Amnesty International: Office of Maternal Health need to be established to reduce maternal deaths nationwide

Amnesty InternationalMar 12 2010

New, National Amnesty International Report Finds Systemic Failures and Shocking Disparities in Maternal Health Care, Contributing to High Rates of Deaths and Rising Incidences of 'Near Misses'

Amnesty International called on President Obama today to quickly establish an Office of Maternal Health to lead government action to reduce soaring pregnancy-related complications and maternal deaths nationwide.  The human rights organization said the government must take immediate steps to stop the loss of two to three women every day and reduce the risk of complications that now affect one-third of all pregnant women -- 1.7 million women a year.

With a lifetime risk of maternal deaths that is greater than in 40 other countries, including virtually all of the industrialized countries, the United States has failed to reverse the two-decade upward trend in preventable maternal deaths, despite pledges to do so.  Most recently, the government has failed to meet the goals set forth in the 2010 Healthy People initiative, which called for reducing the number of maternal deaths to one-third of current rates.

"This country's extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful," said Larry Cox, executive director of Amnesty International USA.  "Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors.  Women should not die in the richest country on earth from preventable complications and emergencies."

Cox said: "Mothers die not because the United States can't provide good care, but because it lacks the political will to make sure good care is available to all women."

Amnesty International's new 101-page, national report, Deadly Delivery: The Maternal Health Care Crisis in the USA, reveals the following disturbing findings:

+  severe pregnancy-related complications that nearly cause death -- known as "near misses" -- are rising at an alarming rate, increasing by 25 percent since 1998; currently nearly 34,000 women annually experience a "near miss" during delivery;

+  discrimination is costing lives. Opportunities to save women's lives and reduce complications are being missed, in large part because women face barriers to care, especially women of color, those living in poverty, Native American and immigrant women and those who speak little or no English.

Maternal health is a human right for every woman in the United States, regardless of race or income.  Yet, the United States lacks a systematic, robust government response to this critical problem. Amnesty International is urging President Obama to work with Health and Human Services Secretary Kathleen Sebelius to establish, and seek Congressional funding, for a single office responsible for ensuring that all women receive quality maternal health care. (Please visit: www.amnestyusa.org/deadlydelivery)

Additionally, Amnesty International calls for vigorous enforcement of federal non-discrimination laws and an increase in support for Federally Qualified Health Centers by 2011 to expand the number of women who can access affordable maternal health care.

Amnesty International's analysis shows that health care reform before Congress does not address the crisis of maternal health care.

"Reform is primarily focused on health care coverage and reducing health care costs, and even optimistic estimates predict that any proposal on the table will still leave millions without access to affordable care," said Rachel Ward, one of the authors of the Deadly Delivery report.  "Furthermore, it does not address discrimination, systemic failures and the lack of government accountability documented in Amnesty International's report."

Ward said: "The barriers preventing women from getting the care that they need go far beyond simply lacking health insurance.  Health care reform does not address obstacles to maternal care, recommend nationally standardized protocols for preventing and treating the most common causes of death, eliminate health disparities or ensure that the government takes responsibility for reducing levels of maternal mortality."

Rapid and comprehensive federal leadership is required, as the report found numerous systemic failures, including the following:

• Obstacles to care are widespread, even though the United States spends more on health care than any other country and more on pregnancy and childbirth-related hospital costs, $86 billion, than any other type of hospital care.
• Nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance.  Women of color account for just under one-third of all women in the United States (32 percent) but over half (51 percent) of uninsured women.
• One in four women do not receive adequate prenatal care, starting in the first trimester. The number rises to about one in three for African American and Native American women.
• Burdensome bureaucratic procedures in Medicaid enrollment substantially delay access to vital prenatal care for pregnant women seeking government-funded care.  Twenty-one states do not offer "presumptive eligibility" which allows pregnant women to temporarily access medical care while their permanent application for Medicaid is pending. Women who do not receive any prenatal care are three to four times more likely to die than women who do.  
• A shortage of health care professionals is a serious obstacle to timely and adequate care, especially in rural areas and inner cities. In 2008, 64 million people were living in "shortage areas" for primary care (which includes maternal care), but federally-supported community health centers -- a critical safety net -- are available in only 20 percent of these areas.
• The lack of nationally standardized protocols addressing the leading causes of death -- or the inconsistent use of them -- may lead to preventable deaths or injuries. Measures used widely in the United Kingdom to prevent blood clots after caesarian sections are not consistently taken in the United States, for example.
• Many women are not given a say in decisions about their care and do not get enough information about the signs of complications and the risks of interventions such as inducing labor or cesarean sections.  Cesarean sections make up nearly one-third of all deliveries in the United States -- twice as high as recommended by the World Health Organization.  The risk of death following c-sections is more than three times higher than for vaginal births.
• The number of deaths is significantly understated because there are no federal requirements to report maternal deaths or complications and data collection at the state level is insufficient.
• Oversight and accountability is lacking.  29 states and the District of Columbia have no maternal death review process at all.

As a result, women are more likely to enter into pregnancy in ill health, receive late or inadequate prenatal care, are given inadequate or inappropriate care during childbirth and receive insufficient post-natal care.