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 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," says Larry Cox, executive director of Amnesty International USA.
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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.