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Birth control + Prenatal care = Less Women Dying

December 9, 2010

Did you know that maternal mortality is a problem in the U.S.?  According to an Amnesty International report Cristina Finch wrote about, “two to three women die each day in the US because of pregnancy-related causes.”  On top of that, tens of thousands of women experience “near misses.”  Let’s call this what it is: insane.  Finch quotes the past president of the International Federation of Obstetricians and Gynecologists, Mahmoud Fathalla:

“Women are not dying of diseases we can’t treat…They are dying because societies have yet to make the decision that their lives are worth saving.”

I expected that the statistics for the U.S. would reveal that many more women of color die than white women, and many more poor women die than middle-class and upper-class women.  I was right.  According to Finch:

  • Black women are four times as likely as white women to die of a pregnancy-related cause.
  • Native American women are 3.5 times more likely to have no prenatal care than white women; Black and Latina women are 2.5 times more likely to have no prenatal care.
  • Women are 2.5 times more likely to die if they become pregnant again within six months of giving birth.

Finch makes the case crystal clear: Nearly half of all maternal deaths could be prevented with better access to good quality maternal health care, for all women

Reflecting on Finch’s excellent post, I couldn’t help but make a few connections to related issues. 

First, poverty means less access to health care of any kind and therefore a higher likelihood of having an unplanned pregnancy.  Unplanned pregnancies aren’t necessarily unwanted, but you’re more likely to start prenatal care late – possibly much later in pregnancy – if you weren’t planning to become pregnant.   And that can lead to more pregnancy complications.  How great would it be if every woman in America knew she could get any birth control she wanted without having to pay for it?  We’ll soon be required to have some kind of health insurance, and preventive health care is supposed to be free.  Add your name to our call for free contraception, because planning a pregnancy can save a life.

Second, I remembered a microblog I had come across shortly after my own pregnancy: My OB Said WHAT?  This may sound like a ridiculous or facetious connection to maternal mortality, but give me a moment to explain.  It’s amazing the things that obstetricians, labor & delivery nurses, and even midwives and childbirth educators say to women during labor and delivery.  Most of what’s posted comes down to one simple thing: many medical professionals just don’t trust women, or our bodies, or even see us as people.  There are countless posts that denigrate women for doing something wrong.  Some statements are just fearmongering.  And some are just plain ludicrous.  Here’s a sample:

  • “No birth plans.  I’m a professional.  I know what I’m doing.”
  • “You can refuse [an induction], but you’ll kill your baby.
  • “Just putting in an extra stitch, it will make your husband really happy.”
  • “The reason the cesarean rate is so high is that human brains are getting bigger.”

These posts are a window into what pregnant women experience during labor, and surprise, it’s a microcosm of the kinds of discrimination women, and pregnant women specifically, experience every day. 

Finch could not have been clearer that a high c-section rate in the U.S. is a leading factor in our maternal mortality numbers.  The World Health Organization recommends a rate between 5% and 15%; the U.S. has a c-section rate of 32%, and, “a woman’s risk of death is over three times higher with c-sections.”  In addition to the problems created by complicated pregnancies for women who don’t receive prenatal care promptly, these glimpses of how women in birth are treated provide another motivation for the high c-section rate.  Doctors and other medical professionals simply believe that they know better – and they do not trust women to make their own medical decisions.

Good quality maternal health care means allowing women to make their own, informed decisions about not just whether to become a mother but also how to give birth.  And to make sure a woman’s decision is well-informed, it’s best to communicate possible complications, and benefits of interventions, without condescension.  Treating pregnant women as equals in the process of prenatal through postpartum care means trusting women.  It’s as important for maternal health as for keeping abortion legal.

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