For much of the last decade, maternal mortality rates (MMRs) have declined globally. But in the United States, they have consistently increased and are now at one of the highest points in the last 25 years. If conservatives have their way with social and economic policy, it’s unlikely the U.S. will make significant strides to improve the health of mothers in the near future.
According to a report released last week in the The Lancet, the U.S. now ranks 60th out of 180 countries for maternal deaths. China is number 57. Only seven other countries experienced an increase in MMR over the past 10 years. They include Greece, Afghanistan, and South Sudan. The report estimates that for every 100,000 births, 18.5 mothers die in the U.S. By comparison, 13.5 women die in Iran, 6.1 in the United Kingdom, and only 2.4 in Iceland.
It is no coincidence that the U.S. MMR has increased as poverty rates have steadily climbed. In 2010, Amnesty International released a report that showed women living in the lowest-income areas were twice as likely to suffer a maternal death. States with high rates of poverty were found to have MMRs 77 percent higher than states with fewer residents living below the federal poverty level. Women of color have poverty rates more than double those of white women, and black women are 3-4 times as likely to die from pregnancy-related causes.
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The numerous factors that contribute to the high U.S. MMR are complex, as are the solutions required to effectively address the problem. However, one solution is already in place and is working. The Affordable Care Act (ACA) will significantly improve maternal health by mandating coverage of pre-natal, maternity, and post-partum care in all insurance plans. But some of the women in greatest need will remain uninsured and at increased risk because of the refusal of 21 states to expand Medicaid. Many of those states have among the nation’s highest rates of poverty and maternal mortality.
Expanding Medicaid would save women’s lives. A 2010 study conducted in New York City showed that the MMR for women with no insurance was approximately four times higher than for insured women, and that the rate for women insured by Medicaid was comparable to that of women with private insurance.
Many states have higher Medicaid eligibility limits that enable pregnant women with incomes above the standard Medicaid threshold to receive coverage. However, that coverage does not begin until women are already pregnant, and it is often terminated soon after their babies are born. This short coverage period leaves women uninsured for much of their lives and places them at higher risk for health problems that can lead to complications during and after pregnancy. Following implementation of the ACA, some states reduced eligibility limits for pregnant women, and loopholes in other states will leave many women without coverage during this critical time. Expanding Medicaid would provide continuous coverage for women whose incomes exclude them from the program and who do not qualify for subsidized insurance through the exchanges.
Despite the maternal health crisis unfolding in many states, conservative state lawmakers stand firm in their refusal to expand Medicaid, even though the federal government will cover 100 percent of the cost for the first three years and a minimum of 90 percent thereafter. Some states, like Georgia, are so intent on undermining the ACA that they have passed laws to prevent state employees from advocating for expansion and have made it more difficult for people who already qualify for Medicaid to enroll.
Conservatives do not have plans to solve this crisis. In fact, their plans will only make it worse. Family planning cuts and abortion restrictions in places like Texas have shuttered women’s health clinics and obliterated the health infrastructure on which poor women relied for their basic needs. And while many women and their families are still reeling from the recession, cuts to safety net programs like food stamps have led to greater insecurity in health, income, and food than ever before.
Last week’s Lancet report is a stark reminder that women suffer heavy casualties in the partisan battles raging in states across the country. But what we are witnessing today is more than a nasty game of politics: it is a violation of women’s human rights. We should be ashamed and outraged.