[Trigger warning: mentions of pregnancy related death rates]

These days, it seems that Republicans collectively have one goal: ensuring that every womb in the country is occupied. Putting aside for a moment that pregnancy is a choice, let’s talk about how this country treats pregnant folks. In short, it’s abysmal.

The United States has one of the worst maternal mortality rates in the industrialized world and it’s continuing to rise. While other industrialized nations have seen their maternal death rates decline, the United States has sharply risen. The Maternal Health Task Force reports that pregnancy-related deaths in the United States, “…increased from 17 deaths per 100,000 live births in 1990 to 26 deaths per 100,000 live births in 2015.” Meanwhile, in the rest of the world, maternal death rates dropped by 44 percent.

It is significantly more dangerous to be pregnant in the United States now than it was thirty years ago. In short, “American women today are 50 percent more likely to die in childbirth than their own mothers.”

It’s worse for people of color

It’s important to note that the maternal date rate is particularly bad for people of color. In the United States, Black folks have the highest rate of pregnancy-related deaths. The Center for Disease Control reports that Black individuals are three to four times more likely to die during pregnancy than their white counterparts. This horrifying discrepancy has not improved at all in the past sixty years. Between 2011 and 2014, there were “12.4 deaths per 100,000 live births for white women,” while there were “40.0 deaths per 100,000 live births for Black women.”

Black women are 3 to 4 times more likely to die from pregnancy or childbirth than white women and are more likely to experience maternal health complications than white women. #WhatMomsNeed are policies that address this maternal health crisis. Now. pic.twitter.com/L5Lg8Kw0xu — National Partnership (@NPWF) May 10, 2019

In comparison to white folks, other demographic groups also have horrendous maternal mortality rates. American Indian and Alaskan Native individuals have approximately twice as many pregnancy-related deaths, as compared to their white counterparts. Taken as a whole, other racial groups report, “17.8 deaths per 100,000 live births for women of other races.”

The LGBTQIAP+ community is often overlooked

For LGBTQIAP+ individuals, pregnancy can be a difficult and isolating experience. Although the Affordable Care Act, technically prohibits health care providers and insurance companies from discriminating against LGBTQIAP+ folks, homophobia and transphobia still permeate the healthcare system. A study conducted by the Center for American Progress found that LGBTQIAP+ “…people experience discrimination in health care settings; that discrimination discourages them from seeking care; and that LGBTQ[IAP+] people may have trouble finding alternative services if they are turned away.” Transgender individuals reported the highest levels of harassment, abuse, and refusal of medical services.

As a result, maternity care is often unattainable for LGBTQIAP+ individuals. To begin with, pregnancy is still thought of in cisgender, heteronormative terms. Many health care providers and facilities incorrectly assume that only cisgender women can have children and that the parents will be a cisgender man and woman. Consequently, there is very little data on LGBTQIAP+ pregnancies. We do not know the maternal death rate for LGBTQIAP+ individuals. Nevertheless, given the pervasive discrimination that LGBTQIAP+ folks experience in the healthcare system, we can surmise that the maternal death rate for this demographic group is disproportionately high.

That being said, what we do know about LGBTQIAP+ experiences with maternity care is that it is often laden with discrimination and harassment. According to a study published by Nursing for Women’s Health, lesbian mothers are subjected to heteronormative exclusion and heteronormative assumptions. Heteronormative exclusion is defined as an instance in which, “nonbiological or co-mothers were excluded from care because of their gender and assumptions about family makeup.” Heteronormative assumptions refer to the misconception that all children have a cisgender and biological mother and father. The study reported that “…heterosexual assumptions were present on medical forms, which had spaces only for ‘father’ and not for any other type of partner/parent.”

Transgender men also experience barriers in terms of maternity care. A study conducted with 41 transgender men who gave birth found that “…they were often greeted with double-takes, suspicion and even hostility from strangers and health care providers.” Furthermore, participants in the study also reported that “there were plenty of insensitive comments and harsh experiences …both in and out of the health care setting, ranging from inappropriate use of pronouns…to actually turning them away and denying them prenatal care.”

It doesn’t have to be this way

Perhaps the worst aspect of the maternal health crisis is that the vast majority of these deaths could have been avoided. An internal report on American maternal death rates found that “…more than 60 percent of pregnancy-related deaths were preventable.” That statistic is probably surprising to many people. According to Dr. Neel Shah, professor of obstetrics and gynecology at Harvard University, this disbelief is, in part, due to a serious misconception about the cause of maternal deaths. “The public image of maternal death is a woman who has a medical emergency like a hemorrhage while in labor. However, very few deaths counted in maternal-mortality statistics occur during childbirth. Rather, four out of five of these deaths happen in the weeks and months before or after birth.”

There’s no universal healthcare in the U.S.

There are a plethora of reasons why it’s so dangerous to be pregnant in the United States. But let’s start with one of the most obvious: the United States has no universal healthcare system.

The phrase “universal healthcare” has been thrown around a lot lately and there are significant amounts of misinformation about what universal healthcare actually is and how it operates. Here’s the official definition from the World Health Organization: “Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

Simply put, universal healthcare guarantees that all people have access to quality healthcare services, regardless of their financial means. When a country has universal healthcare, its citizens are taxed to fund the system and therefore all people can utilize it. Whereas, the United States has a healthcare system funded by private insurance. Americans pay for insurance and pay for individual healthcare services they receive. As a result, maternal healthcare is incredibly expensive in the United States.

Under the Obama administration, the Affordable Care Act, also known as Obamacare, was passed and made some considerable changes to the American healthcare system. Obamacare “…made changes to define minimum coverage, create[d] an individual mandate requiring consumers to purchase coverage and expand[ed] federal subsidies for middle-income households.” As a result, more Americans obtained health insurance and more people became eligible to use Medicaid, which is a form of health insurance funded by the government.

However, the Trump administration has made repeated and concerted efforts to dismantle Obamacare protections. Trumpcare, or the American Health Care Act, eliminates the individual mandate, reduces Medicaid expansion, and rolls back the essential health benefits stipulated by Obamacare. The Affordable Care Act required “…that all major health policies sold to consumers offer coverage for 10 categories of essential health benefits: outpatient services, emergency services, maternity and newborn care, hospitalization, mental health and substance abuse services, prescription medication, laboratory services, rehabilitation services, pediatric services, and preventative, wellness, and chronic disease management services.” This aspect of Obamacare was particularly relevant to maternity care, given that prior to the law being enacted “…3 out of every 5 people didn’t have maternity coverage.”

Trumpcare does not enforce these protections. It allows “…states to apply for a waiver to define what they consider essential health benefits.” As a result, “states could allow insurance companies to sell plans that do not cover…maternity care.”

Maternity care is cost-prohibitive

In fact, the United States is the most expensive country in which to give birth. While the exact cost of childbirth varies between states, the average cost of a vaginal birth is $12,290 and a C-section costs approximately $16,907. Keep in mind these costs are for births with no complications. If complications arise or if it’s a multiples pregnancy, additional costs are incurred.

It’s also worth noting that prenatal care, which is the medical care received during pregnancy, isn’t cheap either. In a healthy pregnancy, the average cost of standard prenatal care is $2,000. This $2,000 does not include the price of prenatal vitamins, additional tests, lab work, or sonograms, all of which can cost thousands of dollars. Pregnant folks who are chronically ill, experience pregnancy complications, have a family history of certain medical conditions, or over 35 years old, typically require several of these additional tests.

Simply put, it is very expensive to be pregnant in the United States, rendering prenatal care cost-prohibitive for many people. The Maternal Health Task Force reports that 25 percent of pregnant folks in the United States do not receive the recommended amount of prenatal visits. This alarming statistic sharply rises when broken down by demographic groups: 32 percent of Black folks and 41 percent of American Indian and Alaskan Native folks do not receive adequate prenatal care.

Republicans don’t care

When presented with the damning cost to be pregnant in the United States, Republicans promptly doubled down. This past March, Senator Bernie Sanders tweeted about the astronomical cost of childbirth in the United States, as compared to Finland, where it costs about $60. In response, former UN ambassador, Nikki Hayley, asserted that the lower cost of Finnish maternal care means that they get substandard care.

Haley’s claim is all-too-common among Republicans hoping to disparage universal healthcare. The erroneous argument goes something like this: Americans pay the most for healthcare, therefore we must get the best care. Given the rising number of maternal deaths that occur in the United States, this is clearly not true.

But since Haley went to the trouble of inaccurately discrediting the Finnish healthcare system, let’s take a look at it. A study published by the Global Burden of Disease found that Finland has one of the best healthcare systems in the world. Finnish citizens, along with Swiss and Icelandic citizens, receive the highest quality healthcare in the most egalitarian healthcare systems. In terms of maternal care, 99.6 percent of pregnant folks in Finland receive the recommended amount of prenatal care. They are also four times less likely to die in childbirth than folks who give birth in the United States. Still think that the Finnish want to have their babies in the United States, Haley?

Obstetrical care is disappearing

Meanwhile in the United States, if you’re lucky enough to have decent health insurance or can afford to pay out of pocket, there’s a good chance you could end up in a hospital that can’t provide obstetrical care. Obstetrics services are disappearing in American hospitals at an alarming rate. A study conducted by Health Affairs concluded that “access to obstetric services in rural U.S. counties has fallen, with 9 percent losing all their hospital obstetric services in the 10 years to 2014. It also showed an additional 45 percent of rural U.S. counties had no hospital obstetric services at all during the same period.”

Racism is deadly

Another major contributing factor to the abysmal rate of maternal mortality is systemic racism. Simply put, many doctors do not take Black patients’ pain or concerns seriously. According to the Maternal Health Task Force, “women of color tend to have poorer access to high-quality reproductive health information and services than white women, are discriminated against in the healthcare system and experience higher rates of disrespect and abuse.”

Dr. Monique Tello explains how systemic racism and internal biases can negatively impact the healthcare that Black patients receive. “Doctors take an oath to treat all patients equally, and yet not all patients are treated equally well. The answer to why is complicated… ‘most physicians are not explicitly racist and are committed to treating all patients equally. However, they operate in an inherently racist system.’ In addition, we know that our own subconscious prejudices, also called implicit bias, can affect the way we treat patients.”

The near-constant stress and anxiety associated with racism can have particularly detrimental consequences for people of color who are pregnant: “…there is evidence suggesting that the stress associated with daily experiences of racial discrimination can increase the risk of negative perinatal outcomes including preterm birth and delivery of a low birth weight infant for women of color.” In other words, institutional racism can create disastrous health outcomes for pregnant people of color.

The U.S. doesn’t adequately calculate maternal death rates

Currently, there are “…no national standards for data collection and reporting of maternal mortality statistics.” As a result, there is insufficient data on maternal mortality in the United States. Therefore, the actual maternal mortality rate may be much worse than we already know it is. In addition, without this information, healthcare providers can’t be held accountable for malpractice nor can we effectively combat these problems.

How can this be addressed?

Maternal healthcare is nothing short of a travesty in the United States, but there are fantastic organizations who are working to bring attention to this issue and provide pregnant folks with maternal care. Black Mamas Matters and the National Birth Equity Collaborative are “…both comprised of academicians, medical professionals and community health activists who have collaborated to develop compelling personal stories, research and policy strategies to reinforce the message that Black women face serious, quantifiable risk of death or major disability related to pregnancy.”

Every Mother Counts is an international organization that increases awareness of inadequate maternal care, encourages leaders to address this issue, and provides grants to increase the accessibility of maternal care. The Changing Woman Initiative, founded by certified nurse-midwife Nicolle Gonzales, aims to provide high-quality maternity care in conjunction with traditional Native American birth practices.

As previously discussed, LGBTQIAP+ individuals are typically ignored in maternal healthcare, and when acknowledged, often experience discrimination and mistreatment. The National LGBT Health Education Center aims to address these inequities in the healthcare system. This organization provides resources, training, and educational materials for health care providers, in order to make healthcare more inclusive to LGBTQIAP+ folks. Their educational manual entitled, “Pathways to Parenthood for LGBT People”, specifically addresses the ways in which LGBTQIAP+ individuals can pursue parenthood. It also provides information as to how healthcare providers can be more inclusive and accommodating towards LGBTQIAP+ folks who are pregnant.

Birth for Every Body is a midwifery organization that aims to provide high-quality maternity care for all childbearing individuals, regardless of race, gender identity, or sexual orientation. This organization specifically seeks to offer gender-inclusive maternity care, which expands beyond the cisgender and heterosexual norms that pervade the medical field: “…we strive towards making the Midwives Model of Care™ accessible for every person and family who seeks it, regardless of race, ethnicity, religion, ability, sexual orientation, gender identity or gender expression. We acknowledge the disproportionate effects of transphobia on those with other marginalized identities such as being a person of color, low-income or disabled. Many racial health disparities that concern midwives and impact our communities are experienced in greater numbers by people who are both Black and transgender.” A donation of any amount to any of these organizations would assist in addressing the plight of maternal healthcare.

That being said, while charitable donations are important, sadly the maternal healthcare situation in the United States is so dire, that charity alone will not be enough. There need to be massive, structural changes in the American healthcare system. Universal healthcare would be the most effective way to decrease costs and increase the accessibility of maternal care. Moreover, there need to be major efforts to combat systematic racism, homophobia, and transphobia in healthcare. Until both of these factors are thoroughly addressed, throughout the entire country, maternity care in the United States will continue to be abysmal.

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