With Congress trying and failing to repeal Obamacare, this summer has seen the issue of healthcare thrust into the spotlight. Healthcare is a broad-reaching issue as all Americans require some form of healthcare, from periodic check-ups to emergency services. Debates about healthcare often center on costs (e.g. pharmaceutical) and insurance. However, I’d like to step back from these fiscal issues and focus on a far more visceral one: maternal mortality.
Many of us are under the impression that American healthcare is exceptional. And unfortunately in the case of maternal mortality that is true. America leads the developed world in maternal deaths. In fact, it is not even close. NPR reports that the US rate of maternal deaths is triple that of the UK and nearly ten times that of Finland. Frighteningly, the problem has been getting worse, not better. Over the past few decades, the rate of women dying in or after childbirth has continued to rise, to a current rate of 26.4 of 100,000 live births. Why, in the richest nation in the world, are so many mothers dying?
This public health crisis is driven by three deficits in the American healthcare system: lack of prioritization of maternal health, lack of access to healthcare, and lack of education. Understanding each of them will help us understand the human cost of a broken healthcare system.
Over the past century, America has done great work to reduce infant mortality. Organizations like the March of Dimes raise millions each year, and advancements in medicine have saved countless young lives. However, this focus on infant care has come at the expense of maternal care. Pro Publica explains that of all the federal and state grants for maternal and infant health, only 6% of them go to fund maternal health programs. Forty years ago, America had the lowest maternal mortality rate in the world, and many in the medical field were willing to declare victory on maternal mortality. Since then, few advancements or innovations have taken place in the area of maternal care. New approaches are critically needed, all the more so given rising obesity and older first-time mothers.
In America, women experience strikingly different outcomes in pregnancy depending on where they live and their socio-economic status. Driving these differences primarily is access to quality care. The UN population fund explains: “the poorer and more marginalized a woman is, the greater her risk of death.” This finding holds true in America as it does around the world. In certain states that did not expand Medicaid, women are less likely to visit a doctor until late in their pregnancy, when severe complications are more likely. Similarly, in states where lawmakers have closed women’s health clinics like Planned Parenthood, the nearest clinic may be hours away or even out-of-state. Nick Kristof in the New York Times notes that the closing of women’s health clinics in Texas in recent years likely has contributed to the shocking fact that maternal mortality is ten times higher in Texas than in Spain. When women cannot access care, they delay check-ups and treatment programs that may identify or mitigate future problems with their pregnancy.
Compounding a lack of access to care is a lack of broad education about reproductive health and family planning. For women with underlying conditions or potential complications, medical professionals recommend planned pregnancies in order to provide the best monitoring and care to at-risk women. Yet, in America, nearly half of all pregnancies are unplanned. Worse, almost one-third of American girls will become pregnant as teenagers. This problem will certainly be made more severe by the administration’s $213 million in cuts to teenage pregnancy prevention programs. Additionally, many states have cut funding for sex education programs that teach about contraception, preferring “abstinence-only” programs, which medical professionals believe to be ineffective in preventing unplanned pregnancies. As a result, many women become pregnant under non-ideal circumstances and have little knowledge to empower them to deal with this major life event.
Many of the Congressional proposals for revamping healthcare in America involve steep cuts to programs and services that benefit the mothers who need them most. Maternal health is an issue where your voice really matters. Call your representatives and tell them that mothers in the greatest nation in the world should have the greatest care in the world. Ask them about how their proposals will impact funding for maternal health. On the ground, you can also make it easier for women to access vital health services and information by supporting organizations that do this work. Planned Parenthoodand the National Women’s Health Network provide invaluable resources to women across the country and are under threat from lawmakers. These organizations and many more are in need of urgent support from all of us who believe that America’s mothers deserve better.
If you would like to learn more about the issue of maternal mortality, the resources below are a great starting point.
a. Pro Publica
b. New York Times