Do you believe, as many Americans do, that the U.S. health care system is the best in the world? Think again.
We spend more than any other country on health care, and more on maternal health than any other type of hospital care. Yet maternal mortality rates have more than doubled in this country since 1987. Women here have a higher risk of dying of pregnancy-related complications than those in 40 other countries. African American women are nearly four times more likely to die of pregnancy-related complications than white women, a disparity that hasn't changed in more than twenty years. It should shock us all that about three women die every day in the U.S. from complications of pregnancy and childbirth and about half of those deaths could be prevented if maternal health care were available, accessible, and of high quality for all American women.
This is a public health emergency, and as Amnesty International says in its report "Deadly Delivery: The Maternal Health Care Crisis in the USA", it is a human rights crisis based on multiple failures ranging from discrimination to bureaucracy.
Let's put a human face on this disaster. Inamarie Stith-Rouse, an African American, was 33-years old when she delivered a healthy baby girl by C-section in 2003. After the birth she developed shortness of breath but the staff dismissed it. By the time they took her complaint seriously it was too late. She died a few days later. Trudy LaGrew, a Native American, died in 2008 after giving birth to her second child. Her pregnancy was considered high risk but she couldn't get proper pre-natal care because the closest obstetrician was a two-hour drive away and she didn't have a car. Trina Bachtel, a 35-year old white woman, was insured at the time of her pregnancy but the local clinic demanded a $100 deposit because of a past medical debt that she had repaid. Trina delayed care for lack of funds. Her son was stillborn and two weeks after the birth, she died of complications.
Listen to what women say: "The woman in the hospital told me "Yes, I speak Spanish, but at this hospital we only speak English." "If you go to apply for Medicaid you need a "proof of pregnancy' letter"where do you get that kind of letter? A doctor, but if you have no Medicaid, how are you going to get to the doctor to get the letter?" "I went for an ultrasound and got a bill for $1,000. I freaked out!'
Unequal care, barriers to care, system failures and lack of accountability have created a crisis in this country and no one who hasn't experienced it first-hand seems to know much about it. How can it be, in a country as wealthy and sophisticated as this one, that access to family planning is constrained by budgets and legislative measures? How do we justify lack of prenatal care, inadequate care after birth, or variability in quality of care in obstetric practices across the country when proven guidelines exist?
It's a truism that if you want to know how a country is doing, ask the women. Most of them here know that things have gone terribly awry in the health sector and that the problems are symbolized by the crisis in maternal health. Here are just a few things that could be done to correct the situation: First, legislators need to recognize that this is a human rights issue. Good quality health care should be available, accessible, and acceptable to everyone, without discrimination. Congress should fund an Office of Maternal Health under the Department of Health and Human Services to improve data collection, protect the right to non-discriminatory care, and recommend necessary regulatory and legislative changes. Congress should also increase funding for Federally Qualified Health Centers so that there are an adequate number of health service facilities and health professionals, especially in underserved areas. And state health departments must ensure that pregnant women have "presumptive eligibility" while waiting for Medicaid.
If these things had been in place, perhaps 22-year old Tameka McFarquhar would not have bled to death in her apartment in 2004 for lack of a post-partum check-up. The hospital that turned away a laboring woman named Maria for lack of funds would not have been able to do so. Hospitals that "keep the fewest nurses on the floor due to finances" would staff up. Women of color would be taken seriously.
This is a matter of great urgency. In the words of Dr. Martin Luther King, Jr. spoken more than 40 years ago. "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Surely the best health care system in the world should be neither shocking nor shameful. When are we going to get it, and insure as countries like Rwanda do that health care is a human right and not a selective privilege?
