What will Trump do to maternal mortality rates?

The United States likes to advertise its health care system as the best in the world, with top of the line treatments and pioneering care, but the truth is more complex. Financial status can have a huge influence on the type and quality of care received, as can race, especially when the two are compounded. The US also doesn’t perform terribly well on some basic metrics for health care outcomes, including maternal mortality.

While much of the Western world is experiencing a decline in maternal mortality rates, thanks to practices that make pregnancy and childbearing much safer, the United States is having the opposite problem. Our rates are going up, particularly in low-income communities of colour, despite the vast body of evidence-based practice that should make the process of giving birth in the US much safer than it is. After all, we have the best health care system in the world, right? So why are pregnant people dying to bring children into this world, especially in light of the foetus fundamentalism that dominates US politics?

The right has made it abundantly clear that while they worship foetuses, they don’t care a whit for pregnant people, or for infants once they’re born. Cut after cut to services designed to make pregnancy, childbearing, and childrearing safer and healthier drive home this point, as did the vicious debate over whether pregnancy care should be protected in the disastrous reconciliation bill designed to gut the ACA in March. The sheer unadulterated hatred with which the right views children in America is really rather breathtaking.

Which is why I have concerns about the future of the maternal mortality rate, and the neonatal death rate, in America under a right-wing administration. I’m worried about even steeper cuts to programmes designed to protect the welfare of pregnant people and children, including services that ensure complete prenatal coverage, those that promote evidence-based practice in labour and delivery, whether in hospitals, birthing centres, or at home, and those that create a supportive environment for young children to protect their health and welfare.

We already know how to address these issues. We have millennia of experience, but also decades of substantive research highlighting ways to make it much safer to have children. Pregnancy and childbirth will always carry an inherent level of risk, just as life itself does, because being alive is dangerous. But there’s no reason for it to be as dangerous as it is. We know this because wealthy white people in the United States tend to fare much better than those of other races and classes. And we know it because we can look to other nations and see extremely excellent outcomes for pregnant people and children. It’s not like this is uncharted territory.

And it’s not necessarily something that costs oodles of money, either, for those who want to plead fiscal conservatism. Many interventions to improve the safety of pregnancy and childbirth are very affordable, especially when contrasted with the costs of taking action when something goes wrong. It’s much more cost-effective to support healthy pregnancies and safe experiences in labour and delivery, hands down. It also sets up children for more success in life, which is an inherent good but one that can also benefit society, as healthy, happy children can grow into adults who do great and wonderful things — which isn’t to say that an unhealthy, unhappy childhood automatically condemns adults to misery and struggle, but it certainly doesn’t set them up for success.

It troubles me to see the right making war on the people who are birthing and/or raising the next generation, especially when it’s so starkly delineated by class and race. The cynic in me thinks of the saying: ‘We all like to see our friends get ahead…but not too far ahead.’ This is a culture in which the right is heavily invested in maintaining the status quo and actively depriving some Americans of opportunities because of their class, race, religion, disability status, gender, and other inherent traits. This is a government that knowingly develops and cultivates harmful policies, fully aware of the fact that they will harm people, and in a sense, that feels like part of the point.

Knowing that the administration hates so many people in America, it’s hard to shake the sense that the administration doesn’t care what happens to the maternal death rate because letting it get even higher doesn’t hurt them where their bread is buttered. In fact, it even helps them, by entrenching social inequality that keeps some Americans fighting for life while others are eating cake. This is an inherent injustice, and one that is extremely difficult to recover from, too — we’re talking about years of work to push that rate back down, and an entire generation of children presented with unfair obstacles because of the circumstances they were born into.

This is how the right kills, in America, through a slow war of attrition, through policy with known effects and a demonstrated lack of interest in doing anything about it, because those effects are part of the point. This is what the right wants, is for people to struggle and die because they cannot afford health care, and because they cannot afford the supports needed to have positive pregnancy outcomes. Every time people bleat about the sacred unborn and protecting babies, all I can think of is the people I know who have lost their pregnancies or experienced serious complications because they couldn’t access basic health care in America — and that was under the ACA.

Image: AspettandoViola, Tania Caruso, Flickr