American's Health-Care System Endangers Mothers' Lives

Here in my tiny outreach maternity clinic on the west side of
Orlando, we achieved in 12 months something that the U.S. health care
industry has failed to accomplish in more than a quarter century. We
dramatically improved birth outcomes among poor pregnant women living in
central Florida, an area desperately lacking in health-care services.
What's more, all the women we cared for--including several with risk
factors, such as pre-existing health problems and poverty--had healthy
hospital births.

Since we didn't prescreen or select our clients, we can only surmise
that these gains, measured by a 2007 independent study of 100 clients by
the Health Council of East Central Florida, were the direct result of
providing consistent, quality prenatal care for pregnant women who would
have otherwise faced nearly insurmountable obstacles to getting it.

Maternal mortality is a domestic human rights crisis that kills
hundreds of American women and affects thousands more every year,
according to Amnesty International's new report, Deadly
Delivery: The Maternal Health Care Crisis in the United States.
Here in the wealthiest country in the world, two or three women die
daily from complications of pregnancy or childbirth and the rate of
maternal death for African-American women is four times that of white
women. These grim statistics do not include more than 34,000 "near
misses" --severe complications in which women nearly die--each year. Our
country prides itself on pioneering medical advances and spends more
than any other country on health care, yet it ranks 41st in the world in
maternal mortality and 29th in infant mortality.

"Mothers are dying notbecause 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," says Larry Cox, executive director
of Amnesty International USA.

As a midwife working in the trenches of Florida's poorer
neighborhoods, I have witnessed firsthand the many reasons for this
failure. What overwhelms me the most is the sheer number of hours my
staff and I must spend performing bureaucratic triage for pregnant women
trapped without health care in the purgatory of this broken system.

Most of the pregnant women who come to our clinic have been turned
away elsewhere, or have already visited a local emergency room. Medicaid
has instructed women to apply online. Yet to qualify for coverage, they
must fax in proof of pregnancy in the form of a letter signed by a
physician or a registered nurse. Private medical practices require
uninsured women to pay up to $200 for a lab test or exam upfront, unless
they can provide proof of Medicaid coverage. Sometimes a woman will
successfully jump through all the hoops required to get Medicaid
coverage, only to be turned away by doctors because by then she is 20
weeks pregnant and considered "high risk," since she has gone through
nearly half her pregnancy without prenatal care.

In many other countries health care, including maternity care, is
understood as a basic human right. The unwillingness of the United
States, however, to guarantee pregnant women access to quality maternity
care contributes to the high number of childbirth-related deaths from
common causes. Standardized protocols exist but are applied
inconsistently, and too often race and economic status are factors.

As the Amnesty International report recommends, the United States can
make substantive immediate gains. First and foremost, the government
should establish a single office within the Department of Health and
Human Services that ensures that all pregnant women have access to
quality maternal care. In addition, our elected officials must support
federal oversight and accountability for maternal health standards.
Nothing less than the survival of hundreds of pregnant women each year
is at stake.