/images/logo.jpg){kind=logo}
U.S. Maternal Mortality
From January to August of 2008, over 2 million homeowners received foreclosure notices. What health insurance coverage do they have? How many of them have children? How many of them are pregnant women? If you are uninsured in my state, Colorado, the average expense for prenatal care and delivery is $15,000. The amount increases for any complications or for cesarean delivery. In this economy, how many people can afford to pay that amount?
America is a nation that takes care of the world. We fight disease and malnutrition in other countries. So, I wondered how we ranked with the rest of the world when it comes to providing for our own citizens.
According to the 2007/2008 Human Development Report, the United States ranked 36th in commitment to health, which includes resources, access, and services. How do our pregnant women fare? The same report reveals that the U.S. shares ranking 39th with three other countries for maternal mortality. That means that 38 other countries have less maternal deaths than us. I previously wrote that when there is a lack of medical care for the mother and child, death rates increase. The Human Development Report supports this conclusion.
We are the United States of America. Why are we in 36th and 39th place in this report? Why are we not leading in less maternal deaths? Why are we not united in the endeavor of health care for all?
Our country lacks basic health care system infrastructure that is in place in the countries that have lower maternal mortality rates. Our Centers for Disease Control lack the mandate (and authority) to accurately ascertain the true number of maternal deaths stemming directly from the woman’s pregnancy or care related to it. Unlike most wealthy countries, we have only an honor system for reporting of maternal deaths, which makes no sense, given that we have a for-profit health industry. Half of our states have no functional state-wide maternal mortality/morbidity review committees. Each of the other states has its own system, and most lack the stringency required to elicit useful information.
Contrast our system with that of the UK’s CEMACH (Confidential Enquiries into Maternal and Child Health), which claims a high (97%) degree of accuracy of ascertainment. The CDC in 1998 said that there is a large degree of underreporting here and that the actual number could be as much as 3 times greater than the number officially published each year.
With so much data missing, it’s no wonder that there is no real analysis of why maternal death rates were more than 2x higher in 2005 than they were in 1982. The UK system calls for careful review of all records by an impartial multidisciplinary committee, analysis as to whether each death could have been prevented, and recommendations to be made to the facility in question and to the various relevant professions. If we want our maternal death rate to go down instead of rising even higher, we’ll have to follow the example of countries who have already put in place systems to accurately count and analyze maternal deaths (without putting the various professionals at heightened risk of malpractice liability). It is possible to do this, as the experience of many countries shows.
See my website (Articles and Article Archive) for more of my work on this important subject.