Don't Give Birth in the US

The US has the highest maternal mortality rate of any high-income nation in the world.

In 2018, there were 17 maternal deaths for every 100,000 live births in the US. In 2019, it was over 20 deaths. The maternal mortality statistics in the US have actually worsened over the past 20 years as peer countries' have improved. And ironically of all, we spend more than 2.5x more per person on health than the OECD average.

Compare that to those ratios in other high income countries.

High income countries include Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.

17% of deaths occur on delivery day, but a whopping 52% of deaths occur postpartum.

Currently, states are only required to provide coverage for 60 days postpartum despite most deaths and complications occurring more than 60 days later.

The US and Canada have the lowest overall supply of midwives and OB-GYNs. Around 12 to 15 providers per 1,000 live births.

Other high-income countries have 2-6x more. The US and Canada also have a lot more OB-GYNs than midwives, and most births could be managed by midwives. Midwives in the US are generally not covered by private insurance especially if you aren't giving birth in a hospital. ACA requires Medicaid programs to cover midwifery but provider supply is too low.

Postpartum care is critical given how most deaths occur in the postpartum period. Home visits by a midwife or nurse are associated with improved mental and physical health as well as reduced healthcare costs.

All countries, except the US, guarantee at least 1 such visit within 1 week postpartum.

The US is the only high income country that does not guarantee paid leave to mothers after childbirth.

Other high-income countries mandate at least 14 weeks of paid leave, and several provide more than a year of maternity leave.

The number of deaths per 100,000 births for black non-Hispanic women in 2018 (37.1) was 2x+ higher than that for white mothers (14.7). Hispanic women have the lowest rate (11.8). These issues exacerbate racial disparities. However, these differences persist in other countries too such as the UK which has universal health coverage but also has 5x more maternal deaths in black women pre-pandemic and 2x more common amongst Asian women.

Racial discrimination is real and hasn't improved much in the health care system even with women having significantly more socioeconomic and educational parity.

Equity in maternal outcomes is a global challenge.

It's appalling that us as one of the best nations in the world has one of the worst maternal health policies.

It's hard though - to tackle issues in the space it requires top down policy pushes that are not just 1 time suggestions but actually consistently enforced. And it takes a bottoms up approach from the rest of us building and supporting companies in the space. I'll focus a bit more on the latter approach.

What does it take to build a good healthtech for this space?

Founders having domain insight AND domain experience

I feel like this is appropriate for any space, but I feel like it is especially pertinent for healthtech given the technical nature of the space, and high levels of regulation

In Healthtech, at least for now, distribution IS the product - don't necessarily need a technical background at all

Unless you're creating a new medical device or in deep tech, then you're solving a distribution and access problem in healthcare, which is debatably just as important as new technology given how shitty access is

Having a personality people from all different old school industries want to work with as well as a deep understanding of the space will help you win

And of course creating a sleek product that people find easy to use and actually want to use. Because healthcare systems and insurance are the worst

Some startups in the space:

  • Zaya Care - Book practitioners for maternal care, pre-conception to postpartum

  • Mombox - A labor and delivery recovery subscription box

  • Oula Health - In person and virtual prenatal appointments, pregnancy education, virtual coaching

  • Poppyseed Health - 24/7 text access to a network of doulas, midwives, nurses

  • Oova Life - Urine test with an app to read results, to help monitor and detect fertility

  • Modern Fertility comprehensive fertility hormone test

  • Kindbody - Fertility clinic (IVF, Egg freezing, and more)

  • A bunch more distribution contraception products