Report shows District of Columbia stands 51st on maternal mortality ranking

Amnesty InternationalMar 12 2010

50 Percent of Women Live in a Medically Underserved Area

In releasing a new report on maternal health nationwide, Amnesty International today revealed that flaws and shocking disparities in maternal health care that the government is ignoring lead to two to three women dying daily in the United States from pregnancy-related complications, with half of these deaths believed preventable, according to the Centers for Disease Control. A state-by-state examination shows that the District of Columbia is 51st on a maternal mortality ranking, with 34.9 deaths per 100,000 live births. 

The new Amnesty International report, Deadly Delivery: The Maternal Health Care Crisis in the USA, also reveals that 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. 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.

The report cited numerous causes for the crisis and offers lengthy recommendations on improving maternal health care.

Inadequate prenatal care is cited as a contributing factor in the crisis; women who do not get prenatal care are three to four times more likely to die than women who do. In Washington, DC, almost one in four women (23.2%) receives delayed or no prenatal care. The number rises to 27.9 percent among women of color.

Obstacles to care are widespread: the most obvious being that across the United States nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. In Washington, DC, one in ten women (11.5 percent) is uninsured; among women of color the number of uninsured climbs to 14 percent. The city's Medicaid eligibility level for working parents is $36,396. Lack of access to health care centers and providers is a problem nationwide, the report found; in Washington, DC, 50 percent of women live in medically underserved areas.

"How can this nation ignore a crisis that claims two to three mothers or mothers-to-be per day?" asked Folabi Olagbaju, Mid-Atlantic Regional Director for Amnesty International USA. "These findings are a call to conscience and action: federal officials must urgently address the maternal health situation and inequities in this nation. The well-being of United States' communities, families and children depend on decisive, rapid action."

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. An Office of Maternal Health would lead government action to reduce the soaring pregnancy-related complications and maternal deaths nationwide.

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.

"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. "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 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 government accountability documented in Amnesty International's report."

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

• 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.
• 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.