American Women—The weakest link in American Health care—and the most compelling reason for health care reform.

American Women—The weakest link in American Health care—and the most compelling reason for health care reform.
By Carlos T Mock, MD, F. A. C. O. G.
March 18, 2010

As my grandmother used to say in her 50 years as a midwife, “If men got pregnant there’d be an abortion clinic in every corner instead of a bar, and morphine would be legal, sold at every pharmacy.”

The truth is that American women have the most to gain from health care reform. Amnesty International issued a report Friday in which it claimed that: “deaths from pregnancy and childbirth in the United States have doubled in the past 20 years. About 1.7 million women a year, one-third of pregnant women in the United States, suffer from pregnancy-related complications, most of them occurring among minorities and women living in poverty. Minorities, women living in poverty, Native Americans, immigrants and those who speak little or no English are particularly affected.”

According to the report, "Deadly Delivery: The Maternal Health Care Crisis in the USA," the lifetime risk of maternal deaths is greater in the United States than in 40 other countries, including virtually all industrialized nations.

Figures compiled by the Centers for Disease Control and Prevention in Atlanta, Georgia, show that black women are three times more likely to die from pregnancy and childbirth than their white counterparts. White women have a mortality rate of 9.5 per 100,000 pregnancies, the CDC said. For African-American women, that rate is 32.7 deaths per 100,000 pregnancies.

The CDC analysis shows that deaths during pregnancy and childbirth have doubled for all U.S. women in the past 20 years. In 1987, there were 6.6 deaths for every 100,000 pregnancies. The number of deaths had climbed to 13.3 per 100,000 in 2006, the last year for which figures were available. Statistics for other highly industrialized countries show that the U.S. goal of four deaths for every 100,000 pregnancies is attainable. Great Britain, for example, has fewer than four deaths for each 100,000 pregnancies.

Women's health is at risk. We spend the most, and yet women are more likely to die than in 40 other countries. And that disconnect is what makes it such a problem. Sadly, Up to 40 percent of these deaths are preventable with better quality of care, according to a 2007 study in the American Journal of Obstetrics & Gynecology. Thirteen million U.S. women of reproductive age (15 to 44 years old), or one in five, do not have health insurance. Minorities account for 32 percent of all women in the United States but 51 percent of uninsured women. Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies. Furthermore, 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.

Other factors that have increased the number of maternal deaths include the increase in Cesarean Sections in the country. In 1980, the U. S. Cesarean section rate was less than 3%. Today, one out of every three pregnant women now has a C-section, the most common surgical procedure in the U.S. The skyrocketing C-section rate has been hotly debated in birthing and medical communities, yet little attention has been paid to one of the consequences: Once a woman has a C-section, she often has to fight to deliver subsequent babies the old-fashioned way, if a hospital or obstetrician allows her to try it at all.

Repeat C-sections have become so routine that 90 percent of pregnant women who have the surgery give birth that way again. That is a concern to health experts, who say vaginal births after a cesarean, or VBACs, should be far more common.

VBAC has long been the subject of heated debate. For decades, the mantra was "once a cesarean, always a cesarean." Doctors were concerned that the scar left in the womb from a previous cesarean would tear during labor, leading to life-threatening bleeding. But in 1980, an NIH conference panel suggested that the chance of uterine rupture was small in most women and that VBAC was as safe as other vaginal births. Maternity wards soon began embracing VBAC as a means to slash high cesarean rates.

As more and more women gave birth vaginally, however, reports of uterine ruptures increased, and VBAC rates began to slump in the mid-1990s. By 2004, they had dropped to less than 10 percent, despite high overall success rates between 60 and 80 percent for the procedures. It is important to stress that even though uterine rupture occurs in less than one percent of the women who attempt VBAC, and fewer than 4 in 100,000 women die, the risk of maternal death for any Cesarean Section is about three times higher. Women who undergo several cesareans also seem to have a higher risk of having their womb removed.

Finally, the failure to provide adequate birth control to women—either for religious or economic reasons—places high risk women at risk for unwanted pregnancies. This, combined with the decrease access to pregnancy termination for unwanted or high risk pregnancies—adds to the maternal mortality in the USA.

There is no doubt that mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good reproductive care is available to all women.

Dr. Mock has published four books with Floricanto Press, Berklety, CA. His articles have appeared on publications like The Chicago Tribune and several gay and lesbian newspapers. He was inducted in The Chicago GLBT Hall of Fame in 2007. He can be reached at: www.carlostmock.com