Dear All,
We share
courtesy of Doximity an interesting article that confirms that of all Developed
countries, America has seen increases in Maternal Mortality - even though it
spends the most on Health in the world. There are many causes but the most
significant is poor access to pregnancy care.
This week
the House of Representatives is hosting a Public Hearing on the NHIS/ HMos/
Provider facilities. We said it in 1998 and we repeat the missing link is the
profit-driven HMOs in the system. They are justified as private companies to
pursue profit and more profit for their shareholders but their involvement in
any Health Insurance system is an anomaly and anathema to achieving Universal
health Coverage (UHC).
''In the
first 15 years of this century, the rate of maternal mortality around the world
decreased by more than a third. Shockingly, rates in the United States have
been rising.
In
2005, 23 US
mothers per 100 000 live births died from complications related to
pregnancy or childbirth. In 2015, that number rose to 25. In the United
Kingdom, the number was less than 9. In Canada, it was less than 7.''
READ ON -
'Why Is US
Maternal Mortality Rising?
news@JAMA · June
8, 2017
Youproduction/Shutterstock.com
In the first
15 years of this century, the rate of maternal mortality around the world
decreased by more than a third. Shockingly, rates in the United States have
been rising.
In
2005, 23 US
mothers per 100 000 live births died from complications related to
pregnancy or childbirth. In 2015, that number rose to 25. In the United
Kingdom, the number was less than 9. In Canada, it was less than 7.
Very few
wealthy countries saw increases over those years. Many poorer countries,
including Iran and Romania, saw declines. But here in the United States, things
got worse.
These
numbers have been confirmed by independent research. Last year, a study
published in Obstetrics and Gynecology found that the maternal
mortality rate in the United States had increased by more than 25% from 2000 to
2014. This trend differed by state, however. Although California had shown some
declines, Texas had seen significant increases.
Texas in
particular has been the focus of much of the news on maternal mortality in the
last few years. From 2011 to 2014, the rate doubled. Although we lack good data
to tell us why, many have postulated that changes to family planning in the
state coincided with this increase. In 2013, for example about half of the state’sclinics that provided abortion in addition to other
reproductive health services were closed because of regulations passed against
them. In 2011, the family-planning budget was slashed in an attempt to defund
Planned Parenthood. Many clinics closed and more were forced to reduce their
services.
Family
planning matters. About 50% of pregnancies in the United States are unplanned
and might lack preventive care that properly planned-for
pregnancies might.
There’s more
to this story than changes in regulations and family planning. Some of the
increase is likely due to the growing prevalence of other chronic conditions.
Obesity, diabetes, and heart disease likely contribute to maternal mortality,
and trends for many conditions have been increasing over the last decade. Women
are having children later in life than they used to, and some have more complex
conditions. More women have caesarian deliveries, which can lead to
complications. The opioid epidemic may
contribute to maternal
mortality, as well.
Disparities
exist in maternal mortality as they do in other areas of health care. The
increases we’ve seen are most noticeable in non-Hispanic black women. The
number of deaths per 100 000 live births among black women is more than 3 times that among white women. In fact, for any
state, the higher the percentage of black women in the delivery
population, the higher its rates of maternal mortality. But racial disparities
can only account for so much of the problem. Even if you look only at white women in the United States, the
rates of mothers who die is greater than those in other developed countries.
The
fragmented nature of the US health care system doesn’t help either. Too many
people in the United States go without necessary care, because they lack access
to care or avoid it because of cost. This is just as true of pregnant
women as it is of everyone else. As many politicians argue that maternity care
shouldn’t be considered essential benefits, some worry that coverage might get
worse with reform.
It is
possible that some of the increase in maternal mortality is due to better record keeping. States have been working to improve
how they keep track of maternal deaths, as well as other causes of death, and
better reporting would be reflected as increases in prevalence. It’s hard to
imagine, however, that this increase in better records has been solely in the
United States, and could account for all of the increases. There’s no reason to
believe that all other countries would be keeping themselves in the dark.
Moreover, the more universal and socialized health systems are less likely to
have women, and their deaths, fall through the cracks and be missed.
Pregnancy
and childbirth are risky. We don’t like to talk about it, but maternal
mortality is the sixth most common cause of death among US women age
25 years to 34 years old. Proper maternal care helps to prevent morbidity and
mortality, but that care is difficult when clinics close and insurance lapses.
Medicaid can help to close the gap and often does with pregnant women, but even
then, both physician services and mother’s finances are strained.
As with many
things in health care, a rising tide would lift all boats. Efforts to improve
the health of women in general would improve our rates of maternal mortality.
Reducing levels of obesity, diabetes, and heart disease would achieve results.
So would getting a handle on the opioid epidemic. But we’ve spent the last few
years—if not more—focused on efforts to reduce infant mortality. Mothers may
need a similar commitment.''
Joseph Ana
Africa Center for Clin Gov Research &
Patient Safety
@ HRI West Africa
Group - HRI WA
Consultants in
Clinical Governance Implementation
Publisher: Health and
Medical Journals
8 Amaku Street Housing
Estate, Calabar
Cross River State, Nigeria
Cross River State, Nigeria
Phone No. +234 (0) 8063600642
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