by Karyn Pomerantz, October 13, 2019
Washington, DC has the highest rate of maternal death in the country, and deaths of black mothers and pregnant women are three times higher than white women. The maternal mortality rate is 33 deaths per 100,000 live births, compared to the national rate of 17 and Maryland’s 12 deaths. This huge disparity persists no matter what the level of income or education.
So what does the DC government do? Rather than improving and reopening an obstetric service at United Medical Center (UMC), which was closed because of poor quality, the City wants to replace it with a for-profit, union-busting hospital that will take years to build, leaving women far from hospitals for delivery and emergency care. UMC (formerly Greater Southeast Hospital) serves residents of Wards 7 and 8, primarily black families, where there are high rates of poor housing, poverty, unemployment and displacement as developers ravage historic neighborhoods to enrich the rich. Housing insecurity and homelessness multiply the stress for pregnant women and new mothers dealing with inadequate income and a new life to support.
At this writing, there will be 2 community meetings to organize and protest this attack on women’s health (see below for URLs):
October 21: City Paper Community Conversations – HEALTH & WELLNESS: The State of Maternal Health in D.C., 6:00 PM to 8:00 PM (EDT), The Outrage – 1722 14th Street NW DC
October 25: Health Public Oversight Hearing, 11:00 am, Wilson Building Room 412, 1350 Pennsylvania Avenue, NW, DC, 20004. Come testify for a public
The DC Health Justice Coalition, a coalition of anti-racist activists, health care advocates, and community organizations, have mobilized to fight these plans. They organized community forums and a social media presence (DC Health Justice Coalition on Facebook), and plan to testify before community and City Council hearings. Other NGOs have produced analyses and recommendations for years. In 2018, the City established the Maternal Mortality Review Committee to ascertain the reasons for the high rates in order to implement solutions. It will initiate meetings and hearings soon.
Maternal mortality is the death of a woman caused by pregnancy, abortion, or childbirth. Statisticians measure it as the number of deaths per 100,000 live births. Bleeding, infection, high blood pressure, and chronic diseases, like cardiovascular conditions, are the most common causes.
Maternal mortality rates differ by country, class, and racial/ethnic categories. Worldwide, 800 women die each day; in 2017, 295,000 women died. Globally, women in low income countries suffer more deaths (462 per 100,000 live births!) than women in high income countries (11 per 100,000 live births). Countries with the highest rates include South Sudan, Somalia, Central African Republic, Yemen, Syria, Sudan, the Democratic Republic of the Congo, Chad, Afghanistan, Iraq, Haiti, Guinea, Zimbabwe, Nigeria and Ethiopia.
In the United States, deaths from pregnancy and childbirth have climbed from the rate of 7.2 deaths for every 100,000 live births in 1987 to 17.2 deaths in 2015. Seven hundred (700) women die each year in a country with the richest resources and a government steadily reducing access to reproductive health services, such as abortion and contraception.
As bad as these rates are, they are much worse when stratified (organized) by categories of race, ethnicity, and income. In the United States, rates run from a high of nearly 43 per 100,000 live births for black women to a low of over 11 per live births for Latinas.
The specific rates are:
- 42.8 deaths per 100,000 live births for black women.
- 32.5 deaths per 100,000 live births for American Indian/Alaskan Native women.
- 14.2 deaths per 100,000 live births for Asian/Pacific Islander women.
- 13.0 deaths per 100,000 live births for white women.
- 11.4 deaths per 100,000 live births for Latina women.
Capitalism Kills: Inequity and Racism Drive Maternal Deaths
Friedrich Engels and Rudolf Virchow characterized preventable deaths of poor people as “social murder,” an apt description of maternal deaths. The major immediate causes driving these deaths include the lack of access to primary care, medicine, and assisted birth; poor quality care; no resources for family planning; and chronic diseases. Socio-economic reasons include the lack of clean water, transportation, education, and nutritious food. Politicially, women suffer from a lack of power, support, social status, and autonomy.
In the United States, where the medical system offers high tech care, women’s deaths have various causes. For upper income women, provider error and inattention to women’s complaints of problems, often precede death. Yet poor women, black and Native American women, share many of the same problems of poor and darker skinned women in other countries. Black women with college degrees actually suffer worse birth outcomes than white women without a high school education.
Capitalists make money by extracting as much profit as possible from their workforce. Today, this means maintaining low wages, creating more gig jobs, laying off workers, transfering industries to countries with the lowest pay, and fighting unions. Women and black, Latin, Asian, and indigenous people earn the least and have the highest unemployment rates, creating even more profits and more stress and insecurity. The corporate controlled government also reduces expenses through privatizing public goods, as with charter schools and private hospitals. Today, we can see this in the support for Medicare Advantage run by private health insurance companies and resistance to publicly funded “Medicare for All.”
Racism also saves vast amounts by providing lower levels of social spending on items such as transportation, housing, health care, food stamps, and disability payment payments to communities of color and, perhaps most importantly, keeping workers divided from each other. Since the development of capitalism, the power elites needed to prevent rebellion and revolution. In the American colonies, the plantation owners separated black and white people, promising whites a paycheck and a higher status and blacks enslavement and inhumane conditions. Yet even whites suffered as the availability of unpaid labor led to lower wages and unemployment for them.
As this blog reveals, racism maintains the status quo by separating and scapegoating people. Ideologically, it convinces whites that they are privileged because they are not black, making racism appear to benefit whites. When ideas are not enough, the ruling class unleashes terror, such as lynchings, race wars, and right wing organizations.
Racism Affects Our Bodies
In 2008, PBS featured a series called Unnatural Causes: Is Inequality Making Us Sick? that included a segment on birth outcomes. Researchers explained the effects of negative social conditions on the body.
“There’s something about growing up as a black female in the United States that’s not good for your childbearing health. … Recent data suggests that chronic stress associated with being a minority, particularly being African American, for some biological reason [thought to reflect cortisol levels] , increases the risk of delivering a premature, low birth weight infant. … When you have a reaction to a situation in your life that makes you anxious or gets you stressed out, you not only have a psychological or emotional reaction to that; you also have a body reaction. … And if that stress is chronic, constant, and you just can’t escape it, over time that chronic stress, the chronic activation of that response, creates wear and tear on your body. So if we’re serious about improving birth outcomes and reducing disparities, we’ve got to start taking care of women before pregnancy and not just talking about that one visit three months pre-conceptionally…taking care of women and families across their life course.”
Solutions-Abolish Capitalism and Implement Prevention and Treatment
There is no real mystery about how to prevent maternal death. If society could fulfill the following recommendations, it could eliminate most deaths. However, under capitalism as described above, the drive for profit dominates all health policies. The capitalist class does not want to support expensive health and social policies, such as increases in corporate taxes, free utilities and medical care, and environmental regulations. Therefore, it is essential to build a movement to abolish this system and implement the recommendations described below.
The World Health Organization, WHO, published Effective Prevention of Maternal Mortality that included these recommendations:
- “Empower women, girls, families and communities,
- Give attention to gender equality and empowerment,
- Facilitate women’s capacity to care for, and choose for themselves, (with) autonomy over their own reproductive lives and health-care decisions, and access to health-care services and options,
- (Have) the ability to influence the quality of those services through participatory mechanisms.
- (Ensure) equal access to resources, education, information and focused efforts to eliminate gender-based violence and discrimination, including disrespect and abuse of women using health-care services.
- Address structural, historical and social determinants of health, and gender discrimination including economic inequality and workplace discrimination, to ensure equal outcomes for women and girls.
- Integrate maternal and newborn care, and protect and support the mother–baby relationship
- Apply a human rights framework to ensure that high-quality sexual, reproductive, maternal and newborn health care is available, accessible and acceptable to all who need it
- (Include) gender equality, poverty reduction, universal coverage and access, and equity within the overall context of a rights-based approach to health and health care.”
Black Women’s Health Project (BWHP)
The BWHP, a US health advocacy organization, also calls for broader improvements in the conditions that promote health and reproductive justice, such as access to housing, education, and jobs.
- access to quality health insurance,
- health promotion across women’s lives,
- prevention and control of chronic diseases,
- provider anti-bias education,
- medical and family leave policies,
- resources for young parents and caregivers,
- data collection,
- affordable contraceptives and safe, legal abortion.
“Black women and girls (need) to control their bodies, their sexuality, their gender identity, their work, and their reproduction.”
City Paper Community Meeting, October 21, https://www.eventbrite.com/e/city-paper-community-conversations-health-wellness-the-state-of-maternal-health-in-dc-tickets-74959210015
October 25: Health Public Oversight Hearing, , https://dccouncil.us/event/health-public-oversight-hearing-7/
World Health Organization. Maternal mortality. Viewed 10-3-19. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Harvard Health Newsletter. A soaring maternal mortality rate: What does it mean for you? 2018. Viewed 10-3-19. https://www.health.harvard.edu/blog/a-soaring-maternal-mortality-rate-what-does-it-mean-for-you-2018101614914
World Health Organization. Strategies for reducing preventable maternal mortality. 2015. Viewed 10-4-19. file:///home/chronos/u-7fc90ef709e1739e54e2629510063cdbb7173e05/MyFiles/Downloads/EPMM_Strategies-document_2015.pdf
California Newsreel. Unnatural Causes: Is Inequality Making Us Sick? When the Bough Breaks. Viewed 10-7-19. http://unnaturalcauses.org
World Health Organization. Ending Preventable Maternal Mortality. 2016. Viewed 10-8-19. https://www.who.int/reproductivehealth/topics/maternal_perinatal/epmm/en/
CDC. Pregnancy Mortality Surveillance System. Viewed 10-4-19. file:///home/chronos/u-7fc90ef709e1739e54e2629510063cdbb7173e05/MyFiles/Downloads/EPMM_Strategies-document_2015.pdf
Black Women’s Health Project. Health Agenda, 2019. Viewed 10-8-19. https://3hqwxl1mqiah5r73r2q7zll1-wpengine.netdna-ssl.com/wp-content/uploads/2019/03/BWHI_HealthAgenda_2019_Final.pdfhttps://3hqwxl1mqiah5r73r2q7zll1-wpengine.netdna-ssl.com/wp-content/uploads/2019/03/BWHI_HealthAgenda_2019_Final.pdf