• Thursday, July 24, 2014
  • A program of IPS Inter Press Service supported by the Dutch MDG3 Fund

    US Confronts its Dying Mums

     Obstetrical nurse Melissa Hilmanowske

    Obstetrical nurse Melissa Hilmanowske

    Amanda Bransford

    NEW YORK: The United States spends more money on healthcare than any other country in the world. It also has a higher maternal mortality rate than nearly any other highly economically developed nation, and higher than that of 39 other countries.

    The federal government set a goal in 1998 to achieve a rate of 4.3 deaths as a result of pregnancy and childbirth per 100,000 pregnancies by 2010. This goal is far from attained: the current rate is 13.3 per 100,000, with much higher rates among minority groups. The rate in 1980 was 9.2. — significantly lower than it is today.

    Part of the problem, says obstetrical nurse Melissa Hilmanowske, is the poor health of many Americans before pregnancy. “Our obesity rate is huge. We have poor nutrition.  Conditions like diabetes and preeclampsia are related to that.”

    Diabetes and preeclampsia are major contributors to maternal deaths. Embolism, or blood clots, is also related to obesity — and is the number one killer of women in pregnancy and childbirth.

    Hilmanowske says that she has seen a dramatic increase in the number of obese patients.  “Our population is getting so much bigger.”

    Other factors contribute to poor health, including vast numbers of Americans without health insurance. A study by the New York City Department of Health and Mental Hygiene found that the maternal mortality rate among uninsured women was four times that of women with insurance, whether private or Medicaid.

    Though pregnant women unable to afford insurance can apply for Medicaid, bureaucratic hurdles can slow the process, often delaying prenatal care. Even when a woman is able to obtain insurance during pregnancy, she is more likely to have received inadequate care and to be in poor health already if she was previously uninsured.

    “All signs point to the condition of the mother predicting the outcome of the pregnancy,” says Loretta Ross, national coordinator of SisterSong, a coalition of reproductive justice advocacy groups.

    This year’s healthcare reform bill — the Patient Protection and Affordable Care Act (PPACA) — is expected to reduce the number of uninsured Americans by 32 million, according to Congressional Budget Office estimates.

    Ross isn’t entirely convinced, however, that the government’s model will be effective.  People will be required to purchase insurance or pay a penalty, which will be expensive for those with lower incomes.

    “It probably will have a prophylactic effect, though,” she says. “People will probably take the attitude that, now that I’m paying for it, I better go use it.” This could lead to better health all around, and in turn better outcomes in pregnancy.

    One aspect of healthcare reform that Ross does believe can reduce maternal mortality is the increase in funding by 10 billion dollars over five years for community health clinics.
    These clinics are federally funded and charge based on a person’s ability to pay. Many women, especially poor women, immigrants, and those in rural areas or inner cities, rely on them for care.

    This provision, says Ross, “missed the headlines, but it is a win from healthcare reform.”  Ross adds, however, that the funding may not be enough to fill the large need.

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