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Robert Reich: Healthcare for Pregnant Women is Inadequate

May 13, 2014

How right-wing ideology puts pregnant women at risk.

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Image from Flickr via novemberjing

By Robert Reich
By arrangement with Robert Reich

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.

Even if you’re still skeptical, consider that our rate of maternal death is heading in the wrong direction.

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. In 2003, it was 17.6. 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.

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.

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.

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.

This tragic trend is a clear matter of public choice.

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 tells 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, 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: The Next Economy and America’s Future and The Work of Nations: Preparing Ourselves for 21st Century Capitalism. 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.

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