America has one of the most comprehensive healthcare systems in the world. Sure, it’s full of injustices and inequality but access to proper healthcare is a guaranteed right in that if you are injured and taken to the emergency room, you will be serviced (albeit with an arbitrary and extortionate bill).
One would think that because our healthcare system is held in global regard, its experience and results should be a reflection of it. While we have made tremendous strides in medicine, have eradicated diseases, and continue to increase our numbers in life expectancy, our system is flawed and in urgent need of reform.
A testament to this is our shocking maternal mortality rates. In the US, a baby is born every 8 seconds. Despite its frequency, The Harvard Business Review highlighted that the maternal mortality rate has more than doubled from 10.3 per 100,000 live births in 1991 to 23.8 in 2014. Of these deaths, two-thirds are preventable.
Maternal mortality rates are used to indicate the level of development a country has. In 2015, the UN announced its sustainable development goals, one of which was the reduction of maternal mortality to 70 per 100,000 live births. Great lengths have been made globally that have resulted in the reduction of maternal mortality rates, especially in developing countries. However, maternal mortality rates in the United States continue to increase due to a confluence of factors.
Medicine has fostered a detachment between doctor and patient. There is a degree of aloofness and hierarchical structures that ignores the experience of patients and the understanding of our bodies.
Women tend to experience gender hierarchy and a higher level of dismissiveness than their male counterparts which plays out in pregnancy, changes and concerns often being ignored or not taken seriously.
A poor experience during pregnancy results in an unwillingness to continue medical follow ups after pregnancy, resulting in poor postpartum care which can be accountable for half of postpartum deaths. An article by NPR points out how, for American women in general, postpartum care can be dangerously inadequate, often, with women keeping no more than a single appointment after going home. (The World Health Organization recommends at least three visits for postnatal care following pregnancy.)
Another glaring factor that cannot be ignored in our current healthcare system is the experience of people of color. Statistics point to the increased number of deaths of women of color as accounting for America’s rising maternal mortality rates. The Harvard Business Review reports, “Black women are three to four times more likely to die in childbirth than white women — regardless of education, income, or any other socio-economic factors. According to the World Health Organization, black mothers in the US die at the same rate as pregnant women in Mexico or Uzbekistan.” This is because the hospitals where black women give birth are often the products of historical segregation. Furthermore, there is an unconscious bias embedded in the medical system affecting the quality of care in stark and subtle ways.
ProPublica and NPR have collected more than 200 stories of African-American mothers who described feeling devalued and disrespected by medical providers. In an NPR survey conducted this year, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that 33% of black women said they had personally been discriminated against because of their race when going to a doctor or health clinic, and 21% said they have avoided going to a doctor or seeking healthcare out of concern they would be racially discriminated against.
For a change to be made there must be comprehensive reform, which will not be easy. We must dismantle structural racism and gender inequalities and recognize racial and gender bias in medicine. There needs to be a larger presence of people of color, women, and gender non-binary individuals in the medical industry. And, lastly, patients must be their own advocates. You know your body better than anyone else and only you can use your voice to stand up for it.