By Malena Amusa
Sunday, July 29, 2012
As the U.S. maternal mortality rate continues to increase, the new health care law could offer improvements in preventative care for women. Yet, definitive answers to why more American mothers are dying remain scarce
Credit: Celine Vignal on Flickr, under Creative Commons 2.0 (CC BY-NC-SA 2.0)
(WOMENSENEWS)--The future of pregnant women in the United States will significantly change Aug. 1.
That is when the new health care law, the Affordable Care Act, will require insurance providers and Medicaid to cover clinical preventative services for women, including pre-natal care, all without charging a co-pay, co-insurance or a deductible.
Under the new guidelines, millions of women will gain access to health care services for free, including well-woman preventative care visits and screenings for gestational diabetes and sexually transmitted infections. These guidelines do not include maternity care or simply any service the doctor orders. However, starting in 2014, all maternity care will be covered by all new individual, small business and government exchange plans.
"This will provide an extraordinary opportunity to improve women's health not only during pregnancy but before, between and beyond pregnancy, and across the life course," said Dr. Michael C. Lu, the associate administrator of the Maternal and Child Health Bureau of the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services.
Not only will preventative care be provided next year without cost to women, under the new health care law, $125 million will go this year to the Maternal, Infant and Early Childhood Home Visiting Program to expand maternal and newborn support for mothers at home.
The changes are being introduced amid a wealth of data indicating that the number of mothers dying in America during or shortly after pregnancy is consistently growing. The rate of maternal mortality in the United States has more than doubled, rising from 6.6 deaths per 100,000 live births in 1987 to 16. 1 per 100,000 live births in 2009 – the highest among developed nations, Lu's agency reports.
Various studies have attributed higher risk of maternal death to race, income, region, C-section rates, obesity-related problems and chronic disease. States where poverty exceeded 18 percent, the immigrant population exceeded 15 percent and the C-section rate exceeded 33 percent had 77 percent, 33 percent and 21 percent higher risks of maternal mortality, respectively, a 2007 report by Gopal K. Singh of the Health Resources and Services Administration indicated.
Women's eNews has also reported previously that African American women's maternal mortality rates are higher than those of other American women. African American women, regardless of levels of income and education, are three to four times more likely to die as a result of pregnancy. Yet conclusive data answering the question of why are scarce.
Ahead of the federal health insurance reform, several states have already been using funds provided by the federal government's Maternal and Child Health Services Block Grant Program to improve pregnancy care.
For example, the California Maternal Quality Care Collaborative develops toolkits, protocols and recommendations for hospitals to tackle the leading causes of maternal death and morbidity, including hemorrhage (excessive bleeding) and preeclampsia (extreme high blood pressure).
At least two-thirds of California hospitals have adopted the toolkits. At the same time, the collaborative is devising a program to reduce first-birth C-sections, which range from 15 percent to 45 percent of births in California.
"The challenge is getting hospitals to adopt recommendations and change, but this is an area that we are making real progress in," said Dr. Elliot Main, medical director of the collaborative. "It's a shame mothers are still bleeding to death in the United States."
In addition to the block grant, the Maternal and Child Health Bureau has developed intervention programs for low-income women at risk of having a low-birth weight baby, including the Home Visiting program and Healthy Start.
In 2009, 685 U.S. mothers – up from 548 in 2007 – died of pregnancy-related complications during or within 42 days of the end of their pregnancy, according to unpublished data provided by the Health Resources and Services Administration.
As a result, the United States is one of 23 countries – including Zimbabwe and Costa Rica – where maternal mortality rates have increased, according to a 2010 World Health Organization report "Trends in Maternal Mortality: 1990- 2008."
Many pregnant mothers go into labor with chronic health problems, the top being diabetes, hypertension, obesity and cardiovascular disease. The federal maternal health agency reports that these contribute to poor maternal outcomes, but these studies are not conclusive and do not explain the maternal mortality difference between white, African American and Hispanic mothers.
Higher rates of health disorders are reported during pregnancy as well. In 2008, among the 27 states that collect this information, gestational diabetes and pregnancy-related hypertension were reported in 40.6 mothers per 1,000 live births and 38.7 mothers per 1,000 live births, respectively.
Final maternal mortality and morbidity data for 2010 are not yet available but the trend is clear. While developing countries are lowering their maternal mortality rates, the United States is backsliding.
The problem here does not correlate to monetary expenditure. The United States spends more on health care than any other country and more on maternal health than any other type of hospital care, according to a 2010 report by the London-based human rights group Amnesty International.
Lu, at the Maternal and Child Health Bureau, has been researching maternal distress for years.
"To improve maternal mortality in America, there are two things we must do," he said in an e-mail interview. "First, we need to improve women's health before they get pregnant. Second, we need to improve the quality of care that women receive during pregnancy."
That echoes an international consensus that maternal deaths are preventable in most cases and that maternal morbidity can be foreseen and addressed long before the mother gives birth.
Improving women's health before pregnancy involves what Lu has described as a "life course model" that begins in early life and extends to checkups for teens and access to contraceptives, all of which are covered by the health reforms about to take effect.
"Programs and policies that improve women's health before they get pregnant, including those that address social determinants of health over the life course, as well as those that improve the quality of care women receive during pregnancy, will be critical for offsetting the risks which contribute to increased maternal deaths," Lu said.
Malena Amusa is a freelance reporter based in St. Louis.
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