Authors: Mickey Huff
2
. Ibid.
3
. Douglas Schwartz, “Quinnipiac University Poll,” May 8–12, 2008,
http://www.pnhp.org/campaign/materials/AP%20polling%20is%20quite%20clear.pdf
.
4
. Robert Blendon et al., “Poll Finds Americans Split by Political Party over Whether Socialized Medicine Better or Worse than Current System,” press release, Harvard University School of Public Health,
http://www.hsph.harvard.edu/news/pressreleases/2008-releases/poll-americans-split-by-political-party-over-socialized-medicine.html
.
5
. Aaron E. Carroll and Ronald T. Ackermann, “Support for National Health Insurance among American Physicians: Five Years Later,”
Annals of Internal Medicine 1
48, no. 7 (2008): 566–67.
6
. Jacob Hacker, “Reform Beyond Access: A Plan to Extend Medicare that Would Also Limit Costs, Improve Quality,” New America Foundation, February 13, 2007,
http://newamerica.net/publications/articles/2007/reform_beyond_access_4877
.
7
. Ari Berman, “Jim Messina, Obama’s enforcer,”
Nation
, April 18, 2011,
http://www.thenation.com/article/159577/jim-messina-obamas-enforcer
.
8
. Ceci Connelly, “Obama Asks Nation to Discuss Health-Care Reform and Provide Input,”
Washington Post
, December 6, 2008,
http://www.washingtonpost.com/wp-dyn/content/article/2008/12/05/AR2008120503322.html
.
9
. “Americans Speak on Health Reform: Report on Health Care Community Discussions,” US Department of Health and Human Services, March 2009, 69,
http://www.healthreform.gov/reports/hccd/report_on_communitydiscussions.pdf
.
10
. John Geyman,
Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform
(Monroe, ME: Common Courage Press, 2010), 92–93.
11
.
Kate Murphy, “Single Payer and Interlocking Directorates: The Corporate Ties Between Insurers and Media Companies,”
Extra!
, August 2009,
http://www.fair.org/index.php?page=3845
.
12
. “Media Blackout on Single-Payer Healthcare: Proponents of Popular Policy Shut Out of Debate,” study, Fairness & Accuracy In Reporting, March 6, 2009,
http://www.fair.org/index.php?page=3733
.
13
. “Frontline Responds on Sick Around America,” Fairness & Accuracy In Reporting, April 9, 2009,
http://www.fair.org/index.php?page=3757
.
14
. Jim Acosta, “Obama’s Former Doctor Critical of White House Health Care Plan,” CNN, Politics, July 30, 2009,
http://articles.cnn.com/2009-07-30/politics/obama.doctor_1_single-payer-health-care-public-option?_s=PM:POLITICS
.
15
. “NYT Slams Single-Payer: Fails to include advocates among ‘diverse’ experts,” Fairness & Accuracy In Reporting, September 22, 2009,
http://www.fair.org/index.php?page=3907
.
16
. Dana Bash and Lesa Jansen, “Reality Check: Canada’s government health care system,” CNN, Politics, July 6, 2009,
http://articles.cnn.com/2009-07-06/politics/canadian.health.care.system_1_government-run-health-health-care-system-mayo-clinic?_s=PM:POLITICS
.
17
. Heather, “Reality Check on Shona Holmes: Holmes’ ‘brain tumour’ was actually a Rathke’s cleft cyst on her pituitary gland,” Crooks and Liars, July 27, 2009,
http://videocafe.crooksandliars.com/heather/reality-check-shona-holmes-holmes-brain-tu
.
18
. Rachel Weiner, “Stephen Hawking Enters US Health Care Debate,”
Huffington Post
, August 12, 2009,
http://www.huffingtonpost.com/2009/08/12/stephen-hawking-enters-us_n_257343.html
.
19
. Wendell Potter,
Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans
(New York: Bloomsbury Press, 2010), 110.
20
. Gabe Bullard, “Demonstrators Sit In at Humana,” WFPL News, October 29, 2009,
http://www.wfpl.org/2009/10/29/demonstrators-sit-in-at-humana/
.
21
. Alicia C. Shepard, “Is NPR Ignoring the Single-Payer Health Care Proposal?” National Public Radio, Ombudsman, July 17, 2009,
http://www.npr.org/blogs/ombudsman/2009/07/is_npr_ignoring_the_singlepaye_1.html
.
22
. Avi Lewis, “Healthcare Reform,”
Fault Lines
, Al Jazeera English, August 6, 2009,
http://english.aljazeera.net/programmes/faultlines/2009/08/20098663722846685.html
.
23
. Michael Getler, “Single Minded About Single Payer,” Public Broadcasting Service, Ombudsman, April 23, 2010,
http://www.pbs.org/ombudsman/2010/04/singleminded_about_singlepayer.html
.
24
. Vivienne Walt, “E.U. Gloats Over Belated U.S. Health Care Reform,”
Time
, March 23, 2010,
http://www.time.com/time/world/article/0,8599,1974424,00.html
.
25
. Daniel Ward, “The Money Taboo in Health Reform Coverage: Industry donations to powerful players often go unmentioned,”
Extra!
, November 2009,
http://www.fair.org/index.php?page=3935
.
26
.
The Lancet
374, no. 9705 (December 5, 2009).
27
. “Pro-single-payer doctors: Health bill leaves 23 million uninsured,” statement, Physicians for a National Health Program, March 22, 2010,
http://www.pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured
.
by Ina May Gaskin, MA, CPM, PhD (Hon.)
The myth that we have the greatest maternity care in the world pervades most media coverage of birth issues. If you get your news from the mainstream media, it will probably surprise you that, according to the Centers for Disease Control (CDC), women in the United States today face more than twice the chance of dying from causes directly related to pregnancy and birth than their mothers did.
In some states, the maternal death rate has more than doubled what it was years earlier. For instance, in 2010, California reported a tripling of the death rate between 1996 and 2006, attributing a significant part of the sudden rise to an excess of cesarean sections (C-sections).
1
New York State’s report in 2011 was no better: the maternal death rate between 2005 and 2007 was an unacceptably high 16.6 deaths per 100,000 births, when according to the US Department of Health and Human Services, that rate should not exceed 4. For African American women in New York City in 2008, the rate was an incredible 79 per 100,000 births. The leading cause of death in the state was pulmonary embolism, a complication whose incidence rises significantly after C-section or prolonged bed rest.
2
Neither of these startling state reports received national news coverage.
In the US today, one in three babies is born surgically, despite the World Health Organization’s recommendation that rates not exceed 10 percent in hospitals serving the general population, or 15 percent in hospitals serving high-risk cases. C-section rates in some US cities are rapidly moving in the direction taken by Brazil, South Korea, Thailand, and Chile, where rates in private hospitals exceed 90 percent
of all births. When this happens, the profession of obstetrics is essentially eliminated, along with that of midwifery, and replaced with surgery, with drastically negative results for women and their babies. When C-section rates are too low, women and babies will pay with their lives, but the same result occurs when C-section rates climb too high. This is a lesson we have yet to learn in the US.
Further, far more babies than ever are born after a host of technological interventions such as induction and the use of pitocin to speed up labor, which bring along their own risks. Amnesty International published a damning report in 2010 titled
Deadly Delivery: The Maternal Health Care Crisis in the USA
, which outlined various failures in the way our health care system treats pregnancy and birth. The facts surrounding the sharply increasing dangers to women giving birth are brutal and shocking, but they cannot be denied. According to a recent report published in the
Lancet
, about forty-one other countries, including Bosnia and Macedonia, do a better job of preventing maternal death and serious maternal disease or injury associated with giving birth than we do in the US, even though every one of these countries spends considerably less on maternity care than we do.
3
We need to ask ourselves why our maternal death rates are increasing while the death rates in most countries of the world are decreasing.
Unfortunately, our health care industry (we gave up calling it a “system” years ago) is woefully ill-equipped to answer this question. California and New York are two states that in recent years have made enhanced efforts to identify maternal deaths that might have been misclassified in the first pass. Additionally, these two states are two of only a handful that have taken steps in recent years to set up statewide systems to review the causes of maternal deaths, in order to determine which deaths could have been prevented with more appropriate care. The reason for conducting such reviews is to find out whether any errors were made in a woman’s care, so that lessons can be learned from them and evidence-based recommendations for safer future care can be disseminated.
Unfortunately, most of our states have no such systems of review and analysis, which means that even in cases where a review is done, hospitals are left to investigate themselves. Only six of the fifty states even make it mandatory to report maternal deaths at all. In other words, in almost every state, it is still optional for a hospital to report a
pregnancy-related death as such and to enter the accurate cause of death on a death certificate. The result is that our maternal death rates are grossly underreported, and there is good reason to believe that the excessively poor outcomes we’ve seen in California and New York are happening in other states as well. Due to the lack of media curiosity concerning the question of safety in maternity care, most Americans are ignorant about how drastically inferior our data-gathering of maternal deaths is compared with that of other industrialized countries. The CDC produced its own report card about the shortcomings of our system in 1998, admitting that it’s possible that two-thirds of the maternal deaths that actually occur weren’t even classified as such.
4
This much is clear: literally every industrialized country in the world has a better system of counting maternal deaths than ours, because other countries don’t allow their various provinces, states, or cantons to each decide what questions (if any) will be asked on their death certificates regarding the prior pregnancy status of a deceased woman. Other industrialized countries have formulated standard methods for identifying maternal deaths—standards that are consistent throughout each country.
Countries that actually try to count every maternal death know that it is often far from obvious when a woman dies from causes related to a pregnancy. This can be the case, for instance, when a woman dies from a ruptured ectopic pregnancy and no autopsy is performed. Another possible scenario is that a woman may die from an infection or a hemorrhage after hospital release, and the cause of her death may not be recognized as related to her pregnancy because most medical records are still not computerized in the US. A suicide due to postpartum psychosis may not be classified as a maternal death for similar reasons. It’s necessary, therefore, for epidemiologists to widen the field of inquiry beyond the standard information gathered on a death certificate for other demographic groups (such as men, infants, and children), in order to find out whether a woman was pregnant during the year preceding her death. Unfortunately, though, the CDC has never required that the various states use the same death certificate form. This failure to require a single standard has led to a hodge-podge of mismatched data, which has inevitably lowered the quality of US data.
When we attempt to understand what excuse we might have for
allowing such chaos in the most elementary step in data-gathering, it’s difficult to pinpoint anything beyond an uncritical allegiance to states’ rights. While prioritizing states’ rights over public health considerations may not affect the counting of deaths among other demographic groups, when it comes to distinguishing maternal deaths from deaths of women of childbearing age who died from other causes, such sloppiness can make a huge difference in the annual counts that are reported to the CDC. Lower maternal death counts than are real inevitably lead to a false sense of security and increased risk for childbearing women.
Incredibly, when the CDC finally created a US Standard Death Certificate in 2003—its first step toward remedying our system of ascertainment of maternal deaths—with five questions specifically designed to gather the necessary information, it stopped short of
requiring
its use. At this writing, at least one-third of the states have still opted not to adopt the use of the US Standard Death Certificate.
5
Some states stubbornly continue to use their old death certificate forms that do not ask all of the questions recommended by the CDC, while others use death certificates with no questions whatsoever regarding the previous pregnancy status of a deceased woman. Such gradualism in reform does women little good.
The question arises as to why we have so many shortcomings when it comes to dealing with maternal deaths. Is it because we don’t put very much value into ensuring maternal safety? Or is it perhaps that we have never found the political will to design a good system? There is quite a lot of literature in English about how such systems of feedback are designed and executed. Our epidemiologists at the CDC attend international conferences and thus have some familiarity with other countries’ ways of counting and reviewing maternal deaths. If the reason for our laidback approach to studying maternal deaths is lack of political will, one way to explain this is that there has been literally no media curiosity about the many flaws in maternal death reporting and analysis here. This creates a situation in which virtually no one understands why a highly developed, standardized system is necessary and why it should be federally funded.
New York Times
best-selling author T. R. Reid put his finger on this kind of problem when he wrote, “The US health care system developed without much planning, and without the serious assessment of national values that prompted other
nations to create systems for universal care.”
6
Reid wasn’t focusing on maternal death reporting when he wrote that, but his analysis does a good job of explaining why we have so far neglected to create a feedback system to help make sure that childbearing is as safe as it should be.