In 2024, the maternal mortality rate (MMR) in the United States and the United Kingdom will grow, although postmortems conclude that 80 percent of maternal deaths are preventable in high-income countries. Rates in high-income countries across Western Europe and Asia did decline between 1990 and 2010, but in some of these countries, such as the UK, MMRs have risen over the past decade. The US MMR has consistently been an outlier, almost doubling in the first decades of the 21st century.

Reasons to support the prediction that MMRs will rise include the ongoing effects of the Covid-19 pandemic. However, MMR increases in the US and UK predated Covid, suggesting the pandemic exacerbated deeper problems.

Neglect and systematic bias in medical care systems is one of them. In the US, critical challenges to improvement include the lack of universal health insurance and the increasingly competitive health care system: The US has maternity care providers to the point that 36 percent of US counties, mostly rural, have none. In the United Kingdom, health care is theoretically available to all, but the NHS has suffered insufficient investment in its facilities and equipment. Half of NHS maternity units are now rated substandard; shortages of midwives have reached crisis proportions. Obstetricians and midwives in both countries suffer from burnout and choose to strike, practice abroad, retire or change professions.

Racial and class inequality is entrenched. The highest MMRs and largest increases are in minority, working class, or disadvantaged populations. Devastating as inadequate health care systems are for these groups, the fundamental causes of their health inequalities are adverse living conditions, including the stigma and discrimination they face. Solid scientific evidence that the multiple systemic assaults they must contend with in their daily rounds—material hardship, environmental toxicity, dilapidated municipal infrastructure, and structurally rooted psychosocial stressors—chronically activate their human physiological stress response.

Combined, the stressors and the persistent coping they entail cumulatively damage health down to the cellular level, actually accelerating biological aging. Such erosion, called “weathering,” leaves the marginalized, vilified, or exploited to suffer multiple infectious and chronic diseases, functional limitations, and even death long before they are chronologically old. In populations subject to the worst weathering, the increasing tendency to have children at older ages increases the risk of adverse maternal and infant outcomes. Maternal mortality is a barometer of weathering’s contribution to excess mortality, as the physical stresses of pregnancy are more difficult to withstand for a weathered body, while other manifestations of weathering often become life-threatening only after reproductive age.

In 2024, attrition will still be fueled by racism, classism, xenophobia, political polarization, resentment, white nationalism and austerity budgeting. Brexit, one outgrowth of this resentment, is now exacerbating UK labor shortages, supply chain bottlenecks, inflation and a reduced gross domestic product. Neither the US nor Western Europe fully embrace their minority or immigrant populations.

In 2024, this problem will worsen as wars and climate change increase the flow of immigrants of color. Despite the facts, the official position of the UK Equality Secretary is dismissive of systemic racism as a cause of health inequality. The 2021 report by the UK Commission on Racial and Ethnic Inequalities turns to an unfounded victim-blaming shibboleth, inferring that inequality stems from the failure of minority populations to exercise agency and take advantage of seemingly abundant health-promoting opportunities. In the politically polarized USA, active and influential populist movements seek to whitewash American history.

In 2024, countermovements to take racist and classist history seriously will continue to face strong undercurrents of political scapegoating and zero-sum thinking across both countries, increasing the severity and scope of weathering.