According to a report released
last week 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.
That’s not a
measurement error because we’ve been measuring the rate of maternal death in
the United States the same way for decades.
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. The
others that are heading in the wrong direction with us are not exactly a league
we should be proud to be a member of. They include Afghanistan, El Salvador,
Belize, and South Sudan.
China was ranked 116 in
1990. Now it’s moved up to 57. Even if China’s way of measuring maternal
mortality isn’t to be trusted, China is going in the right direction. We ranked
22 in 1990. Now, as I’ve said, we’re down to 60th place.
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.
This theory might be
convincing if it had data to support it. But contrary to the stereotype of the
pregnant young teenager, 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 – almost double the earlier rate.
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 timesas 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 twenty-one 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.
Right-wing ideology is
trumping the health needs of millions of Americans.
Let’s be perfectly
clear: These policies are literally killing women.
ROBERT B. REICH, Chancellor’s Professor of Public Policy at
the University of California at Berkeley and Senior Fellow at the Blum Center
for Developing Economies, was Secretary of Labor in the Clinton administration.
Time Magazine named him one of the ten most effective cabinet secretaries of
the twentieth century. He has written thirteen books, including the best
sellers “Aftershock" and “The Work of Nations." His latest,
"Beyond Outrage," is now out in paperback. He is also a founding
editor of the American Prospect magazine and chairman of Common Cause. His new
film, "Inequality for All," is now available on Netflix, iTunes, DVD,
and On Demand.