Tag Archives: preventive health services

Maternal Mortality: A National Embarrassment

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Americans spend more money on childbirth than any other country, but we’re not getting a good return on our investment.

Less than a century ago, approximately one mother died for every 100 live births — an occurrence so common that nearly everyone belonged to a family, or knew of one, that was devastated by such a loss. Fortunately, in most nations, those tragedies have declined over the years. In fact, in the decade between 2003 and 2013, only eight countries saw their maternal mortality rates rise.

Unfortunately, the United States was one of those eight countries, joining a club that also includes Afghanistan and South Sudan. Within the 31 industrialized countries of the Organization for Economic Cooperation and Development, an American woman is more likely to die as a result of pregnancy than a citizen of any other country besides Mexico. Among developed countries, the United States has one of the highest maternal mortality rates — and those rates are only getting worse.

Graph: CDC

U.S. maternal mortality has attracted the attention of organizations whose oversight you wouldn’t expect. Amnesty International, which most Americans associate with the fight against human rights abuses in far-flung authoritarian regimes, considers our high maternal mortality rates to be a violation of human rights. Additionally — and pathetically — one of the biggest sources of funding for maternal health in the United States comes not from taxpayers but from the pharmaceutical company Merck. The Economist quoted a Merck spokesperson as saying, “We expected to be doing all our work in developing countries.” Continue reading →

Bearing the Burden of Injustice: Black Maternal Mortality

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Mother and babyWhen it comes to maternal mortality, American women don’t all live in the same country. While white women live in Qatar, black women live in Mongolia.

Maternal mortality is death related to complications from pregnancy or childbirth. Most of us don’t come from a time or place where the prospect of dying in childbirth is a tangible possibility — in the past century, as medicine has advanced, maternal mortality rates have plummeted.

To raise healthy families, we need access to general and reproductive health care, including preventive care, prenatal care, and maternity care.

The United States, though, hasn’t come as far as would be expected. Although its wealth should have put it on par with other developed nations like Canada, the United Kingdom, Australia, Japan, and those in Scandinavia, women in these countries fare far better than those in the United States. So do women in Libya, Bosnia and Herzogovina, Bulgaria, and Kazakhstan, indicating that national priorities — and not necessarily national wealth — are key to ensuring maternal health.

The United States’ high maternal mortality rate is heartbreaking no matter how you look at it, but is even worse for women of color. African-American women are 3.5 times more likely to die as a result of pregnancy or childbirth than white women. Between 2011 and 2013, the maternal mortality rate for white women was 12.7 deaths per 100,000 live births. Comparing that to 2015 data from the World Health Organization (WHO), that rate puts white women’s maternal mortality on par with mothers in Qatar and Bahrain, two wealthy Persian Gulf nations. African-American women, however, suffered 43.5 deaths per 100,000 live births, putting their maternal mortality on par with those of Turkmenistan, Brazil, and Mongolia. Continue reading →

Eroding the Birth Control Mandate

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The Trump administration made its boldest move against contraception access on Friday, when it reversed Obama-era policies requiring most employers to include birth control in employee insurance plans. Nonprofit companies, private firms, and publicly traded companies can opt out of providing birth control through employee insurance plans by claiming a “sincerely held religious or moral objection.” This change was made, effective immediately, with no period for public comment.

If you have insurance that still covers contraception, now might be the time to look into IUDs or implants, which can last for at least three years.

Previously, only a small group of religious employers was exempt from the requirement to include birth control in employee insurance plans; the new rule expands the types of businesses that can claim religious exemptions. Furthermore, these employers need not cite any particular religious beliefs, but can simply claim to have moral objections to birth control in order to opt out of including contraception in employee insurance plans.

The ruling drew condemnation from the American Congress of Obstetricians and Gynecologists, Planned Parenthood Federation of America, the American Civil Liberties Union, the National Women’s Law Center, and the Center for Reproductive Rights.

Under the provisions of the Affordable Care Act, contraception is considered a “preventive” service and, therefore, legally must be made available with no out-of-pocket costs to patients. Zero-copay birth control, as this is called, has saved users and their families billions of dollars in the years it has been in effect. Continue reading →

The American Health Care Act, Act 2

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It’s time to raise your voice.

When the House of Representatives failed to pass the American Health Care Act in March, we thought they would move on to other things. They had already faced the wrath of their constituents in town halls across the country, defending themselves against charges that they were taking people’s health care away.

But a promise is a promise, and the Republicans had promised their voters they would get rid of Obamacare. So they began to negotiate — only instead of negotiating with the moderates in their party and perhaps some Democrats, they chose to work with the tea party faction, who now call themselves, without irony, the Freedom Caucus — which had disparaged the original AHCA as “Obamacare-lite.” If the angry constituents packing town halls to capacity thought the first iteration of the AHCA was too extreme, what on earth made House Republicans think a Freedom Caucus makeover would produce a bill that would inspire less animosity than the first?

We must insist that our representatives remember that health care is a matter of life and death.

So Tom MacArthur, a supposedly moderate Republican who makes Ronald Reagan look liberal, and Mark Meadows, the Freedom Caucus leader who makes Reagan look like a full-blown socialist, hammered out a deal. The tea party objection to the AHCA was that it didn’t get rid of the ACA’s regulations on insurance companies — such as barring insurers from charging more money to women, older patients, or patients with preexisting conditions, or requiring them to cover essential services like preventive health care without cost to patients, emergency services, prescription drugs, and prenatal care. MacArthur and Meadows’ supposed compromise allows states to apply for waivers to opt out of these essential services, or to allow higher rates for those with preexisting conditions if they set up “high-risk pools.” MacArthur’s constituents were not pleased. Continue reading →

Who Controls Your Birth Control?

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On the day after Valentine’s Day, the National Domestic Violence Hotline released a report about disturbing behavior that may be displayed by many abusive partners. According to the New York Times, the hotline collected stories of abusers sabotaging their partners’ contraception, whether by hiding their birth control pills, poking holes in condoms, or refusing to use condoms altogether:

About a quarter [of respondents] said yes to one or more of these three questions: “Has your partner or ex ever told you not to use any birth control?” “Has your partner or ex-partner ever tried to force or pressure you to become pregnant?” “Has your partner or ex ever made you have sex without a condom so that you would get pregnant?”

One in six answered yes to the question “Has your partner or ex-partner ever taken off the condom during sex so that you would get pregnant?”

The survey was not part of a scientific study. The respondents were not made up of a representative cross-section of the general population, but rather were a self-selected group, already in abusive relationships and willing to talk about their experiences. From the data released by the National Domestic Violence Hotline, it is impossible to tell how widespread such forms of abuse are in society as a whole. Despite this, the data collected do point to a disturbing way that intimate partner violence can manifest itself. It is important to recognize interference with one’s birth control — and therefore one’s bodily integrity — as abusive behavior.  Continue reading →