Two Women a Day Die Giving Birth in America -- and Many of These Deaths Can Be Prevented

A damning new report from Amnesty International castigates the U.S. for dismal maternal mortality rates and a double standard of care that leaves racial minorities and lower-income women out in the cold. The report notes that nearly two women a day die from complications related to pregnancy or childbirth--and many of these deaths could be prevented.  

"Mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good care is available to all women," Amnesty International America's Executive Director Larry Cox said when the report's findings were released. Somehow this miserable trend hasn't gotten much attention from the anti-choicers who claim to only care about the preciousness of human life.

Pro-Life Only Until Birth

In the United States, where supposedly "pro-life" people make up around half the population, we're not very good at securing either end of the spectrum--looking out for women seeking family planning or those women about to start a family. And the political allies of the folks exhorting women to "choose life" have been fighting tooth and nail against health reform that would improve access to insurance and care for pregnant women and young children.

On Tuesday night's episode of "The Good Wife" a pro-choice activist took the stand in a lawsuit against an insurance company that refused to pay for fetal surgery. The lawyer for the opposition mocked the woman's supposed hypocrisy in trying to save her own pregnancy while giving other women the choice to terminate theirs. While the character sputtered about fighting for all reproductive rights and then gave up and begged for a chance (thanks for the positive portrayal, network TV), she was absolutely correct about the connection between fighting for healthy pregnancies and fighting for abortion rights, two battles united under the reproductive justice umbrella. While anti-choicers focus only on preventing access to a single procedure, women across the country are dying pointless death due to lack of access to proper prenatal, birth and post-birth care. Among the chilling conclusions in Amnesty International's report, titled "Deadly Delivery: The Maternal Health Care Crisis in the USA":

• One in four women do not receive adequate prenatal care, starting in the first trimester. The number rises to about one in three for African American and Native American women. 

• Burdensome bureaucratic procedures in Medicaid enrollment substantially delay access to vital prenatal care for pregnant women seeking government-funded care.  

• A shortage of health care professionals is a serious obstacle to timely and adequate care, especially in rural areas and inner cities. In 2008, 64 million people were living in "shortage areas" for primary care (which includes maternal care).

The numbers are even more disturbing when put up against statistics in other nations: we are 40th in the world in lifetime risk of maternal death--essentially slumped at the bottom of the heap of industrialized countries. While those opposed to health care reform claim we have the greatest system in the world, they blatantly ignore the fact that thousands of patients aren't able to take advantage of that system--because of costs and also bureaucracy. 

"If you go to apply to the medicaid system, you need a 'proof of pregnancy' letter, with the due date, the date of your last period, and the gestational age of the baby," Jennie Joseph, a professional midwife from Florida told the report's authors. "Where do you get that kind of a letter? A doctor. If you have no Medicaid, how are you going to get to the doctor to get that letter?"

Furthermore, the number of maternal deaths that could have been prevented with better access to prenatal care or improved care has risen over time in America. In 1987, the rate was 6.6 deaths per 100,000 live births; in 2006, it had risen to 13.3 deaths per 100,000 live births. 

Autonomy Threatened

The report also faulted the American health care system for a lack of women's medical autonomy and for the over-medicalization of care, two vital reproductive justice issues. Amnesty mentioned trends such as an increase in unnecessary Cesarean sections, lack of proper health insurance for younger women, and women having little or no say over their medical decisions, including whether to have invasive procedures, as among the serious barriers to successful, complication-free deliveries.   

The data sources for the report were varied, and included the Centers for Disease Control and Prevention, but its authors cautioned that maternal mortality might in fact be under-reported, since the mechanisms for collecting this kind of data are flawed--maternal mortality. "The ability to investigate deaths in depth does not exist with the exception of Massachusetts, California and maybe Florida…Frankly, it’s a disgrace," an anonymous federal official told the report's authors.   

Healthy expectant mothers means healthy babies, and competent caregivers. So where are the so-called pro-lifers on this issue? Their only interest in African American women these days is perpetrating the anti-choice "black genocide myth," most recently by spending cash on a Georgia billboard campaign that drew dubious mainstream media attention, not to mention serious heat from women of color in the reproductive rights community.   

Why is Georgia Right-to-Life spending money on billboards shaming African American women for having abortions when it could be improving access to prenatal care for those women who do want to carry pregnancies to term? The racial disparities when it comes to maternal mortality are stark and depressing. Women's eNews has published a 14-part series called "Black Maternal Health," in which a variety of writers address the idea that "the stress of living with racism--from workplace discrimination to maltreatment in maternity wards--" is a major contributor to health-related inequality.   

Amnesty International made a substantial group of recommendations to the Obama administration, including that congress set up an Office of Maternal Health within the Department of Health and Human Services whose purview would include collecting more reliable data and policing discrimination in health care access. Increased funding for health centers for under-served areas and ensuring that state health departments give pregnant women “presumptive eligibility"--or the ability to avail themselves of Medicaid's services while waiting for approval.

It's doubtful that any of these provisions will make it into health care reform. They certainly won't be introduced by the anti-choicers, who are more interested in policing women's behavior than in actually saving the lives of women and children desperate for care.