48th in Maternal mortality....really US?

-->According to the CIA World Fact Book, the United States sits at 48^th in maternal mortality rates compared to the rest of the world.  Some sources (www.huffingtonpost.com) estimate that it is now 50^th as of 2012.  This puts the United States behind every other industrialized nation (and a couple developing nations).  Why is this?  How can a country with so much wealth and advances in technology be so far behind?  Many people in this country claim that it is the best in the world, well, this stat certainly doesn’t seem to prove that.  Here is the list of the 47 countries that have better maternal mortality rates than the US:

Table 1: Top 50 Countries Ranked by Maternal Mortality Rates and Showing Health Expenditure

Rank	Country	Deaths/100,000 births	Heath expenditure %/GDP & world rank
1	Estonia	2	6%, 85
2	Singapore	3	4%, 24
3	Greece	3	10.3%, 173
4	Italy	4	9.5%, 158
5	Austria	4	11%, 179
6	Sweden	4	9.6%, 161
7	Finland	5	9%, 149
8	Iceland	5	9.4%, 155
9	Poland	5	7.5%, 119
10	Czech Republic	5	7.9%, 130
11	Japan	5	9.5%, 157
12	Spain	6	9.5%, 159
13	Slovakia	6	8.8%, 145
14	Netherlands	6	11.9%, 193
15	Ireland	6	9.2%, 153
16	Norway	7	9.5%, 156
17	Qatar	7	1.8%, 1
18	Australia	7	8.7%, 144
19	Germany	7	11.6%, 189
20	Israel	7	7.6%, 123
21	Portugal	8	11%, 180
22	Montenegro	8	9.1%, 152
23	Lithuania	8	7%, 112
24	Switzerland	8	11.5%, 187
25	Malta	8	8.7%, 142
26	Belgium	8	10.7%. 177
27	France	8	11.9%, 182
28	Bosnia/Herzegovina	8	11.1%, 181
29	Kiribati	9	11.3%, 184
30	Cyprus	10	6%, 86
31	Macedonia	10	7.1%, 113
32	Bulgaria	11	6.9% 108
33	Denmark	12	11.4%, 186
34	Canada	12	11.3%, 185
35	Serbia	12	10.4%, 174
36	United Arab Emirates	12	3.7%, 20
37	Slovenia	12	9.4%, 154
38	United Kingdom	12	9.6%, 160
39	Kuwait	14	2.6%, 7
40	New Zealand	15	10.1%, 170
41	South Korea	16	6.9%, 107
42	Croatia	17	7.8%, 127
43	Luxembourg	20	7.8%, 126
44	Turkey	20	6.7%, 99
45	Bahrain	20	5%, 50
46	Puerto Rico	20	N/A
47	Hungary	21	7.3%, 117
48	United States	21	17.9%, 190
49	Iran	21	5.6%, 72

Additionally, the WHO Health Statistics Report shows that, since 1990, maternal mortality rates have nearly doubled going from 12/100,000 live births in 1990 to 21/100,000 live births in 2010.  This abysmal ranking is in spite of the fact that in 2010 the US spent a higher percentage of its GDP in health care (17.9%) than every other country in the entire world except for the Marshall Islands (18.1%, well at least we aren’t the worst right?).

While it does not appear that money spent = lower rates, the majority of the top 20 countries spend between 8-11% of their GDP on health care, with the exceptions of Estonia (6%), Singapore (4%) and Qatar (1.8%).  This seems to indicate that spending between 8-11% of GDP is the optimum amount to spend on health care.  Much more (like the US) and there seem to be issues with efficiency and overuse of expensive procedures, and much less (Somalia, Chad) and there are not enough services to help every woman.  Some countries, especially in the Middle East show low percentages due to very high GDPs and smaller populations (United Arab Emirates, Qatar)

According to an article done by Frontline ((http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html), there are basically four ways of paying for health care: The Beveridge Model, the Bismarck Model, The National Health Model and the Out-of-Pocket Model.  The majority of the countries in the top 46 have one of the Beveridge Model, the Bismarck Model or the National Health Model.  All three of these models require the involvement of government to either provide health care or provide regulation on health care so that prices stay low and affordable.  The Beveridge Model is government controlled health care where all health care professionals either work for the government or receive their payment directly from the government.  This model is used in countries like the UK, Scandinavia, Spain, and New Zealand.  The Bizmark model uses private insurance and health care providers funded by employers etc (similar to the US), but the government is responsible for regulating the industry to make sure that everyone is insured and prices stay low.  Countries like Germany, France, Belgium, Japan, the Netherlands, Switzerland and much of Latin America.  The National Health Model uses private health care providers, but bills are paid for by the government, which is funded through taxes.  In all three sections, health care providers and insurance companies are non-profit, which keeps prices low and ensures that the patient will get preference not the procedure.

So here is the thing, almost all of the countries that are doing better than us in maternal mortality rate use one of those three systems.  The United States has pieces of all four systems (including the out-of-pocket system, which means rich people get health care and the poor do not).  This makes our system completely disjointed, inefficient and means that the systems values practices that cost the most money rather than save the most lives. 

The US C-section rate is 33% and growing; that is worse than 175 other countries in the world and more than twice the WHO recommendation for 15%.  A C-section is a costly procedure that benefits both doctors and for-profit insurance companies.  Delivery of mediations (epidurals, spinals, Pitocin), running fetal monitors, these are all things that hospitals get to charge people for, which increase the bills and gets more money for them and the insurance companies.  C-sections and medications are necessary in some cases and o help some women, but these rates show that there is too much unnecessary intervention going on.

These “standard” procedures are also what cause most of the complications that women face during labor, which leads to higher death rates.  In countries that use one of the 3 primary health care models, the government is able to control the use of these procedures because they end up costing tax payers and people more money (which they do here too, even if you have health insurance, don’t kid yourself you are paying for these expensive procedures!).  For instance, in Canada, doctors are now trained to deliver breech babies vaginally in order to lower the rate of C-sections and keep rates and prices low for the people.

In many of these countries (Canada, Scandinavia, the UK, Germany, etc.), midwives are also an integral part of the health care systems.  Their services are less expensive and since they promote natural birth, the births themselves cost less.  For the majority of low-risk mothers, this is the best way to have a baby, and it is the cheapest.  The systems of doctors and midwives work together in these countries to insure that the majority of mothers who do not need interventions have healthy babies, but when the mothers come in that do need help to save their lives and those of their babies, doctors and hospitals are necessary as well.

While acceptance of midwives is growing in the US, there are still many states where the practice is illegal, or midwives are so strictly regulated that they can’t perform their duties to the best of their abilities and it actually causes problems. 

The US health care system is so disjointed that we cannot effectively treat women. Too much depends on expensive procedures, expensive medicines and not enough on the health of the woman (or anyone for that mater).  I’m not saying that there is a perfect system out there (because that isn’t possible, we are human after all and gloriously imperfect), however we need to streamline this system, pick one, and move forward.  Pick a system that promotes the health and wellness of the people and not the pocket books of the insurance companies and health care professionals.