U.S. Health Bills Show C-Sections Cut Two Ways

(WOMENSENEWS)–Congresswoman Lois Capps of California couldn’t have been less surprised when the recent U.N. development goals review conference spotlighted faltering financial commitments to maternal health in the developing world.

Already aware of the problem, Capps this spring introduced a bill prodding the United States to make good on its commitment to Millennium Development Goal No. 5, which seeks to reduce maternal deaths by 2015 by three-quarters from 1990 levels. Called the Improvements in Global Maternal and Newborn Health Outcomes While Maximizing Successes Act, it’s better known as the Global Moms Act.

The act would require the president to develop and implement a comprehensive strategy to improve global maternal health in developing countries, which account for 99 percent of the deaths tied to pregnancy and childbirth, according to the World Health Organization.

It also says the money should be spent to ensure greater access to voluntary family planning services, antenatal and prenatal care and making available Cesarean sections, when necessary.

While Capps’ bill focuses on women in the developing world, Rep. Lucille Roybal-Allard, a congresswoman representing the 34th District of California, which includes downtown Los Angeles, has authored a maternal-health bill that asks U.S. legislators to turn their gaze inward to what’s going on here.

She introduced the Maximizing Optimal Maternity Services for the 21st Century Act–better known as MOMS for the 21st Century Act–in July.

Other lawmakers–Rep. Kathy Castor of Florida and Rep. Eliot Engel of New York–are also either already backing or introducing legislation on maternal health care.

Hearings Likely Next Year

Debbie Jessup, a nurse midwife and staffer at Roybal-Allard’s office, doesn’t expect that any of them will get a hearing this year; early 2011 is more likely. "The more involved consumers get in pushing for some legislative action, the better chance we will have of moving the packet of maternity care bills," she said.

Roybal-Allard’s bill is spurred by the rising maternal death toll over the last two decades in the United States, particularly among black women.

The two bills–one focused on women in the developing world and one on women in the U.S.–show the different approaches needed for the best maternal health outcomes.

"Successful models that work here won’t necessarily work abroad," said Ann K. Blanc, director of the maternal health task force at EngenderHealth, an international reproductive health organization based in New York.

Access to life-saving drugs such as misoprostol, an anti-inflammatory medication used to prevent hemorrhaging, can go a long way to protect mothers around the world, she says. In the United States maternal fatalities are not due to a scarcity of basic drugs.

In particular, the Moms acts show the two faces of C-sections in preventing and promoting maternal death.

In the developing world, limited access to C-sections is one reason mothers are dying in childbirth. While the Global Moms Act seeks to make C-sections more available to women who lack access to them, Roybal-Allard’s bill confronts what she sees as a problem of excess in the United States.

Cesarean sections in the United States account for nearly 32 percent of all births, according to the National Center for Health Statistics. The World Health Organization says the optimal rate for C-sections should not be less than 15 percent.

Reexamining Routine Practices

Roybal-Allard’s bill calls for a reexamination of the routine practice of elective Cesarean sections and scheduled inductions. It notes that both procedures put women at risk for hemorrhaging and infection, the leading causes of U.S. maternal death.

Cesareans are three times more likely to cause death than natural births, according to the World Health Organization.

Last summer Amnesty International released a report that found the U.S. lagging behind many developed nations in its maternal mortality ratio. Coming in behind 40 other countries, U.S. women were found to be five times more likely to die in childbirth than in Greece and four times more likely than in Germany.

The United States spends about $86 billion a year on hospitalization related to pregnancy and child care. Jennifer Dohrn, director of the midwifery education program at Columbia University in New York, thinks too much of that is paying for unwarranted Cesareans and inductions that can worsen maternal risks.

"We are misusing billions of dollars," she said.

Roybal-Allard’s bill seeks to cut U.S. maternity care costs through public education about the best maternity medical practices, research on gaps in communities’ capacities to provide top maternal care and the promotion of culturally-competent and interdisciplinary approaches to maternity care. All of this, Roybal-Allard says, will contribute to lowering maternity care costs.