Mothers need advocates, too
Kimberly Ross
The abortion debate has always involved two parties: an unborn child and the mother who carries him or her. Even with the recent judicial victory in Dobbs v. Jackson Women’s Health Organization, which effectively ended Roe v. Wade and Planned Parenthood v. Casey and returned the legal parameters of this issue to the states, this essential dynamic remains unchanged.
The unborn and the mother are of equal importance. For that reason alone, the pro-life movement must address the issue of maternal mortality with as much vigor as abortion.
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In the United States, the maternal mortality rate stands at 23.8 deaths per 100,000 live births. By race, this breaks down to 19.1 deaths per 100,000 births for non-Hispanic whites, 55.3 deaths per 100,000 births for non-Hispanic blacks, and 18.2 deaths per 100,000 births for Hispanics. By shocking comparison, the overall rates for other highly developed nations are much lower: In Germany, it’s 3.6; in the United Kingdom, it’s 6.5; and in Canada, it’s 8.4, to name a few. A study, which took place between 2011 and 2015, focused on the timing of when maternal deaths occur during pregnancy and childbirth and found that 31% occurred during pregnancy, 17% occurred on the day of delivery, 40% occurred between 1-42 days after delivery, and 12% were deemed “late maternal deaths” and occurred 43-365 days postpartum.
The disparity between the U.S. rates and those of other Western countries is not only wide — it has also been growing. That these outcomes exist in a country with excellent healthcare resources is nothing short of alarming.
It would be easy to assume that long-standing abortion restrictions in the U.S. and the varied access to it nationwide are the main reasons for the high rate of maternal deaths. But this would be to dismiss the facts. The maternal mortality rate in the U.S. is higher than most developed countries that have less permissive abortion laws.
To claim that abortion restrictions can or do increase the rate of maternal death is quickly shut down when reviewing data from European countries. In a New York Times piece shortly after the Dobbs decision, tellingly titled, “The End of Roe Doesn’t Need to Bring an Increase in Maternal Mortality,” Dr. David Albert Jones, a bioethics professor at St. Mary’s University, asserted why it’s futile to assume restricted abortion access means, or will mean, an increase in maternal mortality.
As he explained in one example case: “In 2009, the Republic of Ireland joined the United Kingdom in its Confidential Maternal Death Enquiry. This allowed direct and robust comparison between the two countries. The most recent report, published in December 2020, found that the maternal mortality rate was lower in Ireland and statistically was no different, at a time when there were around 30 abortions a year in Ireland and more than 200,000 abortions a year in England and Wales. Again, for comparison, the maternal mortality rate in the United States during this period was roughly twice that of the United Kingdom and more than three times that of the Republic of Ireland.”
If neither abortion restrictions nor abortion permissions are to blame for the maternal mortality rate, then the reason must be centered on access to and utilization of care. A shocking statistic in Jones’s article is that the maternal mortality rate in 2017 was the same for both the U.S. and the country of Moldova, situated between Romania and Ukraine. He wrote, “In 2017, both the United States and Moldova recorded 19 maternal deaths per 100,000 live births. That year, while the United States spent $10,103 per person on health care, Moldova spent the equivalent of $244. This rate of death is the average across America, with many states having a far higher rate of maternal mortality than Moldova.” Clearly, higher costs don’t always translate to better service or health outcomes in hospitals and from doctors, nurses, and other health professionals.
There is no reason the rate in the U.S. should be equivalent to some of the poorest, most ill-equipped countries in the world. Data from the Centers for Disease Control and Prevention on maternal deaths show a steady, albeit choppy, rise in the death rate over the last several decades. In 1987, the maternal death rate was 7.2 per 100,000. By 1997, it was 12.9. In 2007, the rate stood at 14.5. Lastly, in 2017, the rate was 17.3.
In terms of causes, infection or sepsis, cardiomyopathy, hemorrhage, and embolism follow behind the leading cause, which is listed as “other cardiovascular conditions.” Importantly, preexisting conditions do in fact play a role, per the CDC: “Studies show that an increasing number of pregnant persons in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. These conditions may put a person at higher risk of complications during pregnancy or in the year postpartum.” Geographically, the ratio of maternal deaths is relatively similar across most metropolitan areas, with 15.7 deaths per 100,000 in large central metropolitan areas and 17.9 deaths per 100,000 in small metropolitan areas. The geographic area most affected by maternal deaths is the especially rural areas known as noncore, with a ratio of 24.4 deaths per 100,000.
Suffice it to say the problem of a steadily increasing maternal death rate for a country as advanced as the U.S. is broad in scope. Addressing the problem with the kind of exactitude that produces results and a lower death rate is necessary. But with so many factors involved, there are some uncomfortable conversations to be had.
Reproductive healthcare in the U.S. is often focused on abortion, the “right” to terminate a pregnancy, and political battles between both parties. Anti-abortion advocates are aware that abortion will still exist in the country in various forms. Dobbs changed the landscape but did not bring an end to abortion.
Since abortion has been a major focus of discussions surrounding reproduction, the topic has always been fraught with partisanship. There is a great disservice done to females of all ages if the focus is solely on abortion at the expense of other important topics, such as maternal mortality. Even casual observers of social media and news might note there seems to be a willful, limited understanding of reproduction, fertility, and the like. Contrary to popular belief, consequence-free sex does not exist. As a result, females must be mature enough to expect the unexpected, pregnancy, and prepare for what that means for them and their bodies. In other words, a heavy dose of personal responsibility is at the heart of a woman’s health and her baby’s health. Women must be educated, involved, and informed if pregnancy is a possibility in their lives. This is the foundation.
Any time spent receiving healthcare services in the U.S. leaves one with the knowledge that people have extraordinary resources that carry a substantial price tag. Even routine visits and exams can become too expensive. When the care is for a serious health condition, the bills can easily become overwhelming. A routine pregnancy that includes regular prenatal visits and a hospital birth is not an inexpensive endeavor. According to the Kaiser Family Foundation, “The health care costs associated with pregnancy and childbirth average almost $19,000, including $2,854 paid out-of-pocket.” Even with insurance, the costs can place a major strain on a woman and/or her family. Doing these things without insurance can result in an even greater burden. Putting off care, prenatal or postnatal, in order to reduce costs is understandable. At the same time, care is exactly what women need to ensure their own health during pregnancy, labor, and in the days and weeks following.
One factor that simply cannot be overlooked is the huge disparity between white and Hispanic maternal mortality rates compared to rates for non-Hispanic black people. The rate for the latter group stands at 55.3 deaths per 100,000 live births. This is unconscionable. Recent poverty rate data show black people have the highest rate of poverty, followed by Hispanics, Asians, and then non-Hispanic white people. This is sure to contribute to black women having the highest maternal mortality rate. However, it does not account for it all. In addition, bias from healthcare professionals is a concern that should not be dismissed. This is not to say all or even most OB-GYNs, nurses, and other maternal medicine specialists are inherently racist toward expectant black women. Broad assumptions are never helpful. But the higher rate of death does indicate a great hesitancy to get care when it may be needed most. And addressing any racial components of care is worth doing since multiple lives are on the line.
An additional factor in this complicated equation is the use of midwives. When compared to other countries, the U.S. uses far fewer midwives than other nations. As noted in the aforementioned article by Jones, “Midwife-led maternity services provide an evidence-based approach to reducing maternal mortality. Currently there are only four midwives per 1,000 births in the United States, in comparison with 43 per 1,000 births in the United Kingdom.” Midwives provide the kind of support and knowledge that can stand in the gap outside of traditional visits to a doctor in a clinical setting. They can determine if additional help is needed before a health crisis is reached, and they can also provide postpartum support. The postnatal time period can be filled with health concerns of the physical and mental variety that may seem insignificant after giving birth. Midwives can help ease the burden placed on doctors and patients alike.
The pro-life community has done an excellent job advocating the unborn over the last several decades. There is no reason that work should stall, even for a moment. And while the unborn still need a voice, women need advocates, too. Pregnancy and motherhood are beautiful and difficult roles in a woman’s life. The serious nature of both should not be downplayed. That it’s natural doesn’t make it easy. And in some cases, the physical and mental tolls can take a woman’s life.
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Amid discussions about abortion, it cannot be forgotten that the U.S. has the deadly distinction of possessing a high maternal mortality rate not seen in other developed nations.
The Left regularly argues that the pro-life community only cares about babies after they’re born. The pro-life community should counteract this false assumption by continuing to strengthen child-focused advocacy. At the same time, the pro-life community has the great opportunity to address the significant problem of a high maternal mortality rate. Though the reasons for it are as complicated as the solutions, it cannot be ignored. The rate will never stand at zero, but it is unacceptable that it is so consistently high. Personal responsibility, the astronomical cost of healthcare, how race plays a factor, and the utilization of midwives are a few of the major factors that combine to affect the numbers. Changing hearts and minds has always been the goal of the pro-life movement. This means unapologetic defense of both the unborn and their mothers. Maternal mortality is as pro-life an issue as anything else.
Kimberly Ross (@SouthernKeeks) is a contributor to the Washington Examiner’s Beltway Confidential blog and a spring 2023 visiting fellow at the Independent Women’s Forum.