In the novel “Catch-22,” the protagonist Capt. Yossarian considers the U.S. Army his enemy. Why? Because it sends him into battle, where he could be killed. The enemy, he reasons, is anyone trying to kill you — whether they target you, or make you a target.
Consider the circumstance of a pregnant person in the United States. Giving birth may not be as hazardous as going into battle, but it’s far more dangerous than many people realize.
In the United States in 2020, there were 24 deaths per 100,000 live births. That rate is three times as high other high-income nations — and it’s getting worse. In The Netherlands, the maternal death rate is close to zero.
And like a lot of things in America, it’s worse for black women. Their maternal death rate is double the average and three times higher than the rate for white women. For Native American women, the maternal mortality rate is 3.5 times worse than for white women.
Sadly, most of these deaths are preventable. The Centers for Disease Control and Prevention estimates that four out five deaths of women during or shortly after pregnancy could have been avoided with proper health care. A third of our nation’s counties do not have access to a hospital or birth center offering obstetric care.
Plain and simple, we are failing American women, and most especially non-white American women.
The lack of maternity care, both during and after pregnancy, is a stain on our country’s values and ability to care for our own.
But the travails go deeper, and are more fraught than you might expect.
The Threat to Pregnant Women at Home
The leading cause of death of pregnant women has nothing to do with pregnancy.
Women who are pregnant are more likely to be murdered than to die of causes related to childbirth, such as high blood pressure or sepsis. Women who are pregnant or postpartum are also more like to be killed than women who aren’t.
All of those trends will get worse with abortion restrictions. Without the ability to make their own reproductive choices, pregnant people will face a greater threat of domestic violence while at the same time losing access to the heath care they need.
There are already plenty of stories of women experiencing miscarriages or other complications and not getting necessary medical attention. Their lives are put at greater risk because doctors and hospitals are afraid of legal problems.
And in addition to worse health outcomes, women in states with abortion restrictions have less access to health care and financial assistance than in states that allow abortion.
Deaths of pregnant and postpartum women increased during the pandemic, for reasons including medical complications but also homicides, accidents and even suicide. It’s treacherous terrain today in America for a pregnant person.
What does that say about us, as a country, a community, a society?
A Lack of Empathy for Half the Population
In Texas, where I live, the release of a legally mandated biennial report on maternal health was delayed until after the last election. Its results were unsurprising, yet still shocking, and consistent with national trends.
Severe complications from pregnancy and childbirth all increased, the effects were most felt by Black women, and 90% of the 118 deaths (in 2019) could have been prevented.
This reality is a choice. The solutions are fairly simple — it’s just a matter of will, and, of course, money. Expanding access to comprehensive health services during pregnancy and after childbirth will improve health outcomes for both mothers and their children.
And by extension, their families and their communities. The research is clear: expanding care (of all kinds, reproductive, general health, child and elder care) improves the quality of our communities. Countries with expansive women’s rights are healthier. And expanding child and pre-K care makes for better families and kids. That’s something states like Texas and others with forced birth policies might want to consider.
(And for what it’s worth, businesses with more women leaders also fare better.)
The Texas Tribune reports (in the link above) that a benefit of 12 months of postpartum Medicaid was slashed to six months, and now even that proposal hangs in the balance. Again, it’s a choice. Texas, of course, has some of the tightest abortion restrictions in the country.
It’s a cycle of tragedy for the state’s women. Fewer options, fewer choices, less care, greater likelihood of death and illness.
It’s easy, in our tense polarized environment, to point fingers and pick sides along political lines. And it’s true that one political party wants to expand reproductive care and justice, while the other wants to take it away.
But the lack of empathy given to — and the amount of care and help withdrawn from — those who are pregnant is a moral stain on all of us.
Women in American are fighting for their lives, even more so if pregnant. And so many Americans are OK with that.
I can only imagine what that must feel like: the fear, the anger, the distrust, the anguish.
I can only imagine receiving the message our society sends: that becoming pregnant, by choosing (or worse, being forced) to bring a life into this world, you are putting your own at risk, and your community will do so little for you. In fact, it will actively make it worse.
Do those who enforce these policies, withholding care, share in that imagination? I can’t imagine they do.
For pregnant women, the threats are coming from all sides. I would imagine it’s tough for them to know who is looking out for them — and who is putting them in harm’s way.
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This post was previously published on Scott Gilman’s blog.
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