Contraception leads to better public and individual health
Women today are more likely than their mothers to die in childbirth
A few weekends ago, like many Americans, we thought about the mothers in our lives. We reflected on the milestones and the sacrifices. And with some measure of guilt, we thought about how it can be so easy to take our mothers for granted. Perhaps this is why experts are just beginning to notice that motherhood in the United States has become riskier and costlier today than it was a generation ago.
American women today are 50 percent more likely to die in childbirth than their mothers - risks that are three to four times higher for black women than white women. For every death, hundreds of women experience childbirth complications that bring them to the brink, and tens of thousands more suffer from preventable and under-treated chronic illnesses. Despite advances in modern medicine, the wellbeing of our nations mothers has been steadily getting worse as access to reproductive health care services has eroded.
In 2019 pregnant women who have insurance through their employer may still face astronomical expenses in seeking treatment as a result of high deductible plans and out of network services. Those who receive health insurance through Medicaid - which is about half of all pregnant women-may face the prospect of losing coverage just a few weeks after giving birth.
One of the cruelest features of our health system is that when mothers are newly learning to care for their infants, coping with little sleep, and striving to earn a living wage, we pull the rug out from underneath them. According to a recent Harvard study, 55 percent of women with government-sponsored insurance during pregnancy experience a gap in their coverage in the ensuing six months.
Of course mothers - and all women - also need care before and beyond their pregnancies. According to an analysis performed by Boston University's Dr. Eugene DeClercq, the latest vital statistics data from the Centers for Disease Control and Prevention indicate that it's not only maternal mortality, but mortality rates for all reproductive age women that are on the rise. While the rate of death among women under the ages of 15 and older than 45 has been decreasing for decades, the mortality rate among women between ages 15 and 45 has increased by 14 percent between 2010 and 2016 (the most recent years for which data is available).
These data may reflect the fact that reproductive health care is becoming harder than ever to come by. Seven states have passed bills that severely limit access to pregnancy terminations, many in cases when the pregnancy is not viable and a woman's life is in danger. A sponsor of the Ohio bill recently claimed that ectopic pregnancies, in which the embryo implants outside the uterus, may be re-implanted in the uterus.
The medical capability to do this does not exist. According to the American College of Obstetricians and Gynecologists, termination of the pregnancy in these cases is the only way to prevent fatal internal bleeding.
At the same time, the Trump administration's attempts to dismantle the Title X program risks jeopardizing the ability of millions of women to receive primary and preventive care services from their community health center. Since as many as 40 percent of women are not able to complete a postpartum visit, these clinics provide a necessary source of preventive care to new mothers. In addition to providing contraception counseling and cancer screenings, community health centers, including every one of the over 600 Planned Parenthood clinics across the United States, provide screening for the most common causes of maternal mortality: high blood pressure., suicidal ideation and substance use disorders.
At a time when challenges to maternal health are so widespread, women's health care should be protected and expanded. Rather than taking our mothers for granted, this requires elevating our collective expectations so that all Americans can choose to grow their family with dignity. And it requires support for health services that offer the full range of reproductive and preventive health care and ensuring affordable, quality health care for women - before, during and after pregnancy. All of this must be done in the larger context of a woman's life, principles that reproductive justice organizations have been championing for decades.
Let's reverse the growing epidemic of maternal mortality and make women's health a priority in our country. Let's commit to recognizing that women's health care is health care, and that mothers and their families need more care - not less.
Dr. Neel Shah is an assistant professor of obstetrics at Harvard Medical School and the co-founder of March for Moms. Dr. Leana S. Wen is an emergency physician and the president of Planned Parenthood Federation of America.