human rights – The Monarch Project

In order to measure a system as large and multi-faceted as the American healthcare system, it takes a multitude of indicators asking essentially the same question: in this area, are we failing or are we succeeding? Maternal mortality rate, or the rate of women dying in childbirth or from pregnancy-related causes, is an example of one such indicator. It’s also an example of a question where the answer is clear that not only are we failing, but also, that our failure is only getting worse. In order to address this problem in its entirety, we must first evaluate it, both for white women and also for the women of color who are disproportionately affected by it. Then we will examine the system-wide pitfalls that have become the causes for maternal mortalities, and finally see what it takes to rebuild the system to achieve its end success: benefitting and saving the lives of mothers of all races.

According to the World Health Organization, Maternal mortality is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy…but not from accidental or incidental causes.” Maternal mortality rate is normally measured within 100,000 live births. So, when it comes to maternal mortality rate, how does America stack up? Among western countries, not well. According to a 2018 report from the Centers for Disease Control and Prevention’s National Vital Statistics System, nearly 18 in every 100,000 live births resulted in a maternal mortality; that’s 658 women in 2018 alone. Internationally, the United States is ranked 55th. Out of 10 similarly wealthy and developed countries, the US is ranked 10th. And out of those, America is the only developed country in which maternal mortality rate is actively rising.

The chart shown, published by the Lancet, records unofficial data from 1990, 2000, and 2015 in the number of deaths per 100,000 live births.

But are these rates the same for women of all races? The same statistics from the CDC’s National Vital Statistics System found that “the maternal death rate for black women was more than double that of white women: 37.1 deaths per 100,000 live births compared to 14.7.” These statistics prove that this isn’t just a health crisis; it’s also one of the widest racial disparities in the United States. According to the CDC, “a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes” (Martin, ProPublica).

But why is this? Why is infant mortality the lowest it’s been in fifty years, and maternal mortality rate the highest? And why is it so much worse for women of color? The answer is as complicated and multifaceted as the American healthcare system itself.

First, there’s an unfortunate lack of understanding of the indicators for common pregnancy related complications. While infant death is on the steady decline due to nationwide narrowed, specific care, maternal mortality is on the up: “in the last decade or so, at least 20 hospitals have established multidisciplinary fetal care centers for babies at high risk for a variety of problems. So far, only one hospital in the U.S. — NewYork-Presbyterian/Columbia — has a similar program for high-risk moms-to-be” (Martin, NPR). And the lack of these programs have lasting effects; researchers at the California Maternal Quality Care Collaborative, who spent years studying preeclampsia, a very common complication in maternal mortality, found that “despite triggers that clearly indicated a serious deterioration in the patient’s condition, health care providers failed to recognize and respond to these signs in a timely manner, leading to delays in diagnosis and treatment.” (Martin, NPR)

But complications like preeclampsia are not widely known due to the second issue with maternal mortality rate in the US: lack of reporting. The statistics mentioned before from the CDC’s National Vital Statistics System are the first since 2007, and are still yet purported to be majorly conservative. The system for keeping track is left to a single checkbox on the death certificate, and even then, it’s handled by states who didn’t adopt the checkbox all at once. 2018 was the first year that all states reported and required a comparable check box. In England, where preeclampsia deaths are less than one a year, “maternal deaths are regarded as systems failures. A national committee of experts scrutinizes every death of a woman from pregnancy or childbirth complications, collecting medical records and assessments from caregivers, conducting rigorous analyses of the data, and publishing reports that help set policy for hospitals throughout the country” (Martin, NPR). In the US, this is settled on a state basis, if at all.

The third reason is perhaps the most problematic – and human – of them all. It is also the most deadly for women of color: implicit bias. According to the American Bar Association, “there is little reason to believe that physicians have not been exposed to the negative narratives about racial minorities that circulate in society—discourses that become the stuff of unconscious negative attitudes about racial groups.” So much so that “providers are less likely to deliver effective treatments to people of color when compared to their white counterparts—even after controlling for characteristics like class, health behaviors, comorbidities, and access to health insurance and health care services.” (American Bar Association) Serena Williams, world famous tennis player, winner of 23 Grand Slam singles titles, and black woman, dealt with this firsthand with the birth of her daughter Alexis in 2017. The day after giving birth, she noticed a peculiar shortness of breath. Due to her known history of blood clots, she requested a CT scan with contrast and blood thinner right away. However, the nurse “thought her pain medicine might be making her confused…‘I was like, a Doppler? I told you, I need a CT scan and a heparin drip’…The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs” (Haskell). For Black, Latino, and Indigenous women, these incidents aren’t as rare as they should be, and often with fatal consequences.

So where do we go from here? The CDC Foundation of Maternal Mortality Data used data from four states to find more than 20 “critical factors” that contributed to pregnancy-related deaths. According to this, “the average maternal death had 3.7 critical factors.” It would be foolish to put blame on any one of these problems as the sole cause for such a high maternal mortality rate in America. Instead, it’s imperative we attack these issues across all fronts. Approaching maternal mortality as the systematic health crisis that it is might open doors and opportunities for better research, identification, and diagnosis of common fatal pregnancy related complications. Comprehensive and accurate reporting with thorough investigations will make it easier to recognize the common factors of maternal mortality and diminish them. And finally, attacking the personal and systematic implicit biases in our entire health care system, such as “policies that make public health insurance unavailable to undocumented immigrants as well as documented immigrants who have been in the country for less than five years” will fully equip our systems to serve, protect, and save women of all races. (American Bar Association)

In a time when women’s reproductive health is on the ballot year after year, it’s important to recognize our goals. If it is true that we are actually concerned about saving human lives, then it is important that we redirect our attention to the crisis: admitting to American mothers that we are failing them, and admitting to ourselves that it’s time to do better. Then, doing better.

Author: Paige Kelleher

Citations

Belluz, Julia. “We Finally Have a New US Maternal Mortality Estimate. It’s Still Terrible.” Vox, Vox, 30 Jan. 2020, www.vox.com/2020/1/30/21113782/pregnancy-deaths-us-maternal-mortality-rate.

Haskell, Rob, and Photography by Mario Testino. “Serena Williams on Motherhood, Marriage, and Making Her Comeback.” Vogue, www.vogue.com/article/serena-williams-vogue-cover-interview-february-2018.

“Implicit Bias and Racial Disparities in Health Care.” American Bar Association, www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/.

“Maternal Mortality Ratio (per 100 000 Live Births).” World Health Organization, World Health Organization, 11 Mar. 2014, www.who.int/healthinfo/statistics/indmaternalmortality/en/.

Nina Martin, ProPublica, and Renee Montagne. “The Last Person You’d Expect To Die In Childbirth.” NPR, NPR, 12 May 2017, www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger.

Nina Martin, ProPublica. “Nothing Protects Black Women From Dying in Pregnancy and Childbirth.” ProPublica, www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth.

The question of DACA can be discussed in two spheres.

There, of course, begs the question of morality, what is just based on our own understanding of what is just and unjust. And then, there are the legal aspects of the fate of DACA which in our world is what will ultimately decide the final verdict. In this article, I’d like to tackle both of those perspectives and perhaps demonstrate the connections between the two.

In its most glorious and elevated condition, the law is meant to be solid, unbreakable, fair, and unbiased. The tradition of precedent aims for consistency and the US Constitution aims for timelessness. However, in many aspects the constitution is outdated, and this isn’t simply anti-traditionalist banter, it’s based upon the fact politics itself has completely changed since the time the ancient document, that we worship like the bible, was created. A primary, and very relevant example, is the growth of presidential power over centuries. As Benjamin Ginsberg, a Professor of Political Science at Johns Hopkins University argues, “talented and ambitious presidents have pushed the boundaries of the office adding new powers that were seldom surrendered by their successors”.

Not to mention, that every administration, and I mean every administration, and every party will interpret the constitution and other laws to their advantage.

Now let’s place that in the context of DACA and talk about how this policy was first enacted. Deferred Action for Childhood Arrivals (DACA) is a policy that gives individuals with unlawful presence in the US after being brought to the country as children to receive a renewable two-year period of deferred action from deportation and become eligible for a work permit in the U.S These are individuals who (in summary):

Are at least 15 when they apply and have been under the age of 31 on June 15, 2012.
Are in school, a high school graduate or holder of a high school completion certificate or GED, or an honorably discharged veteran of the U.S. Armed Forces or Coast Guard.
Are not convicted of a felony, significant misdemeanor, or three or more misdemeanors are ineligible for the program.

Former President Barack Obama brought DACA into existence through an executive order in 2012 after Congress failed to pass the DREAM Act. Since then, over 700,000 received DACA and another million are eligible. Now, Trump and other Republicans are arguing that this was an overreach of power on behalf of the executive branch and used it in their justification to get rid of DACA. What I find amusing, and perhaps it is a simplistic perspective, is that presidents in past have waged wars (unofficially, of course, the Vietnam war is a prime example) that have resulted in the death of thousands, but legislation designed to provide a chance of a normal life without the fear of deportation, is a disgraceful overreach of power. Many argue that per Article I, Section 8 of the Constitution, complete authority is given to Congress to determine our nation’s immigration rules. However, if something was so blatantly unconstitutional, it wouldn’t have been enacted in the first place. Quite simply, “DACA is within the scope of presidential authority because it does not change the law, and does not legalize anything that would otherwise be illegal” as Ilya Somin argues in several articles.

In their attempts to challenge DACA, Trump and his Republicans have been successful in stopping new applicants from receiving DACA, however, older recipients can still renew it thanks to many lower court challenges. Why didn’t Trump simply get rid of DACA? Because after all, if one president can place an executive order in place, then the next one can simply remove it. However, Trump hid behind the argument of unconstitutionality instead to avoid even more backlash from politicians and the public because a direct stance against DACA, based on moral disagreements is not a smart political stance, even for Trump. In fact, this is one of the reasons why the lower courts were able to challenge his decision: he didn’t provide an adequate reason as to why it was a bad policy. Simply put, the Trump Administration cannot provide a moral argument as to why DACA should be destroyed.

However, the fate of DACA is no longer in the hands of the executive branch and will be moving on to the Supreme Court in June by the request of Donald Trump. This court hearing will not be deciding the constitutionality of DACA, but instead, the validity of the lower courts challenges to Trump’s decision. And, this decision is going to outlast any presidential executive order. Here are the possible outcomes of this hearing summarized from Vox’s coverage:

1st: The Court could affirm the lower court decisions, meaning that handing a narrow victory to the Dreamers. This outcome is unlikely, given the Court’s Republican majority and the views expressed by several members of that majority in a similar 2016 case.

2nd: It could affirm Trump’s decision and deem the Trump administration’s reasoning regarding its decision to wind down DACA are adequate, and thus the administration can move forward in shutting it down while leaving the door open for future administrations to potentially revive it with good enough reasoning.

3rd: The Court could decide that the DACA program is, itself, unlawful. In this last scenario, the Court would not just allow DACA to be wound down under Trump — it would forbid any future president from reviving it.

The court is presently more right wing, so a victory for Trump is more likely and a fully revived DACA is nearly impossible. In the crossfire of legal battle after legal battle are the lives of Dreamers themselves.

While the political world is having a shouting match over who is right and who is wrong, the 700,000 individuals who have built their lives in the US, who have made deep impacts in their community, and who are now fighting on the frontlines of the COVID 19 outbreak are waiting to see if their safety is in jeopardy, for a choice that they did not make. The USFD could never deport the 11.3 million undocumented immigrants in the US, it only has the resources to deport 400,000 per year. What I find baffling, from a moral standpoint, is that from all the battles the Trump administration could choose to fight in immigration it chose a group of young, working, educated individuals who have no criminal background and cause absolutely no harm. Dreamers had placed their trust in the US Federal Government, giving them personal information that, if in the wrong hands, could lead ICE right to their doorstep.

To forget the people behind the policy, to justify jeopardizing the lives of thousands of people, is simply a consequence of the trend of dehumanization of immigrants in the US. If this concerned any other group of people there would be public outrage across the country.

Because the ball is now in the Supreme Court (no pun intended) there is very little the rest of the country can do. One can only hope that whatever the outcome, Dreamers can continue to dream.

Tag: human rights

A‌ ‌Measure‌ ‌of‌ ‌Failure:‌ ‌Maternal‌ ‌Mortality‌ ‌in‌ ‌the‌ ‌US‌ ‌ by‌ ‌Paige‌ ‌Kelleher‌