By Kimberly Seals Allers
Maternal health editor
Friday, February 20, 2009
Advocates say a focus on maternal health is a critical component of any meaningful health care reform. Addressing deep racial disparities in maternal death rates remains an urgent priority in national reforms that promote women's wellbeing.
(WOMENSENEWS)--Congressional leaders and public health care advocates unveiled an in-depth analysis and new framework for women's health last week that, among other objectives, seeks to eliminate racial health disparities in coverage, treatment and outcomes.
The 14-point policy recommendation and 25-page analysis was put forward by Sen. Debbie Stabenow, D-Mich.; Rep. Jan Schakowsky, the Illinois Democrat who co-chairs the Congressional Caucus on Women's Issues; other lawmakers; and leading health care organizations.
The resolution commits Congress to passing within 18 months legislation that guarantees health care for women and all individuals. It also seeks to establish coverage that enables women to attain good health that they can maintain during their reproductive years and throughout their lives.
"I look forward to working with the health care community, my colleagues in Congress and the Obama administration to win a solution that guarantees affordable, quality and comprehensive care for women and their families," says Rep. Schakowsky.
The stark racial disparities in maternal health highlight the challenge ahead. Recently, the U.S. maternal death rate hit its highest level in decades, topping 13.1 deaths per 100,000 live births, according to the CDC's National Center on Health Statistics. The rate first topped 10 in 1977.
The death rate is even higher among African Americans. The maternal mortality rate among non-Hispanic black women in the United States is 34.7 per 100,000 births or more than four times the 9.3 rate among non-Hispanic white women. This disparity has widened since 2000, according to the U.S. Department of Health and Human Services.
The solution, according to the resolution and report, calls for a lifespan approach to reproductive health and a comprehensive "well-woman standard of care," which would link prenatal, family planning and family care, and also ensure confidentiality and preventive cancer screenings.
The study, based on research and analyses by a cross section of experts, makes a scientific, data-driven case for reproductive health status as a key determinant of women's overall health.
It says any treatments and services that promote reproductive health--such as community-based preventive screenings--should be part of any national health plan.
The report converges with recommendations by advocates for African American maternal health care who have argued for some time that women's reproductive health is closely related to their general well-being.
"Since we have no way of knowing when a woman will conceive, it is critical to have needed support for her health in every possible way along the life continuum in order to reduce or eliminate the risk for adverse birth outcomes," said Dr. Fleda Mask Jackson, professor of applied public health at Emory University's Rollins School of Health. This would include reaching out to younger women and extending post-partum care.
By targeting women, you reach millions more, says Dr. Vivian Pinn, director of the office of research on women's health at the National Institute of Health. "Women are the portal to family and community health. When we talk about maternal health, we are talking about improving families and communities. This is one of the most important things we can address for the health care of the whole country."
Pinn says improving maternal health would also aid the country's ailing economy, since poor health hampers the country's overall productivity.
Health care for a premature infant can cost a company as much as 15 times more than care for a healthy, full-term baby, according to data commissioned by the March of Dimes Foundation, the nonprofit based in White Plains, N.Y. Babies born early are more likely to have lifelong health ailments, such as asthma and learning disabilities, and may need occupational therapy for help with walking, speech therapy or other costly care.
Now, as the nation debates how to pay for health care and the priorities of any national plan, leading health experts who have been focusing on African American health needs say eliminating the racial disparities in maternal health and birth outcomes should also top the list.
"Addressing the racial and ethnic disparities in birth outcomes is one of the greatest health challenges of our time," said Dr. Michael Lu, associate professor of obstetrics and gynecology at the University of California, Los Angeles, at a recent roundtable discussion on the issue convened in Detroit by the W.K. Kellogg Foundation.
Others worry the issue could get crowded out.
"How do we make maternal health a priority in the growing list of health care reform ideas? That is the critical question," said Eleanor Hinton Hoytt, president and CEO of the Black Women's Health Imperative, a Washington-based nonprofit that promotes the health and wellness of black women and girls and lobbies on health issues.
The United States ranks 41st among 171 countries in an analysis of maternal mortality rates released by a group of United Nations public health experts late last year, with South Korea and Bosnia coming in ahead of the United States.
"Women are suffering from the breakdown of their reproductive systems and if this does not become an agenda item on health care reform, women will continue to not have the support of the country," says Hoytt, a long-time champion of eliminating health disparities among women, girls and communities of color.
The policy recommendations put forward last week were endorsed by 38 of 50 deans of public health schools across the country, and include implementing access to a women's "medical home," or community medical center that includes direct access to women's health care providers and care coordination. It also promotes primary and preventive care, including family planning, contraceptive equity and care continuity.
African American women are twice as likely to die from pregnancy-related complications, twice as likely to have a premature birth and twice as likely to have a low-birth-weight infant.
The United States ranks 24th in infant mortality rates, well behind less-developed countries like the Czech Republic and Slovenia.
"The rates of infant deaths in the U.S. are extraordinarily high in comparison to other industrialized and non-industrialized nations," says Jackson, who is also a member of the National Advisory Committee on Health Disparities for the Atlanta-based Centers for Disease Control and Prevention and a senior scientist at the Atlanta Regional Health Forum, a nonprofit dedicated to creating health communities. "The poor birth outcomes among African American women are a reflection of what needs to be improved in this country in order for us to reach our full potential to become a great society."
Getting to a healthier population means changing the approach to treating maternal health, says Lu, a strong advocate of considering women's reproductive health long before childbearing. "We need to look at a woman's life as an integrated continuum," Lu said during his presentation in Detroit. "You can't fix a life course of health issues in the nine-month, prenatal period," he said.
Jackson also stresses the importance of looking at the mounting evidence that the chronic stressors of race and gender have a negative impact on reproductive health and birth outcomes. No stone should be left unturned, she and other advocates say, in creating a solution to improve maternal health.
Kimberly Seals Allers is the editorial director of the Black Maternal Health series, a leading "mom expert" in the African American community and founder of http://www.mochamanual.com, a popular online magazine for mothers of color. An award-winning business journalist and former senior editor at Essence and writer at Fortune, she is also the author of The Mocha Manual series of books. Her first book, "The Mocha Manual to a Fabulous Pregnancy" (Amistad/HarperCollins), is a NAACP Image Award nominee.