“Deadly Delivery” sounds like the name of a horror film. All the more disturbing, however, is that it is actually the title of a recent Amnesty International report on maternal mortality in the United States. The report highlights the fact that that the rate of maternal deaths in our country has more than doubled in the past ten years, rising from 6.6 deaths per 100,000 births in 1996 to 13.3 deaths per 100,000 births in 2006. Many of these deaths could have been prevented with improved access to high-quality health care. And as with most health outcomes, there are significant health disparities for maternal mortality rates—for instance, black women are nearly four times more likely to die of pregnancy-related complications than white women.
Many factors are related to the troubling state of maternal health in the U.S. For instance, the current national C-section rate of 31.8 percent (more than double the rate recommended by the WHO) exposes women to unnecessary surgical risks, while increasing the risk of potential pregnancies, and contributing to future C-sections. Prenatal and postpartum care are important components of a healthy pregnancy; for instance, maternal mortality is three to four times higher in women who do not receive prenatal care.
However, many individual health insurance plans do not cover prenatal or any other form of maternity care and the average postpartum care regimen in the United States consists of just one visit to the obstetrician-gynecologist. Like early and regular prenatal care, good pre-pregnancy health is also important to a healthy pregnancy and birth, but one in five women of reproductive age is uninsured, and thus likely to face barriers to getting the care she needs when she needs it.
Fortunately, there is plenty in the newly-passed health reform bill (which Obama signed into law on Tuesday!) that will directly address the issues raised in the Amnesty report. Health reform will expand health insurance coverage to millions of uninsured women of reproductive age. It will ensure that all new health plans sold to individuals and small businesses (both in and outside of the new Health Insurance Exchanges) include maternity care. It takes a multi-pronged approach to addressing health disparities, such as the staggering difference between the maternal morality rates for black and white women. And it emphasizes improvements in the health care quality, such as a new program under which state Medicaid programs (which currently cover more than 40% of births nationwide) collect and report data on the quality of care that enrollees receive, including maternity care.
Health care reform puts many pieces in place to improve the alarming maternal mortality rate in the U.S., but it is clearer than ever that we will need to institute a breadth of long-term solutions to address the problem. “Deadly Delivery” is a sobering read, but it gives us even more reason to cheer the passage of health reform and look forward to making more improvements in the future!