What’s killing America’s new mothers?

https://qz.com/1108193/whats-killing-americas-new-mothers/?fbclid=IwAR3XRttw6BfjbypIdLBC-4axblHgK2hgLEs9jp5yVNpxKvG7YORRTt6WGjE

By Annalisa MerelliOctober 29, 2017

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On that March day, she joined one of the US’s most shameful statistics. With an estimated 26.4 deaths for every 100,000 live births in 2015, America has the highest maternal mortality rate of all industrialized countries—by several times over. In Canada, the rate is 7.3; in Western Europe, the average is 7.2, with many countries including Italy, Norway, Sweden, and Austria showing rates around 4. More women die of childbirth-related causes in the US than they do in Iran (20.8), Lebanon (15.3), Turkey (15.8), Puerto Rico (15.1), China (17.7), and many more.

While most of the world has drastically reduced maternal mortality in the past three decades, the US is one of just a handful of countries where the problem worsened, and significantly.

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America didn’t always fare so poorly in maternal health. Like most other developing countries, in the decades following the end of World War II, maternal mortality rates dropped across the US—until the late 1980s, when the trend began to reverse.

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“The increasing number of women who enter pregnancy with higher rates of obesity, hypertension, diabetes, abnormal placentation…are typically the first and only factors considered,” points out Christine Morton, a researcher at the CMQCC, in a commentary paper.

In other words, she notes, it’s presented as the women’s fault.

In a culture that places such emphasis on the value of self-determination and personal responsibility, it’s perhaps not surprising that expectant or new mothers would be judged deficient in their apparently poor life choices. But that ignores the fact that increased rates of obesity and related chronic health conditions are global, not just American, and that in other countries, they do not amount to a death sentence. Obesity among white mothers worldwide nearly doubled between 1980 and the early 2010s. Maternal deaths nearly halved (pdf, p.5-6).

Suellen Miller, a professor of gynecology and director of the Safe Motherhood Project at the University of California-San Francisco (UCSF), told Quartz that “all over the world, there is an obstetric demographic shift to older women, to more obese women, to women with more chronic conditions, and in many places to women who smoke.“ And yet, outside of the US, many women are safely delivering babies despite conditions that, some years ago, would have made that impossible. In certain parts of the world—Scandinavia and Western Europe, in particular—a focus on more dedicated care, before, during, and after birth leads to dramatically different results.

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Whether they are pregnant or not, women are second-class citizens when it comes to health care. They wait longer to be seen by doctors than male counterparts, their pain is routinely minimized (by gynecologists, no less), and though they are less likely to seek medical attention than men, their symptoms are more frequently dismissed as superficial—for instance being attributed, mistakenly, to psychological rather than physiological causes. Serious health conditions, from heart attack to cancer, are often downplayed in female patients.

When it comes to pregnant women, this manifests itself in a focus on the child, at the cost of a focus on the mother, as highlighted in a recent investigation by NPR and ProPublica into the issue. Health-care professionals spend their time and energy on the baby. This was the experience of the Logelin family—in the end, it was a case of the woman not being fully seen or heard by the US medical system.

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She says 13% of women who give birth are uninsured, forcing them to pay the cost of childbirth out of their own pockets. Another nearly 50% of deliveries are covered by Medicaid, the federally funded program that pays for prenatal care, delivery, and postnatal care for women who live at 133% or less of the poverty line.

Medicaid for parents, however, typically mandates a lower income qualification than the program’s pregnancy coverage, which leaves many mothers without coverage beyond 60 days post-delivery. But they are still vulnerable well past that timeframe. “Maternal health doesn’t just begin [and end] at pregnancy,” says Nadia Hussein, an advocate with MomsRising, noting that health care before, in between and after pregnancies is equally important, especially for the 20% of women dependent on Medicaid who suffer from chronic conditions like depression, hypertension, and type 2 diabetes.

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