Maternal Health: Despicable Discrimination

Part IV

In a country plagued by discrimination in almost every part of society, it is no surprise that our maternal health system is extremely discriminatory in practice. Women’s reproductive and sexual health has been a point of discrimination and contention in this country forever, and that battle still continues today. The maternal health system’s discrimination toward minorities and lower income women is inhumane yet sadly not shocking. It has become typical for American society to cast aside women, especially minority or low income women. The discrimination in the maternal health care system seems to be two fold. Minorities are often treated without respect at health care clinics and hospitals causing poor quality care. Additionally, overall access to health care is restricted for these women because of their dependence on public services. These are extensive problems within the system that contribute to the deaths of hundreds of women a year.

One of the major roots of discrimination in the system is the general treatment and attitude towards minorities. Not giving women proper and complete information about their health care and options has been a problem for everyone in the maternal health system, but it is greatly accentuated with women of color, women who are uninsured or receive Medicaid, and women who do not speak English. Without the necessary knowledge, women are much less likely to be involved with their own health care. These targeted groups are often purposely denied information. Many minority women have reported receiving poor care, being ignored and treated with disdain and indifference because it was assumed by staff they were uninsured or on Medicaid. These assumptions are demeaning and discriminatory towards these women and put their health at risk. Even women who are uninsured still deserve proper care and to be treated with respect and dignity. Women should be able to access care with equality and nondiscrimination. Not only is it against the law to base health care service on a women’s skin color or income, it should be against the moral code we have as humans.

As discussed in the second part of this series, limited access to quality care is a major problem in the health care system. This is especially true for racial and ethnic minorities who are disproportionately uninsured, rely on Medicaid or other public services, and have lower incomes than white women. The public health system in America has many restrictions and policies that create barriers to accessing health care. Because these barriers and limitations apply primarily to minorities, the inequalities in health care services are extreme.

Minorities reported much higher rates of unintended pregnancies, 69% for African-American women, 54% for Hispanic women, and 40% for white women. Because the risk of maternal mortality increases significantly for unintended pregnancies, minorities face much higher risks of morbidity and complications. Part of why the unintended pregnancy rate is so much higher for minorities is because of their limited access to family planning compared to white women.

Everything that is wrong with the maternal health care system is only intensified for minorities and low income women. The people who have been marginalized by society and the government throughout history, continue to be treated without respect to their rights or humanity. Quality maternal care should be accessible by all women without regard to their skin color or income. African-American women should not be four times more likely to die from pregnancy related complications than white women. Women who don’t speak English shouldn’t be denied proper care just because an interpreter isn’t currently available. Our government entrusted with the responsibility to serve the people based on equality and nondiscrimination should not allow such huge disparities in the health care system. The discrimination within the system is an atrocity that can only be reversed by working to improve maternal health care, one step at a time, always keeping the issue of discrimination fresh on our minds.

Maternal Health: Family Planning

Part III

Planned Parenthood is a big fan of family planning. Whoot Whoot! It’s also an organization that supports maternal health, so it only makes sense that when these two issues intersect I would try and make a big deal about it. Here’s the connection as explained by Carolina Reyes, Clinical Associate Professor of Obstetrics and Gynecology at USC, “Effective family planning services are probably the single largest contributor to reduction in maternal mortality and morbidity in our lifetime.” Basically, limited access to family planning is a huge reason why the United States has such high maternal mortality rates and poor overall maternal health care.

Half of all pregnancies in the United States are unintended- a huge number of accidents. Women who have unplanned pregnancies are much more likely to suffer complications and generally receive less prenatal care than women with intentional pregnancies because they start it much later into their pregnancy. A couple hundred of the women who die from maternal health complications every year are women who should not have gotten pregnant in the first place because of their existing medical conditions. From the very beginning, these women have a high risk pregnancy, putting themselves and their babies in danger.

Minorities and women with low incomes have a high risk of dying from maternal complications and not receiving proper maternal health care. These groups also have the highest rates of unplanned pregnancies. African Americans who are almost four times more likely to die from pregnancy related complications are also three times more likely to have unplanned pregnancies than white women. Women with low incomes are four times more likely to have unplanned pregnancies than women with high incomes. This is at least partially related to these groups’ ability to access family planning services.

Currently, 17.5 million women who need reproductive services because they are sexually active and able to conceive but do not want to become pregnant rely must rely on public health services. Too often, however, publicly funded services are unable to provide the needed care, services and supplies because of budgetary or legal restrictions. Programs like Medicaid are regulated by the government and restricted from covering abortions and have the ability to limit certain woman’s access to reproductive services and contraception. In other cases, clinics or programs just don’t have the funded to provide contraceptives or care to everyone who needs it. The barriers women face in receiving reproductive care and family planning services leaves up to 8 million women in our country without affordable family planning services.

The methods to achieve this are practices Planned Parenthood has been implementing for years including improving sexual education about reproductive health and contraceptives, increasing access to contraceptive and abortion services and increasing funding for title X clinics. All of these will contribute to promoting safe sex and pregnancy prevention, especially among the most at risk groups. Reducing the number of unplanned pregnancies is a key part in reducing the maternal mortality rates in the United States. Just another reason to support Planned Parenthood and the great things it’s trying to accomplish.

Maternal Health: Why Is the System Failing?

Part II

The crisis of the maternal care system is rooted in problems embedded within the core of society. Women are lacking good maternal care, not because we lack the medical technology or the ability to provide it, but because no one has drive to fix the problems with the system. Not enough people care. So why is it that so many women die every year in our country and around the globe from maternal health problems? How can a woman in a hospital struggling to breathe after giving birth be ignored for hours until the internal bleeding was too bad to stop? There are a number of reasons the system fails women, including lack of coverage, lack of prenatal and postpartum care, quality of care, limited staffing, restrictive patient involvement, family planning, discrimination and a lack of accountability. Together these problems create a maternal health care system that is in a state of crisis, unable to provide proper care to some of the people in society who need it the most.

Pregnancy is extremely expensive. Even leaving out all of the baby products, medical necessities like prenatal care and delivery can cost thousands and thousands of dollars. About half of all births in the United States are covered by private insurance. But what about the other half? What happens to pregnant women who do not have private insurance? In the past year, 13 million women of reproductive age (15-44) had no health insurance. That’s one in five. Some of those women could be eligible for public assistance like Medicaid, but many are excluded because they are immigrants or earn too much money to be eligible but not enough to afford their own private insurance. Although the system has set up financial assistance programs to try and help the uninsured, the bureaucracy of the system and limited information given to women keeps these programs a dirty little secret that women in need do not know about. So what is a pregnant woman with no insurance supposed to do? She can’t get private insurance because insurance companies classify pregnancy as a “preexisting condition.” As one insurance company representative said, “We don’t insure a house on fire.” One of the only options is to go to low cost clinics like Federally Qualified Health Centers, but these facilities have their own problems. Because they are often underfunded, crowded, slow it is difficult to recieve necessary care. Although they are better than receiving no prenatal or maternal care at all, these facilities cannot provide the proper care to everyone. In fact, low cost clinics are not accessible in most communities that actually need their services, so many women go without any maternal care every year. Lack of coverage is a major factor in the failings of the maternal health care systems. The recent health care reform does address a part of this issue by banning insurance companies from denying women coverage based on preexisting conditions like pregnancies and past c-sections and making young adults insured on their parents’ health care plan until the age of twenty-six. Hopefully both of these measures will help more women be covered by insurance during their pregnancy giving them access to better care and services.

Prenatal care is an essential part of maternal health. Not only is it important for the baby, but proper care during pregnancy is crucial for the mother’s health as well. When women do not receive adequate prenatal care, they are 3-4 times more likely to die of a pregnancy related complication than those who do receive proper prenatal care. Yet only 75% of women receive the recommended amount of care, 13 prenatal visits from the first trimester on. 1 in 4 of all pregnant women are not receiving the prenatal care they need to have a safer and healthier pregnancy. This trend needs to change drastically to try and reduce maternal mortality and other pregnancy complications. A big part of the reason women do not receive prenatal care, however, is because they do not have health insurance that covers these medical visits. Beginning to see the links?

Maternal health is not restricted to care during pregnancy and labor. One of the most important pieces of maternal health care is postpartum care. More than half of all maternal deaths occur during the postpartum period in the 48 days after birth. The standard for postpartum care in the United States is a single visit to a doctor about six weeks after birth, an inadequate amount of care that allows for many complications from pregnancies to be missed. Women are often sent home without proper education about the signs of hemorrhaging and pulmonary embolisms, the main causes of maternal mortality. These are complications that can develop weeks after giving birth and are life threatening if not caught and treated. The lack of adequate postpartum care in the United States is a major contributor to the high maternal mortality rate, but it is in no way impossible to fix. It just requires the will power to want to improve the system and establish new standards to provide better postpartum care

Even if women are able to access maternal care, there are often many factors that lead to poor quality care. In many hospitals and clinics, especially public institutions serving low-income areas, there is a problem with understaffing. There are not enough nurses, physicians or OBGYNs to provide quality care to every patient or to see patients when they display complications. Numerous studies, personal accounts from health care professionals and the United States government all report that inadequate staffing, especially among the nurses, directly correlates with poor quality care, maternal morality, and medical errors. Without the proper staff, it is impossible for health care providers to give the proper care and medical attention to their patients because they are stretched much too thin. For publicly funded institutions this is usually a matter of lacking the money to pay for more staff, but understaffing is also a problem at private institutions that cut back on staffing to save money for profit. Dealing with economic restrictions makes the issue of understaffing extremely complicated, but it is a necessary and crucial issue to try and fix while addressing maternal health.

And the problems go on and on… A system with so many flaws has to be in a crisis! The maternal health system has for years limited the ability of women to make their own informed choices about their maternal health, especially in terms of giving vaginal birth or cesarean birth (c-sections). One third of all births in the United States are done via c-section, even though this is a risky procedure that the World Health Organization recommends only be used in 1 in 6 births. Instead of being a standard, c-sections are supposed to be used when a vaginal birth is dangerous for the mother. Overall, the risk of dying after a c-section is more than three times higher than a vaginal birth. Even though a c-section is a potentially dangerous procedure, care givers often recommend it, or in some cases don’t give the women a choice. In today’s maternal health care system there is a lack of patient education about their options, the risks and signs of complications. Women need to be able to make decisions for themselves about their own health care. The term pro-choice applies perfectly to this problem. The central idea to the pro-choice movement is that a women should have control over her own body, which can be applied outside the context of abortion to include maternal health rights. Only by fully informing women about their choices and allowing them to make their own decisions, does the maternal health system really give women a choice about their own bodies.

Maternal health care is going to be a difficult problem to tackle because of a lack of evidence and a failure to report maternal mortality. Many maternal deaths are not reported as pregnancy related, and most States lack proper systems or procedures for reporting maternal death. Without standard procedure there is difficulty in collecting data about maternal mortality. The CDC has even reported that the number of maternal deaths may actually be double the current estimates. Without a unified system to collect and analysis data about maternal health for governments, it is difficult to address and face the issue. Solidarity among the states is necessary to make progress in improving maternal health because without standard procedure, a system cannot be effective.

The problems with the maternal health system are extensive, complicated, and intertwining, and these are not the only ones. Family planning gaps and discrimination are two other major barriers preventing adequate care and will be addressed in the next posts. Although the problems with the system may seem impossible o solve, there is a manner in which we can succeed in working towards solutions. One of the first steps in that, however, is making sure we know what to fix.

Maternal Health: Just the Stats

First in a series

Our country has just passed health reform (woohoo!). It was a long struggle that had to overcome a vicious partisan divide and public discontent. Now three weeks later, after people have taken the time to pat themselves on the back, it’s time to start thinking about what else we need to accomplish. All the problems with our health care system have not been solved by this reform. Some of the most serious ailments of the system continue to be under reported and rarely discussed within the political spectrum. Maternal mortality is at a stage of crisis in the United States. It’s an issue that has not been given much attention in the past and lacks extensive data and research. In early March, however, new attention was brought to the issue when Amnesty International USA published a report on maternal health, DEADLY DELIVERY: THE MATERNAL HEALTH CARE CRISIS IN THE USA as part of its ‘Maternal Health is a Human Right’ campaign. This in-depth report examines the state of maternal health in the United States and offers ways to improve the system. This is the first in a series on maternal health based off information from this report and other sources.

The title of the report labels the maternal health in the United States as a crisis. You might think that the language is a bit of a hyperbole, that we aren’t really in a crisis. Well, I urge you to take a look at the data and then reconsider. Before I begin to type out a series of horrific and startling numbers, I should probably clarify what maternal health and maternal morality are. Maternal health is comprehensive care including family planning, preconception, prenatal, and postnatal care. Maternal mortality occurs when a woman dies during or shortly after her pregnancy.

In the United States, two women die everyday from maternal mortality, the 41^st worst ranking in the world. Our maternal mortality rate is higher than any highly developed nation, but we spend the most on health care. Like people have been saying about the health care system for years… something doesn’t seem to fit. The disparity between the U.S.’s maternal mortality rate and the countries ahead of us is no small amount. Ireland has the smallest rate in the world at 1 in 47,600. America’s is 1 in 4,800. That’s almost 10X the difference. How can it be that a comparably developed country takes so much better care of its pregnant women?

The maternal health care crisis goes beyond maternal mortality and encompasses the numerous other health problems associated with pregnancy. Every year 34,000 women experience “near misses,” instances where a woman almost dies from a maternal health issue. Even though these women do survive, it is unacceptable that every single day 94 women face a serious risk of death, when we have the technology and resources to prevent many of these complications and problems. I wish I could say that that’s the extent of the problem, but the numbers continue to roll. 1.7 million women in this country, almost a third of the pregnant women in a given year, suffer from complications and adverse health effects from their pregnancy. In the past twenty years, these rates have not improved, clearly revealing the political and social apathy toward maternal health. Because the system is not working to protect them, Women in this country are becoming ill, dealing with life threatening health problems, and even dying.

Maternal mortality can effect any woman, but hidden in the general data are the racial and class disparities that make maternal health an issue of discrimination. The rates of maternal mortality are extremely disproportionate among minorities. Black women are four times more likely to die from pregnancy related illnesses than white women, and the lack of prenatal care that many women of color receive puts them at a much higher risk of developing a maternal health problem. Native American and Alaska Native women are 3.6 times more likely than white women to receive late or no prenatal care, and Latina women are 2.5 times more likely. Not receiving proper care throughout the pregnancy is dangerous to both mother and child and is often associated with maternal morality..)

Although they can be shocking, right now, these statistics are numbers that stand without a firm context. To have a comprehensive understanding of the issue, it is necessary to know what causes maternal mortality and why women are not receiving the proper care they need. These topics will be explored in the second part of the series to be posted later. Check back soon!

The Big Fuss About Sexting

§N Modern technology is changing the way people, especially teens interact socially. Youth, many of them perpetually clinging to their cell phones, checking facebook, instant messaging and occasionally still using email, are in constant communication with their peers. I hardly go anywhere with out my cell phone. What if someone calls or texts me? Although it may bother parents at the dinner table, cause a disruption during school, and be another step towards the ultimate destruction of face to face personal communication, only recently has texting posed an imminent threat for these teenagers. More specifically sexting. I’m sure by now everyone has heard of sexting, sending sexually explicit messages and photos via cell phone; it’s been splayed across the newspapers and internet enough.

The national media attention that sexting has received the past two years has sparked campaigns to try and prevent teen sexting, but like campaigns aimed to stop underage drinking or drug use, it will never eliminate the practice. Now, not everybody does it, current surveys report that 20% of U.S. teenagers have sent nude or semi-nude photos of themselves electronically, but, sexting has become a natural part of youth communication. For teens sexting can be flirting, fun, a from of seduction, general communication with someone you like or are attracted to, or even a joke. The physical distance created by mobile communication makes it easier for teens to be outgoing and provocative than in person.

Teens are not unaware of the potential harmful consequence of sexting. 75% of teens have said that sexually suggestive content “can have serious negative consequences.” Beyond the legal issues that have been excruciatingly highlighted the past year, there are social consequences including bullying and sexual harassment that can occur when explicit photos are shared. Yet even though they are aware of the consequences, teens continue to sext. It has become a part of their sexual expression and as a part of the culture, it is not going away anytime soon.

Explicit or suggestive photos of minors used for sexting do not always remain private, and when they have been made public there have been serious legal consequences. Teenagers across the country have faced charges of possessing, disturbing and producing child pornography, among others, including three teenage girls in Greensburg in January 2009. Prosecuted for taking photos of themselves or possessing photos their peers have sent them, teenagers face felony chargers and life time sex offender status in sexting cases.

Child pornography laws are designed to protect minors, the victims of exploitation. Teenage boys and girls taking and possessing pictures of themselves and then willing sending them to their peers are not exploiting or taking advantage or children or minors. Using laws that are designed to protect youth to prosecute them seems out of touch with the goals of child pornography laws. The media attention on the issue has caused a backlash against district attorneys who prosecute teenagers for sexting cases. Currently, U.S. legislators are working on legislation to make sexting a second degree misdemeanor for minors instead of a felony.

As our society continues to address this issue and adapt to the new ways teens are using technology to express themselves, it is important to remember that in most of these instances no one is being malicious. Teenagers make mistakes, but if no one is harmed why destroy their future? As a teenager, I also think it’s extremely important to keep youth engaged in the discussion about sexting. Without their perspective and side of the story, people are making decisions about an issue and topic they do not really understand. This is dangerous ground and poses a threat to cooperative efforts to try and reduce teen sexting.

Roller Derby: Strong Women, Strong Roles

Planned Parenthood of Western Pennsylvania has recently become a proud sponsor of Pittsburgh’s only all-female flat-track roller derby league, the Steel City Derby Demons. The focus on strong, independent women makes an affiliation between these two great organizations a perfect fit.



If you aren’t familiar with the Steel City Derby Demons, let us tell you what all the fuss is about. They are currently ranked by WFTDA (The Women’s Flat-Track Derby Association) as sixteenth out of over 100 leagues nationwide. The SCDD consists of three teams. The Steel Hurtin’ is the A-team or varsity-level team. They play other top teams from around the nation such as Detroit, Philadelphia, Maine, and Houston. The other two teams, the B-Unit and the Blitzburgh Bombers, are the B-level teams. They play similarly matched junior-varsity leveled teams; most recently Toledo, West Palm Beach, and Rideau Valley from Ottowa, Canada.

The Steel City Derby Demons is a skater-owned and operated organization that was founded in 2006 by a group of hard-working women who wanted to get fit, make friends, and have fun. In addition to training to be top athletes in their sport, they also run every aspect behind the scenes. From building the website, to P.R. and marketing right down to renting the bouting venue and paying the bills, the roller girls do it all.

Today’s roller derby has eschewed the professional wrestling style of showmanship of the past to be reborn into a full-fledged highly competitive fast-paced sport. Nothing is faked here; although some of the flair from your mother’s roller derby has remained, such as the derby nicknames (‘Snot Rocket Science and Busty Brawler, to name a few) and the occasional pair of fishnet tights. Training for derby can be extremely grueling, and derby girls do it strictly for the love of the sport and that fleeting bit of glory to be snatched at the end of a victorious game. Roller derby is not a professional sport and no one gets paid.

Roller derby is played on a circuit track between two teams of roughly 12-14 players each. Four “blockers” from each team form the “pack.” It is their job to assist their “jammer” (or, point scorer) to pass as many of the opposing team’s blockers as they can in order to score points. At the same time, the blockers must also try and hinder the opposing team’s jammer from scoring points by blocking and checking her off of the track. Roller derby is unique in this way that offense and defense are played concurrently. This makes the game incredibly fast, with outcomes that can change on a dime.

Roller derby girls have often been portrayed as “counter culture” or “punk rock” in the media, but to try and categorize these women into such narrow stereotypes would be misleading. Members of the Steel City Derby Demons cover the whole spectrum when it comes to daytime jobs; examples of which are optometrist, lawyer, junior high school math teacher, nurse, graphic designer, and mother. However, the women of the SCDD and roller derby in general do share many qualities. They are strong, athletic, outgoing, energetic, and lots of fun, but they are definitely not all cookie-cutter copies. The SCDD celebrates diversity and the opportunity for women to lead extraordinary lives and hopes others can embrace those concepts too.


For more information about the Steel City Derby Demons, or to buy tickets, visit www.SteelCityDerbyDemons.com. Bouts are held every third Saturday of the month at Romp n’ Roll skating rink in Shaler off of route 8. Catch the next home bout on Saturday, April 17th, when the Steel Hurtin’ will play The Dutchland Rollers (Lancaster, PA) and Blitzburgh Bombers face off against the Dutch Blitz. Planned Parenthood of Western Pennsylvania will have a table at this event.

Post by Planned Parenthood Volunteer and Steel City Derby Demon Heather Wood