In a tweet last week, Sen. Ted Cruz of Texas said that “pregnancy is not a life-threatening illness.”
However, experts say pregnancy can indeed be life threatening, even in an industrialized nation such as the United States.
Calling on the Food and Drug Administration to classify the abortion pill as dangerous, the Republican senator tweeted: “Pregnancy is not a life-threatening illness and the abortion pill does not cure or prevent any disease. Make no mistake, Mifeprex is a dangerous pill.”
But experts say Cruz is misguided.
“Like a lot of what Sen. Cruz says on reproductive issues, he’s off base, ill-advised, and not based on any medical facts,” said Dr. Elliott Main, the medical director of the California Maternal Quality Care Collaborative and clinical professor of obstetrics and gynecology at Stanford University.
“The rate of death from miscarriage or abortion is probably 20 to 30 times lower than that of a term pregnancy, so there’s no reason to suggest that abortion is high risk in terms of mortality,” Main told Healthline.
According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, the maternal death rate in the United States in 2018 was
“This essentially translates into roughly 650 to 700 women die yearly as a result of pregnancy,” Dr. Marc Incerpi, the chief of the division of maternal-fetal medicine at Keck School of Medicine of the University of Southern California, told Healthline.
“It’s distressing. It’s very upsetting [to have this rate] in the U.S., which is a country that has multiple resources and is a highly developed country. If you look at the top 10 countries that are well developed and have adequate resources, the U.S. probably ranks at the very bottom,” he said.
The data is even more concerning for women of color.
In 2018, the maternal death rate for non-Hispanic Black women was
“One of the critical features of this issue is that Black women have three to four times the rate of maternal mortality as white or Hispanic women in most states,” Main said.
“Black women have a lot of healthcare issues… much higher rates of preterm birth, much higher rates of infant mortality, twice the rates of major pregnancy complications,” he added. “It’s all dwarfed by the three to four times rate of maternal mortality that is seen nationally in every state.”
Dr. Charles Gibbs is director of the division of advanced fetal and maternal care at the University of Kansas Health System.
He also disagrees with Cruz’s categorization of pregnancy and argues no pregnancy is without risk.
“With all due respect, Sen. Cruz is not a physician and is stating an opinion based in a strongly held and controversial ideology,” Gibbs told Healthline.
“We emphasize to medical students and residents the fact that there is no such thing as a no-risk pregnancy,” he added. “Pregnancy changes the physiology of the mother significantly and can exacerbate underlying conditions. Additionally, there are several conditions unique to pregnancy that can affect healthy women and lead to serious morbidity or even death.”
Among developed countries, the United States has the highest rate of maternal death. Gibbs says the reasons for this can be hard to account for completely but are likely due to a number of factors.
“The most likely reason for this increase in mortality is the decline of the overall health of the American population of childbearing age,” he said. “The obesity epidemic, higher rates of diabetes and hypertension, and increase in the average age of the first pregnancy has adversely affected the risk of pregnancy complications.”
Dr. Ilina Pluym, an assistant professor in the division of maternal and fetal medicine at the University of California, Los Angeles, says pregnancy can put the female body under a lot of pressure.
“Pregnancy is a stress test for the body,” she told Healthline. “Many changes happen to the pregnant body that can unmask or worsen preexisting medical conditions. Additionally, conditions unique to pregnancy, such as preeclampsia, can cause seizures, stroke, and even death of the mother and baby.
“Some of the most common causes of maternal death during childbirth are bleeding, infection, and preexisting medical conditions, namely cardiovascular disease. Unfortunately, approximately half of all maternal deaths are found to have been preventable,” she said.
Disparities in healthcare access and quality of care also play a role.
“The bigger part is lack of access to adequate healthcare, especially for Black women. Sometimes mothers decide to seek help too late. Sometimes they live too far from an appropriate hospital, and sometimes they receive inadequate care once in the hospital,” Pluym said.
Gibbs says it’s crucial that women pursue healthcare as soon as possible in pregnancy, and even before they plan on becoming pregnant.
“Preconceptual counseling is recommended for women who are planning a pregnancy in order to optimize their treatment and manage their medications prior to becoming pregnant,” he said.
“During pregnancy, it is important that patients inform their physician with symptoms that may be related to life threatening complications,” Gibbs added. “Rapid weight gain, severe swelling, headaches that are not relieved by over-the-counter medications or are severe could signify the onset of preeclampsia.
“Any bleeding in pregnancy should be evaluated immediately, as should high fevers. Aches and pains are normal in pregnancy. However, back pain with fever may indicate a kidney infection, [and] leg pain with swelling may be symptoms of a blood clot.
“It is important that pregnant women seek out a provider that is experienced, qualified, and most importantly will listen to and take seriously her concerns. All too often early symptoms of serious pregnancy complications can be dismissed as ‘normal’ symptoms of pregnancy, especially in the third trimester,” Gibbs said.
Incerpi says it’s important that women take steps to stay healthy in pregnancy, but argues more needs to be done at the national level to support them in safe pregnancies.
“Proper nutrition, exercise, diet is all very, very important… avoiding alcohol, avoiding cigarettes, avoiding any kinds of drugs is very, very important,” he said.
“We have an opportunity to really empower our pregnant women to feel a lot more confident and comfortable in dealing with their pregnancy,” he added.
“It’s depressing enough to know that our maternal mortality rate is 17 per 100,000, but it’s even more discouraging to know that… about 60 percent of maternal death in the United States can potentially be preventable,” Incerpi said.