Why American women are endangered in pregnancy

05/20/2014 5:33 PM

06/03/2014 10:17 AM

According to a report released earlier this month in the widely respected health research journal The Lancet, the United States now ranks 60th out of 180 countries on maternal deaths occurring during pregnancy and childbirth.

To put it bluntly, for every 100,000 births in America last year, 18.5 women died. That’s compared to 8.2 women who died during pregnancy and birth in Canada, 6.1 in Britain, and only 2.4 in Iceland.

A woman giving birth in America is more than twice as likely to die as a woman in Saudi Arabia or China.

You might say international comparisons should be taken with a grain of salt because of difficulties of getting accurate measurements across nations. Maybe China hides the true extent of its maternal deaths. But Canada and Britain?

Even if you’re still skeptical, consider that our rate of maternal death is heading in the wrong direction. It’s risen over the past decade and is now nearly the highest in a quarter century.

In 1990, the maternal mortality rate in America was 12.4 women per 100,000 births. Now it’s 18.5.

By contrast, the rate has been dropping in most other nations. In fact, we’re one of just eight nations in which it’s been rising.

Something’s clearly wrong.

Some say more American women are dying in pregnancy and childbirth because American girls are becoming pregnant at younger and younger ages, where pregnancy and birth can pose greater dangers.

But the biggest rise in pregnancy-related deaths in America has occurred in women 20-24 years old. Consider that in 1990, 7.2 women in this age group died for every 100,000 live births. By 2013, the rate was 14 deaths in this same age group.

Researchers aren’t sure what’s happening, but they’re almost unanimous in pointing to a lack of access to health care, coupled with rising levels of poverty.

Some American women are dying during pregnancy and childbirth from health problems they had before they became pregnant but worsened because of the pregnancies — such as diabetes, kidney disease and heart disease.

The real problem, in other words, was they didn’t get adequate health care before they became pregnant.

Other women are dying because they didn’t have the means to prevent a pregnancy they shouldn’t have had, or they didn’t get the prenatal care they needed during their pregnancies. In other words, a different sort of inadequate health care.

One clue: African-American mothers are more than three times as likely to die as a result of pregnancy and childbirth than their white counterparts.

The data tell the story: A study by the Roosevelt Institute shows that U.S. states with high poverty rates have maternal death rates 77 percent higher than states with lower levels of poverty. Women with no health insurance are four times more likely to die during pregnancy or in childbirth than women who are insured.

What do we do about this? Yes, of course, poor women (and the men who made them pregnant) have to take more personal responsibility for their behavior.

But this tragic trend is also a clear matter of public choice.

Many of these high-poverty states are among the 21 that have so far refused to expand Medicaid, even though the federal government will cover 100 percent of the cost for the first three years and at least 90 percent thereafter.

So as the sputtering economy casts more and more women into near poverty, they can’t get the health care they need.

Several of these same states have also cut family planning, restricted abortions and shuttered women’s health clinics.

Ideology is trumping the health needs of millions of Americans.

Let’s be perfectly clear: These policies are literally killing women.

Robert Reich, a former U.S. labor secretary, is the Chancellor’s Professor of Public Policy at the University of California at Berkeley.

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