Action Alert

Maternal Healthcare Is a Human Right

Take Action to Support Legislation in the Senate

Maternal Healthcare Is a Human Right

The Senate Committee on Health, Education, Labor and Pensions is sending its maternal mortality review legislation (S.1112) to the full Senate for a vote. Let’s make sure it passes the Senate and is sent to the full House for a vote. We can do this!

Maternal Mortality in the U.S.

The United Nations Office of Human Rights, in its 2010 report, declared maternal health to be a human rights issue, stating that, “The scale of maternal mortality and morbidity across the world reflects a situation of inequality and discrimination suffered by women throughout their lifetimes…” Advancing maternal health as a human rights issue has become an international movement. However, the United States is the only developed country in the world to have seen a rise in the number of maternal deaths. Between 1990 and 2015, the maternal mortality rate in the U.S. jumped from around 17 percent to 26 percent. UNICEF reports that maternal deaths, in total, have declined 54 percent globally, highlighting U.S. regression in this matter.

Not all populations have been equally affected by the growing rate of maternal deaths in the U.S. According to a 2018 report conducted by the Centers for Disease Control and Prevention (CDC), black and Native American women have the highest rates of maternal mortality at around 47 and 39 deaths per 100,000 live births. Additionally, women between the age of 35-44 years are also at a higher risk for maternal mortality at around 39 deaths per 100,000 live births..

Over half of maternal deaths in the U.S. are a result of preventable causes related to various pregnancy and delivery complications. However, because of inconsistencies in data collection and analysis, specific causes are difficult to pinpoint, making the solutions harder to find. Along with limited data in this area, research demonstrates that due to a lack of quality, affordable and accessible maternal healthcare, many women choose to opt out of essential visitations and check-ups, putting them at a higher risk of life-threatening natal complications.

Communication & Data Sharing

One of the major impediments for improving healthcare in the U.S. and around the world is the lack of data collection and sharing between maternal healthcare providers, government agencies and the public. Each year, states compile data on maternal deaths from healthcare providers and forward that information to federal agencies for analysis. However, the data provided often is inconsistent and unreliable. Why is this? According to a 2018 publication of the journal Birth Issues in Prenatal Care, a nationally mandated pregnancy question was placed in the 2003 revision of the United States Standard Certificate of Death to ascertain whether the cause of death was related to pregnancy complications. However, this change was not adopted right away. In fact:

…some states were using the United States standard question, others were using questions incompatible with the United States standard, and still others had no pregnancy question on their death certificates.

Because of this, there has not been an official maternal death count in the U.S. since 2007. Furthermore, it is voluntary for states to provide information as to what the pregnancy complications of the patient were. This makes it difficult for federal agencies, such as the CDC, to pinpoint correlations in maternal mortality data.

Establishing Maternal Mortality Review Committees

Maternal Mortality Review Committees (MMRCs) are great facilitators of state maternal mortality surveillance. There has been a 20-50 percent positive correlation between the creation of MMRCs and maternal survival; however, 21 states have yet to adopt such a council. In addition to the lack of state participation, data communication between states with MMRCs is deficient. Only 9 out of the 29 states with MMRCs are a part of a shared database, the Maternal Mortality Review Information Application (MMRIA), in which information is distributed, compared and compiled into a report. In 2017, all 9 states released a collective report, which analyzed maternal mortality data. State participation in the newly developed MMRIA is essential for providing consistent data on maternal mortality trends. Without participation in MMRIA, states, both with and without MMRCs, will continue to provide conflicting data. If states work collaboratively with each other and the federal government to identify maternal mortality risks, prevention methods can be set in place.

Cost of Maternal Care

While having the highest maternal mortality rate in the developed world, maternal care in the United States is among the costliest in the world. Having an in-hospital birth can cost a woman upwards of $3,500, not including the additional costs of epidural or other procedures, which might include a C-section. Excluding the delivery costs, prenatal and postpartum care can cost an average of $8,800, depending on each state. Furthermore, insurance can legally not be responsible for $7,350-$14,700 in out-of-pocket costs, depending on whether a woman has an individual or family plan.

In 2016, approximately 11 percent of adult women (not including the elderly) were uninsured. People of color are more likely to remain without coverage; among low-income women, Latinas and black women have significantly higher uninsured rates (32 percent and 16 percent, respectively) compared with white women (12 percent).

If a woman has little or no insurance coverage, she may choose to opt out of necessary obstetric care services. Also, insurance may only cover pregnancy-related complications for a limited time. Medicaid coverage, for example, covers only 6 weeks of postpartum care. In 2010, the Guttmacher Policy Review published an analysis of maternal healthcare reform legislation that would extend coverage and limit the amount of out-of-pocket costs, ultimately encouraging women to seek such care.

Accessibility to Maternal Care

The World Health Organization claims that for maternal mortality to be significantly reduced, all women need access to prenatal and postpartum care. Women around the world, especially in low-income and rural areas, lack accessibility to quality maternal care services. A 2011 study from the American Public Health Association found that socioeconomic disparities in maternal healthcare play a vital role when determining pregnancy outcomes. Such disparities include:

… lack of care coordination and appropriate care for high-risk women, lack of timely and appropriate transfers to higher level care facilities, delay in diagnosis, treatment and response to emergency situations by providers, lack of postpartum follow-up care including home visits and maternal education, and lack of care provisions for incarcerated women.

Accessibility not only includes transportation and geographical distance, but also encompasses the timeliness of maternal healthcare services, such as the length of time in between check-ups and visitations, as well as the time it takes to receive emergency care services. Even if maternal care was readily available, cost may deter women from seeking such care.

Increasing Care Accessibility through Midwives

In response to growing disparities in maternal health, midwives have been introduced in various “high risk” low-income areas as a means of alternative care. Midwives are certified medical professionals, who use their expertise to provide prospective mothers with emotional, medical and educative support throughout their pregnancy. A recent study conducted by Every Mother Counts discovered that midwives can help reduce the possibility of pregnancy complications, improve women’s self-care, and reduce “wasteful and unnecessary spending.” This community-centered approach to maternal care can prevent women from experiencing abuse, neglect and disrespect that may occur in institutional settings. Saraswathi Vedam, an associate professor at the University of British Columbia, stated in an interview with ProPublica, “In communities that are most at risk for adverse outcomes, increased access to midwives who can work as part of the healthcare system may improve both [maternal and child survival] outcomes and the mothers’ experience.” Additionally, a study conducted by PLOS One, showed that there were less pregnancy complications and infant deaths among states that integrated midwifery in maternal care. Maternal health organizations such as Our Moment of Truth promote midwife services as a safe and reliable care option that is “grounded in evidence-based practice and professional standards.”

“No mother should die giving life.” Saving Mothers, Giving Life

American acceptance of maternal healthcare as a human right will help push forward legislative action to provide every woman with safe and reliable natal care. To achieve this, healthcare facilities, along with the state and federal government, must work together on establishing set standards for data collection and analysis, as well as for quality, cost-efficient and accessible maternal care. With the help of Congress and public action, in the passage of the MOMMA Act, Maternal Deaths Act and Maternal Health Accountability Act, the U.S. will be taking a step towards achieving quality maternal healthcare for all women.

The Senator Kamala Harris recently introduced, “Maternal Care Access and Reducing Emergencies (CARE) Act,” to the Senate floor in an effort to combat disparities in maternal deaths. United Methodist Women Office of Public Policy will pay close attention as this legislation progresses and will be sure to update members on its status.

Posted or updated: 9/7/2018 12:00:00 AM
 
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Take Action:

Contact your local congressional representative at Capital Switchboard (202-224-3121) or in their district office to voice your support for:
  • Maternal Deaths Act of 2017, H.R. 1318 and Maternal Health Accountability Act, S.1112 incentivizes states with federal funding to establish Maternal Mortality Review Committees.
  • Let your representatives hear from you! Let’s make sure S.1112 gets voted on by the full Senate and sent to the House floor for a vote. Call your legislators today!
  • Mothers and Offspring Mortality & Morbidity Awareness Act (MOMMA) Act, H.R. 5977 – legislation to extend Medicaid coverage for pregnant women, ensures accessible, quality and available natal care.

Maternal Mortality Facts:

Click Here.10 Facts on Maternal Health

Click Here."ABC News: 20 Maternal Health Facts We All Should Know"

Click Here."7 Facts About Maternal Health You Should Know"

Learn about Saving Mothers Around the World:

Click Here."Midwives and doulas aren’t a luxury. They’re a necessity."

Click Here."Black doulas, midwives and reproductive health advocates step up in response to rising black maternal deaths"

Click Here.Saving Mothers, Giving Life

Resources:

Read pages 255-266 on maternal health, (Chapter 162. II. The Social Community) in The Book of Resolutions of The United Methodist Church 2012.
 

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