Just as President Obama and congressional Democrats could nearly see a day in sight where healthcare reform would become law, their year-long struggle hit another pothole as the legislation came under fire from a global human rights group.
Amnesty International’s report, Deadly Delivery: The Maternal Health Care Crisis in the USA, urges action to tackle a crisis that sees between two and three women die every day during pregnancy and childbirth in the United States. A total of 1.7 million women a year, one-third of all pregnant women in the country, suffer from pregnancy-related complications, the organization says.
With a lifetime risk of maternal deaths that is greater than in 40 other countries, including virtually all of the industrialized countries, the United States has failed to reverse the two-decade upward trend in preventable maternal deaths, despite pledges to do so, according to Amnesty International. Most recently, the federal government has failed to meet the goals set forth in the 2010 Healthy People initiative, which called for reducing the number of maternal deaths to one-third of current rates, the organization adds.
The report analysis, however, finds that health care reform before Congress does not address the crisis of maternal health care. The White House put off an overseas trip Obama had planned because of hopes to have the reform legislation signed into law this week.
“Reform is primarily focused on health care coverage and reducing health care costs, and even optimistic estimates predict that any proposal on the table will still leave millions without access to affordable care,” says Rachel Ward, one of the authors of Deadly Delivery. “Furthermore, it does not address discrimination, systemic failures and the lack of government accountability documented in Amnesty International’s report.”
Ward adds: “The barriers preventing women from getting the care that they need go far beyond simply lacking health insurance. Health care reform does not address obstacles to maternal care, recommend nationally standardized protocols for preventing and treating the most common causes of death, eliminate health disparities or ensure that the government takes responsibility for reducing levels of maternal mortality.”
In response to its findings of widespread maternal risk, Amnesty International calls on Obama to quickly establish an Office of Maternal Health to lead government action to reduce soaring pregnancy-related complications and maternal deaths nationwide.
Amnesty International says that rapid and comprehensive federal leadership is required, as the report found numerous systemic failures, including the following:
- Obstacles to care are widespread, even though the United States spends more on health care than any other country and more on pregnancy and childbirth-related hospital costs, $86 billion, than any other type of hospital care.
- Nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. Women of color account for just under one-third of all women in the United States (32 percent) but over half (51 percent) of uninsured women.
- 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. Twenty-one states do not offer “presumptive eligibility” which allows pregnant women to temporarily access medical care while their permanent application for Medicaid is pending. Women who do not receive any prenatal care are three to four times more likely to die than women who do.
- 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), but federally-supported community health centers — a critical safety net — are available in only 20 percent of these areas.
- The lack of nationally standardized protocols addressing the leading causes of death — or the inconsistent use of them — may lead to preventable deaths or injuries. Measures used widely in the United Kingdom to prevent blood clots after caesarian sections are not consistently taken in the United States, for example.
- Many women are not given a say in decisions about their care and do not get enough information about the signs of complications and the risks of interventions such as inducing labor or cesarean sections. Cesarean sections make up nearly one-third of all deliveries in the United States – twice as high as recommended by the World Health Organization. The risk of death following c-sections is more than three times higher than for vaginal births.
- The number of deaths is significantly understated because there are no federal requirements to report maternal deaths or complications and data collection at the state level is insufficient.
- Oversight and accountability is lacking. Some 29 states and the District of Columbia have no maternal death review process at all.
The publisher of the news site On The Hill, Scott Nance has covered Congress and the federal government for more than a decade.