Something needs to change. It is imperative to create a new maternity care system where moms get the care they need, free from corporate interests.
Universal maternal healthcare is most simply defined as easy physical access to no-cost, comprehensive, high quality perinatal healthcare for every birthing person. To refine our vision for such a system, The Century Foundation led a conversation with maternal health stakeholders at the 2026 Association of Maternal and Child Health Programs (AMCHP) Annual Conference. Participants identified four key pillars of universal maternal healthcare:
Working towards universal maternal healthcare provides an opportunity to address the variety of challenges described above. First, it would eliminate the profit motive from the equation and shift the cost of care to the federal government, thereby eliminating out-of-pocket expenses for new moms and growing families so they can utilize their resources where they are needed. Second, working towards universal maternal healthcare would require an investment in new and innovative points of service. If every person is to access timely prenatal care and labor and delivery, then more birthing facilities are needed. Finally, achieving universal maternity care would necessitate government investment in the maternity care workforce and provider pipeline.
What’s more, the idea of universal maternal healthcare is popular among Americans of all backgrounds. New polling of 2,002 registered voters conducted by Morning Consult on behalf of The Century Foundation1 finds that nearly seven in ten voters—69 percent—support a universal maternal health care system that would guarantee every pregnant person access to maternity care at no out-of-pocket cost, with 38 percent of voters strongly supportive. This includes 83 percent of Democrats, 68 percent of independents, and 57 percent of Republicans who support universal maternal healthcare. Only 21 percent of voters oppose the idea.
Here we present a core framework for a new system that builds on these four pillars.
Pillar 1: Accessibility for All
Remove Financial Barriers
A central theme of the AMCHP convening was the total removal of systemic, financial, and logistical barriers to healthcare for every person. Care must be provided regardless of income, age, education, or insurance status, with several participants advocating for free services and the elimination of income limits on government-funded health programs. To achieve universal financial access to maternity care, the healthcare landscape must shift from a fragmented, profit-driven model to one characterized by unconditional, zero-cost coverage at the point of service.
Increase Physical Availability of Care
So far, no effort has successfully replaced all of the hospitals and obstetric units that are closing. Advocates like Birth Center Equity are working to change that by expanding access to high-quality maternity care through the development of birth centers that prioritize midwifery care. As explained above, freestanding birth centers would provide families with another option for prenatal care and childbirth, expanding patient choice. In rural areas, where care shortages are the most extreme, a freestanding birth center might be the only option for obstetric care.
Appropriate Scope and Duration of Coverage
AMCHP conference attendees defined universality as a continuous model of care extending beyond labor and delivery. One proposed framework for the duration of coverage under a universal maternal health program is the first 1,000 days, which covers all of pregnancy up to a child’s second birthday. This framework covers the post-partum period, in which risk of maternal mortality and morbidity remains high, and the eighteen months in which one in three women will become pregnant again. It also covers the most critical period of child development.
Holistic, Person-Centered Care
In the conference session, definitions of universal maternal healthcare focused on dignity, respect, and autonomy, and the specific environment in which care is delivered. Quality of care across the United States is inconsistent and inequitable, varying from hospital to hospital, provider to provider, and between insurance companies. A new maternity care approach must shift toward a holistic, culturally affirming, person-centered standard of care. The people seeking healthcare must matter more than profit.
In 2018, Black Mamas Matter Alliance (BMMA) defined holistic care as addressing the physical, emotional, and social needs of women throughout pregnancy and postpartum. Other guides, such as the midwives model of care, the Black Birthing Bill of Rights, and the birth justice framework, all provide standards of care that enhance the pregnancy and birthing experience and improve health and wellness outcomes for all people, not just Black women.
Coordinated Care and Infrastructure
Conference attendees noted that universal maternal healthcare requires a coordinated effort across all levels of society to address systems and structures that conflict with quality and equitable care. One such system is the corporatization of healthcare. A healthcare system that focuses on money first will never prioritize the best interest of patients. Attendees acknowledged that the “dollars first” mentality requires a deep structural overhaul.
Additionally, maximizing the potential of a new system will involve connecting hospitals, communities, workplaces, and schools to coordinate research and care. This acknowledges the social and structural determinants of health, where health or illness is created as much outside of the clinical setting as in it.
Building a new maternity care system is possible.
The list above is not by any means exhaustive. More pillars and facets of universal maternal healthcare will emerge as experts and advocates develop a complete framework and roadmap. Certainly, a maternity care system overhaul will cost money and require a substantial implementation effort, but it is absolutely worth whatever investment it takes. The only alternative is a worsening healthcare system and maternal health crisis, all at the cost of lives and well-being.
Globally, there are a number of countries that do maternity care well. Norway, for example, has universal healthcare, which includes comprehensive maternity care through the Norwegian Maternal Health Service. Interestingly, while physicians were the primary providers of maternal health services in Norway historically, a 1995 law required that midwifery services be offered. Now, most women choose to receive care from midwives at community health centers. As a result of their reforms, Norway has one of the world’s lowest maternal mortality rates—effectively zero.
Where there is political will, there is a way forward. Universal maternal healthcare requires a shift in priorities, from corporate concerns to care for the health and well-being of the American populace. As other countries have demonstrated, universal maternal healthcare is possible and the money for it exists. It is just that American policymakers, to date, have refused to prioritize the health of its people over corporate profit. The government can and should regulate corporations involved in healthcare, just as it can and should fund a national maternal healthcare system.
Notes
Tags: universal healthcare, maternal health, maternalhealthcare