A yearlong debate on health care reform centered on costs and on methods for extending insurance coverage. Lobbying, congressional posturing, and media focus on deal making were boundless. Missing was any notion of health care serving people rather than interests.
In particular, the issue of staving off of death was left for another day. The fact that the U.S A. ranks 46th in the world on infant mortality and 34th in life expectancy sparked little interest in the centers of power.
On March 12, nine days before the House of Representatives passed its health care reform bill, Amnesty International (AI) released a report on skyrocketing death rates affecting U.S. mothers during pregnancy and childbirth.
According to "Deadly Delivery, The Maternal Health Care Crisis in the USA," 101 pages long, the United States ranks 41st in maternal mortality. Between 1987 and 2006, the U.S. rate doubled, from 6.6 deaths per 100,000 births to 13.3 deaths. The Washington, D.C rate is 34.9; that for Black women in New York City, 83.6.
The maternal mortality rate (MMR) reflects the number of women per 100, 000 births dying during pregnancy, or shortly thereafter. The Centers for Disease Control and Prevention estimate that half such deaths are preventable.
The rate of one in 47,600 Irish women dying during childbirth is the world's best. The comparable U. S. figure is one in 4,800. Of more than 536,000 maternal deaths worldwide in 2005, 99 percent occurred in poor countries. One Millennium Development Goal calls for a three-quarters reduction in the MMR between 1990 and 2015.
The AI report howed close to death episodes from pregnancy-related complications increasing by 25 percent over 12 years. Since there is no federal requirement for reporting childbirth deaths, the numbers of U.S. women dying may have been underestimated.
That means life threatening conditions like hypertension, diabetes, heart conditions, and fetal abnormalities often go unrecognized. Lack of prenatal care, which applies to one third of African American and Native American women, quadruples maternal mortality.
The report says, "Discrimination is costing lives... [W]omen face barriers to care, especially women of color, those living in poverty, Native American and immigrant women." Overall, 25 percent of U.S. women of reproductive age lack health insurance, of which half are women of color. African-American women's risk of death during childbirth is four times that of white women.
The reports protests shortages of health care workers in rural and inner city areas. It highlights Cesarean sections accounting for one in three births, twice the level recommended by the World Health Organization. Caesarian sections present three times the lethal risk of vaginal births. Capabilities for monitoring maternal deaths are lacking in 29 states and in Washington D.C.
AI spokesperson Larry Cox denounced a "haphazard approach to maternal care" that is "scandalous and disgraceful." "Mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good care is available to all women."
The report states that "no legislation currently under consideration would realize the human rights standards of making health care available" to all. Reform "primarily focused on health care coverage and reducing health care costs... will still leave millions without access to affordable care," said Rachel Ward, one of the report's authors. Effects of discrimination, lack of government interest in safe deliveries, and neglect of "nationally standardized [preventative] protocols" will prevail.
The United States last year supported a UN resolution establishing safe birthing as a right associated with "the promotion and protection of the human rights of women and girls." The U.N. sponsored Committee on the Elimination of Racial Discrimination charged the United States, however, with failing to eliminate racial inequalities, "particularly with regard to the high maternal and infant mortality rates."
Meanwhile, hospitalizations related to pregnancy and childbirth cost $86 billion annually, a top revenue producing area in hospitals. The average 2008 salary for employed obstetricians ranged between $231,514 and $304,689, according to internet estimates.
Commenting on the U.S. government passing health care reform applying to most of its citizens, former Cuban President Fidel Castro observed that Cuba had attended to health care "for its entire population half a century ago, despite the cruel and inhumane blockade all of its citizens."