Health and Health Care for Women of Reproductive Age: How the United States Compares with Other High-Income Countries

The maternal mortality crisis in the United States has been well documented: U.S. women have the highest rate of maternal deaths among high-income countries, while Black women are nearly three times more likely to die from pregnancy-related complications than white women are. But maternal deaths and complications may be a bellwether for the U.S.’s wider failures with respect to women’s health and health care. Using data from the Commonwealth Fund’s 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development (OECD), this brief compares selected measures of health care access and outcomes for women of reproductive age (18 to 49) in 11 high-income countries.

Gaps in Health System Performance

Across a wide range of health care needs, the U.S. health care system does a poor job serving women of reproductive age. According to the study findings, among women of reproductive age in high-income countries, rates of death from avoidable causes, including pregnancy-related complications, are highest in the United States. Furthermore, U.S. women of reproductive age have among the highest rates of multiple chronic conditions and the highest rate of mental health needs.

As a result of these challenges, American women of reproductive age were significantly less likely to rate their country’s health care system as “very good” or “good” compared to women in the 10 other countries surveyed. A quarter of U.S. women rated the health system highly, in contrast to majorities of women in the other countries.

Access and Affordability of Care

Having a regular doctor or place of care, such as a primary care physician or a medical home, is important for ensuring good health outcomes, minimizing health disparities, and limiting health care costs. However, access varies by country. While majorities of women of reproductive age in all 11 countries reported having a regular doctor, Sweden, the U.S., Canada, and Australia are the countries where women are the least likely to report this. In contrast, nearly all women in the Netherlands and Norway said they have a regular doctor or place of care.

The Burden of Medical Costs

High health care costs are significant burdens for many U.S. households, even those covered by health insurance. U.S. women of reproductive age are significantly more likely to have problems paying their medical bills or to skip or delay needed care because of costs. Specifically, half of women of reproductive age in the U.S. reported skipping or delaying needed care because of costs, and U.S. survey respondents were significantly more likely to report skipping care than respondents in all other countries.

Summary of Access and Cost Data

• Regular Doctor Access: Netherlands and Norway have the highest rates; Sweden, the U.S., Canada, and Australia have the lowest.
• High Out-of-Pocket Costs (USD 2,000+): Over one-quarter of women in the U.S. and Switzerland; less than 5 percent in the U.K., France, and Netherlands.
• Skipped Care Due to Cost: 50% of women in the United States.
• Avoidable Death Rates: Highest in the United States among all compared high-income nations.

The access and affordability problems highlighted in this brief may contribute to U.S. women’s overall lower assessment of the health care system.