US mothers facing outsized degree of danger

WHOUSTON e love mothers, or at least we say we do, and we claim that motherhood is as American as apple pie. We’re lying. In fact, we’ve structured health care so that motherhood is far more deadly in the United States than in other advanced countries. An American woman is about five times as likely to die in pregnancy or childbirth as a British woman — partly because Britain makes a determined effort to save mothers’ lives, and we don’t.

Here in Texas, women die from pregnancy at a rate almost unrivaled in the industrialized world. A woman in Texas is about 10 times as likely to die from pregnancy as one in Spain or Sweden, and by all accounts, the health care plans proposed so far by Republicans would make maternal mortality even worse in Texas and across America.

Women die unnecessarily in Texas for many reasons, but it doesn’t help that some women’s health clinics have closed and that access to Medicaid is difficult. I spent a day in Houston shadowing Dr. Lisa Hollier, the president-elect of the American Congress of Obstetricians and Gynecologists, in her Center for Children and Women. Hollier is on a mission to make motherhood safer, because of an experience she had as a young medical resident many years ago.

Amy, 23, had arrived at the hospital with a headache near the end of an uncomplicated pregnancy, her first. Her husband was there, and everything seemed normal — and then Amy collapsed and lost consciousness.

Doctors performed an emergency C-section and saved the baby, a daughter, and Hollier struggled to keep Amy alive. She failed. Amy had suffered a preventable massive stroke, related to severe high blood pressure.

“I remember her husband,” Hollier said, and she wiped her eyes at the memory. “Here’s this dad, and it’s supposed to be the happiest day of his life, and there’s this look on his face. He’s just so lost.”

That happens somewhere in the United States on average twice a day.

My day with Hollier underscored that there’s one very simple and inexpensive starting point: Help women and girls avoid pregnancies they don’t want. “You can’t die from a pregnancy when you’re not pregnant,” Hollier noted.

Almost half of pregnancies in America are unintended. And almost one-third of American girls will become pregnant as teenagers. (Meanwhile, President Donald Trump slashed $213 million in funding for teenage pregnancy prevention programs.)

One patient, Monica Leija, told Hollier that she had been on the pill but switched jobs, and her new position didn’t offer insurance for the first three months. That meant she would have had to pay the $40-a-month cost herself, and she figured the odds were against her becoming pregnant during that window.

“I just didn’t think it would happen,” she said. Now she’s bulging with a pregnancy at almost full term.

I heard a lot of comments like that. Derrion Harris, 21, has a year-old child who was not planned, and now Harris is sexually active again. Hollier asked if she uses birth control.

“I use condoms,” she said, then corrected herself: “I use condoms sometimes.”

Some of you readers are thinking this is outrageous irresponsibility. But we should also look at society’s irresponsibility in failing to help all women and girls get access to long-acting reversible contraceptives, or LARCS.

The U.S. failure on maternal mortality is particularly striking because around the world, maternal mortality has plunged by almost half since 1990; the U.S. is a rare country in which maternal deaths have become more common in recent years.

Granted, saving lives in childbirth is often complicated. Hollier examined one pregnant patient, Sarvia Alonzo, who had had three previous C-sections, increasing the risk of a condition called placenta accreta that can lead women to bleed to death very rapidly. Alonzo is due for a C-section again and will have two surgeons perform it so that if there is a crisis, it will be easier to manage.

Saving lives also requires better prenatal care, yet more than a third of women in Texas don’t have a single prenatal visit in the first trimester. One factor is that Texas politicians, on a rampage against Planned Parenthood, have in effect closed a number of women’s health clinics.

The result seems to be more pregnancies as well as more Medicaid births. And, after the number of abortions declined for several years, the loss of clinics also apparently led to a slight increase in abortions in 2015, the most recent year with reported figures. Texas also has high rates of deaths from cervical cancer.

Within the U.S., California has done an outstanding job cutting maternal deaths and showing what is possible. A crucial step is careful counting of maternal deaths and investigation of each one to learn what could have been done differently.

Obstetrics & Gynecology, a medical journal, says that the U.S. ranks below every member of the Organization for Economic Cooperation and Development industrialized club in maternal mortality, except for Mexico.

Obamacare helped tackle maternal mortality by expanding insurance coverage and by making contraception free. The Republican health care plans would instead follow the path of Texas, making motherhood more dangerous across America.

And this is pro-life?

Nicholas Kristof is a columnist for The New York Times.