When it comes to mothers and children, there is one country that is setting the gold standard for the rest of the world: Norway. And the United States has a lot of catching up to do.
Dixie Matre, a teacher and a British ex-pat, has given birth to two children in Norway. Her experiences could be described as downright luxurious compared to American medical standards. She received routine no-cost check-ups with midwives, took aqua aerobics classes to naturally ease pelvic pain, and her hospital rooms came standard with a bed big enough for her and her husband to share with their new family and, as in the case of her second child, and an en-suite bathroom with a large bathtub where she could labor naturally.
She, like other Norwegian mothers, was also given a choice of government-mandated maternity leave options: either 100 percent pay for 49 weeks plus holidays, or 80 percent pay for 54 weeks. And once she and her husband went back to work after their youngest son, Elias, now 2, was born — dads get government-mandated parental leave also — he was enrolled at a government-subsidized nursery school that employs its own cook who bakes bread and cooks organic meals for the children.
“Since most of the staff who work at nursery are qualified, it’s easy to trust their judgment and know that your child is in a nurturing and caring environment which meets their developmental needs,” Matre said. “And when you’re happy with their care, you know it’s okay to focus on your professional development and have a career. “
Matre’s experience raising young children in Trondheim, Norway is a snapshot of the why Norway was ranked atop the Mother’s Index in the Save the Children’s State of the World’s Mother’s report. The United States ranked a dismal 33rd, well behind other developed nations, just ahead of Slovakia and five spots in front of Saudi Arabia.
There is even a section in the 2015 report, most recently released by the global children’s aid organization, explaining why the U.S. fared so badly for such an otherwise wealthy, industrialized nation, even slipping two spots in the international rankings.
“Although the U.S. performs well on economic and educational status,” the report reads, “it lags behind all other top-ranked countries on maternal health (61st in the world) and children’s well-being (42nd in the world) and performs poorly on political status (89th in the world).”
What does that mean for U.S. mothers and children? The data shows a stark and sobering contrast between the U.S. and Norway.
The U.S. performed poorly on political status because of the lack of women in power. Save the Children also puts pointed emphasis on the link between women in positions of government power and maternal and child health. In Norway, women hold 40 percent of Parliament seats, according to the report, while women hold less than 20 percent of seats in the U.S. Congress.
The health disparities between the two countries show an even wider split.
In Norway, women have a 1 in 15,000 chance of maternal death, but American women face a 1 in 1,800 chance, a statistic Save the Children called “shocking” and “the worst performance of any developed country in the world.”
In Norway, the under 5-years-old mortality rate is 2.8 per 1,000 live births. In the U.S., it’s 6.9 per 1,000 live births, on par with Slovakia and Serbia.
According to the Centers for Disease Control, which closely tracks infant mortality rates and causes for children at or younger than one year of age, the leading causes of death for the 23,000 infants that died in 2016 are birth defects, pre-term birth and low birth weight, sudden infant death syndrome, and maternal pregnancy complications.
“Our country doesn’t value women. Period,” said Dr. Christine Morton, a research sociologist who has worked on initiatives to improve maternal health in the U.S.
While top-ranked Scandinavian countries like Norway, Sweden, and Finland have a one-tier healthcare system for mothers and children, she said, the United States is a patchwork of state-funded Medicare programs and private insurance that separates the haves and the have-nots by geographic location, income status, and even skin color. And that patchwork makes it difficult even to adequately track women’s health data on a national level, which she believes also contributes to the United States’ poor international showing.
“There’s the folks who have private insurance and then there’s the folks who have public insurance. And the proportion of women whose births are paid for by Medicaid is near 50 percent,” Morton said. “But I think it is an increasing burden on state governments who are having to pay for not only this care, but care in a time when obstetric outcomes are at their worst. So they’re more costly. There’s more Cesareans, there’s more complications from that major surgery. There’s increased morbidity.”
That has led to what she called a disinvestment in public health on a national scale. Access to quality care largely depends on income and geography, she said.
Midwives, which are standard in many parts of Europe, can be an excellent source of prenatal and postpartum care, but several states place restrictions on midwifery that block their ability to see patients. There’s also often a distinct shortage of quality providers in rural areas and in the flyover states, Morton added, which leads to a massive disparity in health outcomes for mothers and children that don’t live near major cities or on the east or west coasts.
“So you have a country where your maternal outcomes are really going to depend very much on what state you live in,” Morton said.
Matre, who has visited the United States on vacation, has glowing things to say about the States and the people who live there. But the American healthcare system makes her shudder.
“The fact that some people can have the best, but many people have the worst seems so unfair to me,” she said.
“Last time we were in the U.S., in 2016, I remember there was an advert on TV for a payday loan,” she continued. “The ad showed a parent worried about their ill child and they clearly wanted to take the child to the doctor’s. They didn’t have the money to do that, but luckily they could get a payday loan and take their child to the clinic to get treatment. This ad just broke my heart. It’s horrible that parents are having to balance their children’s health up against their bank balances.
For a reported opinion response from a right-leaning perspective, you can access IJR Red’s article here.