Is Having a Baby Bad For Your Health?
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Most American women might presume that the dangers of maternal mortality are a concern and problem only in developing nations. They’re wrong. A March 2010 report put out by Amnesty International entitled, Deadly Delivery: The Maternal Health Care Crisis in the USA, highlights eye-opening findings. The data is based on research carried out during 2008 and 2009. The organization has framed their conclusions as a call to action for women’s human rights in America. The revelation that “more than two women die everyday in the USA from complications of pregnancy and childbirth,” with half of those death being preventable if appropriate maternal health care was accessible, demands accountability. Since there are no federal requirements to report maternal mortality, the actual number of deaths may exceed those counted by double the amount.
What constitutes maternal health? The World Health Organization defines it as the “health of a woman during pregnancy, childbirth, and the post-partum period.” How does America, the number one global spender on health care, measure up against other nations? The latest available statistics come from 2006, when there were 13.3 maternal deaths per 100,000 live births. In an example of a one-on-one matchup, when compared with Germany, the United States racks up figures at four times the German numbers.
Within our borders, the news is even more dismal. Broken down by state, Maine had the best showing at 1.2 deaths per 100,000 live births. The District of Columbia had the most disconcerting figures: 34.9 per 100,000 live births. What, as a country, are we doing wrong?
As documented in the 138-page hard copy Amnesty International report, there is no shortage of contributing factors.
First and foremost, America has no nationally implemented guidelines and standards for a comprehensive system of maternal health care. Amnesty has suggested that the “U.S. Congress should direct and fund the Department of Health and Human Services to establish an Office of Maternal Health.” Projections show that improving the standard of care could prevent close to 50 percent of deaths.
A starting point is the necessity of prenatal care, which is defined by The Healthy People 2010 Goals as thirteen prenatal visits beginning at the first trimester. Those women who do not receive this medical attention are shown to be three to four times more likely to die of pregnancy-related complications than women who do. The reasons women don’t connect with this crucial care emanates from a health system that currently sustains impediments to care, and is rife with bureaucracy, inadequate services, and even discrimination.
In 2009, more than one in six Americans had no health insurance. Thirteen million women from the ages of 15-44 were part of that demographic. Health care costs can be prohibitive. An uncovered ultrasound costs $1,000. Accessibility in both rural areas and inner cities is a major obstacle. In these settings, it can be problematic for women to obtain transportation to clinics, and even then, many of the serving institutions are seriously understaffed. Quandaries arise when a woman has to choose between showing up for her job and keeping a prenatal visit. Inflexible office hours, lack of childcare for other children, and language barriers also present challenges.
Women of color (African-American, Latina, Native American), women in poverty, and immigrant women are hardest hit by these obstacles to prenatal care. It was documented that African-American women were four times more likely to die of pregnancy related complications than white women.
Jennifer Dohrn, DNP, has worked on the frontlines as a midwife since 1987, when she joined forces with the Morris Heights Health Center in the southwest Bronx in New York City. As the first freestanding birth center in the country for urban women, the MHHC served those with no access to health care. Dohrn wrote by e-mail, “Maternal mortality is not an unsolvable problem. We have the technology to provide safe motherhood for women in the United States and globally.” When Dohrn started, one-third of the women in the community had received no prenatal care at the time of delivery, and infant mortality ranked amongst the highest in the country. Opening a center that was accessible to women encouraged early entry into prenatal care given by skilled midwives, continuous involvement of the family, and safe delivery with promotion of breastfeeding. There were no long waits, the staff reflected the culture of the clientele, and state financed programs for pregnancy covered the costs. As Dohrn made clear, “This is a model of how it can be done.”