It's a sad article, but very telling regardless. The root causes for this can be debated, but the bottom line is most of these deaths could have been prevented. For anyone not in the US reading...
It's a sad article, but very telling regardless. The root causes for this can be debated, but the bottom line is most of these deaths could have been prevented.
For anyone not in the US reading this, I posted this article to add to the pile for visibility's sake to draw attention. To some of you, this may be shocking as your own countries don't have these issues on this scale and the age old observation of an apparent Paradox, "the US is the wealthiest nation on earth, why is this happening?" may nag at you.
I assure you, it nags at us too. To some of us, the solutions are apparent: make healthcare more readily available, fund the mental health system, fund education, revamp the strategy to handle drug abuse (currently it's to lock them up) and other common sense items.
We are met with opposition at the very mention of these solutions. The opposition doesn't provide solutions, they just stonewall progress with seldom a reason at best and at worst with contrived reasons that tie in taxes, the economy, equity, and sometimes even religion. And they get their way.
I'd like to invite conversation on what this article talks about.
Is it as simple as lack of social programs? Is it our medical industry as a whole?
When the article mentions systemic racism, is this hyperbole or is there some merit to the claim?
If you're foreign to the US, I welcome your opinion. If you're a citizen, I welcome all opinions and hope we can have a more neutral and civilized discussion. It would be a nice change of pace having come from Reddit at its lowest.
Here are my takes as a German: Both, really, as well as some other coinciding factors: Healthcare access and quality being wealth dependent, combined with barely any social security systems...
Here are my takes as a German:
Is it as simple as lack of social programs? Is it our medical industry as a whole?
Both, really, as well as some other coinciding factors: Healthcare access and quality being wealth dependent, combined with barely any social security systems naturally mean that poor people will have worse health statistics.
Whatever ethnicities make up that economic strata will hence suffer the most from the economic downturns the US has experienced the last 20 years.
Childbirth is among the most dangerous experiences a person can have. It absolutely shocked me when I first learnt how common births at home are in the US. It's almost unthinkable here. If anything goes wrong (which can happen very quickly), I'd want mother and child to be as close to intensive care as possible.
Couple that with shoddy sex education and criminalisation of abortions, and you are raising the chances even more (poor people often receive worse education in general, so they know even less about contraception, and sex is fun and you can do it for free => even more pregnancies, many of them unwanted/unplanned, potentially making a family poor)
Add to all that the lack of proper parental leave, or medical leave in general, mix it with the lack of social security already mentioned, and you have fresh parents being forced to work way to soon, putting them under even more financial and emotional stress (as if new parents aren't stressed enough as it is), potentially having to forgo even more necessary healthcare because they simply can't afford it, either directly monetarily or because they can't take the time off at work.
With all those factors (and many more that I missed or was to lazy to mention) it's little wonder you have child mortality rates I'd expect to see in 3rd world countries.
When the article mentions systemic racism, is this hyperbole or is there some merit to the claim?
I have many criticism for the general concept of systemic racism and what is often considered to be it, but in this case I simply think you don't need that assumption. There are disproportionately many poor POC overall, so they as a group are more affected by situations that affect poor people in general.
Potential solutions could be as "simple" (conceptionally, not politically) as ensuring everybody has free and easy access to healthcare, a robust social security system that makes it possible to break out of the poverty spiral, decoupling school funding from property taxes (thus preventing education quality being overly tied to ones economic situation), and better sex education combined with better access to contraception across the board.
For a last bit of irony, implementing those changes would not just cost less, but make both the government and businesses more money. Healthy people are productive people.
Which to me means this is not a problem of Late Stage CapitalismTM , as one can read so often on the internet nowadays, but an ideological stance of "the poor do not deserve help!"
On the subject of systemic racism. There is a large portion of the black population that do not trust doctors or the Healthcare system because doctors and other providers do not listen to them...
On the subject of systemic racism. There is a large portion of the black population that do not trust doctors or the Healthcare system because doctors and other providers do not listen to them about their issues and provide substandard care.
Another large portion of distrust comes from the horrendous acts done to black people in the medical field. Namely the "Tuskegee Study of Untreated Syphilis in the Negro Male" A.K.A. the Tuskegee experiment. They continued to not treat these men for Syphilis for 25 years AFTER penicillin had become widely available and was the accepted as the standard treatment for the disease. Actively denying the United States Army from treating men from the study who were drafted. There was no education on STD's given to the men in the study leading to 40 of their wives contracting Syphilis and 19 children being infected by birth.
There was a class action lawsuit which was settled out of court for $10 million...in 1974 two years after the study ended.
In essence the medical community in America has been fucking BRUTAL towards any non-white community and it is a systemic problem that is present in every medical discipline and was instilled in the system at its inception. This, imo, rightfully has caused distrust in the medical community for a large portion of non-white peoples and unfortunately that leads to them not seeking care and in this case pre/post natal care.
We're definitely in agreement that this is a bad thing in the US, but it's worth noting that abortion after 12 weeks is also illegal in Germany and is still punishable with prison time. Abortion...
and criminalisation of abortions,
We're definitely in agreement that this is a bad thing in the US, but it's worth noting that abortion after 12 weeks is also illegal in Germany and is still punishable with prison time. Abortion prior to 12 weeks requires a doctor to sign off that you received counseling at least three days prior to the procedure. Up until 2019 it was illegal for doctors to advertise that they provided abortions (such as listing it on their websites) and until last year they were banned from giving medical detail (such as whether they offered medical or surgical abortion or if they only offered abortion prior to a certain number of weeks). German health insurance (public or private ime) also doesn't cover contraceptives for adults.
On the whole, my healthcare in Germany is MILES better than it was in the US and costs me way less. I'm staying here and not moving back to the US for a huge number of reasons, that included. But in terms of abortion and contraception, German law is more restrictive than the red state I grew up in (though they are currently in court trying to make the law worse back in my home state so who knows for how long).
Another good example of systemic racism in the USA, perhaps one of the simplist and most profound, is housing discrimination. Redlining was fully legal in the USA until 1962, 1968 for private...
Another good example of systemic racism in the USA, perhaps one of the simplist and most profound, is housing discrimination.
Redlining was fully legal in the USA until 1962, 1968 for private banks. Redlining is explicitly discriminating against minority neighborhoods. So white families had easy access to mortgages when minorities didn't. The typical mortgage in the USA is a 30 year, so that's less than 2 generations of home ownership removed from explicitly being allowed to deny brown people loans.
Considering that home ownership is the almost-exclusive method of wealthbuilding for the majority of the population, that is a one huge lingering burden on why minorities are so disproportionately poor in the USA. We'd need a 100+ years of minority-favoring policy to tilt those scales back, even if all the actual racist laws are gone. Right now, anything financially rewarding homeowners is disproportionally rewarding white people. And that is an example of how colorblind law still has systemic racism.
Seems as though its a flaw we're not able to address with our economic system, where those who are behind can never actually catch up, and American history was significantly about putting black...
Seems as though its a flaw we're not able to address with our economic system, where those who are behind can never actually catch up, and American history was significantly about putting black people and native americans behind everyone else.
There is a solution, it's called 'reparations.' But that word can make otherwise reasonable white moderates froth at the mouth. And broadly, just eliminating most incentives that benefit from...
There is a solution, it's called 'reparations.' But that word can make otherwise reasonable white moderates froth at the mouth.
And broadly, just eliminating most incentives that benefit from ownership and reducing wealth inequality will help. Bringing back 90%+ taxes on high earners and adding wealth taxes would be a good start.
I love the idea of reparations, but the practicality of it is far more complex than reality would allow for. For that reason, I feel it is not the prudent course of action. A far more realistic...
I love the idea of reparations, but the practicality of it is far more complex than reality would allow for. For that reason, I feel it is not the prudent course of action. A far more realistic way to accomplish this would be to raise up all the poor, regardless of ancestry, such that there is only bickering coming from the wealthy whom are being taxed at a higher rate. The concept of a Universal Basic Income has long been my favored method by which to accomplish this. Of course, any system by which we amend our economic inequality needs to be paid for by those who have benefited the most-- the wealthy.
I think that's more the excuse, rather than the reason, even if it is still an aspect of it. Universal healthcare is a popular idea in the US, with more than 50% of the population supporting it....
For a last bit of irony, implementing those changes would not just cost less, but make both the government and businesses more money. Healthy people are productive people.
Which to me means this is not a problem of Late Stage CapitalismTM , as one can read so often on the internet nowadays, but an ideological stance of "the poor do not deserve help!"
I think that's more the excuse, rather than the reason, even if it is still an aspect of it. Universal healthcare is a popular idea in the US, with more than 50% of the population supporting it. In spite of that though, neither party is making any serious effort to implement it. US politicians are dependent on corporate money to get elected for the most part, so looking at the corporate interests can be illuminating.
First, there are the companies directly profiting off the current system. They definitely don't want things to change, and will lobby hard to keep it that way. Then there are the companies that don't give healthcare benefits to most of their employees. A universal healthcare system would almost surely increase the taxes they pay, so they're going to be against it too. Finally, there are the companies that do provide healthcare to their workers. This is generally done as an incentive to get and keep talent. If that incentive is gone though, they'll probably have to pay for some other incentive, so it's debatable whether they'd save any money at all.
I think it's good to talk about some of the intangible benefits corporations gain from the current system too. Setting up an employee healthcare system is an additional hurdle for new companies, benefitting existing ones and reducing future competition. The other big thing is it increases worker precarity. Healthcare is a demanding need; quite a lot of treatments can't wait, and recurring costs are common. Putting workers in a position where they lose medical treatment if they stop working, whether directly through employer insurance or by losing the means to pay for their own insurance, increases the leverage companies have in negotiations.
So overall, it's a system where companies generally don't want universal healthcare, and some relying on the lack for their business model. Politicians don't want it, because they need that corporate money to get elected. "The poor do not deserve help", often with rascist dog whistling about exactly which poor people they're talking about, is how the politicians sell it to the people.
"but an ideological stance of 'the poor do not deserve help!' " Which we have a lot of that here too. very much pull yourself up by your bootstraps kinda thing. But yes, especially amongst the...
"but an ideological stance of 'the poor do not deserve help!' "
Which we have a lot of that here too. very much pull yourself up by your bootstraps kinda thing. But yes, especially amongst the republicans there is the attitude that if you are poor you must have done something to deserve it. And therefore why should we pay for your shortcomings? I see it from my republican parents all the time (and they'll complain when they can't get help because of all the stuff their politicians put in place to prevent it and complain that "honest working people" can't get help and those freeloaders keep abusing welfare. There is very much this fear that if they help others through government only freeloading lazy people will profit and it will just get abused).
US doctor here, not OBGYN but tangentially related. Tried to access the underlying article that was actually published instead of a journalist's interpretation, but anything beyond the abstract is...
US doctor here, not OBGYN but tangentially related.
Tried to access the underlying article that was actually published instead of a journalist's interpretation, but anything beyond the abstract is behind a large paywall. Classic JAMA.
You discuss access to healthcare, and I agree completely. What I wanted to see was if this increase was related to decreased access to medical care, or if those with access to adequate health care also had an increase in MMR.
Anecdotally, in my region, I see a LOT of pregnant women who have access to care, but choose not to utilize it. Maybe this is due to lingering distrust from COVID, trending stuff on social media, or cost. A majority of my area are government insurance, so copays are likely not the reason, but maybe unable to take time off or transportation issues.
I think another thing to consider is the opaqueness of the systems that people need to use in order to even access information about these services, let alone apply for them. Some of them don't...
I think another thing to consider is the opaqueness of the systems that people need to use in order to even access information about these services, let alone apply for them. Some of them don't have an internet presence; some of them ONLY have an internet presence. If you're in a socioeconomic situation where you don't have time to take off work to go find services (which you mentioned), or if you don't have access to the internet, those services become unavailable very quickly. Knowing where to look and how to find services is a skill that not everyone acquires.
Absolutely correct. We have a full time position dedicated to helping patients navigate this. Even that's not enough, sometimes. It's unfortunate that the "it's expensive to be poor" adage rings...
opaqueness of the systems
Absolutely correct. We have a full time position dedicated to helping patients navigate this. Even that's not enough, sometimes. It's unfortunate that the "it's extensiveexpensive to be poor" adage rings true again.
Lack of access to prenatal care is a factor to consider, especially if you live in more rural areas or those lacking public transportation. Add in a lack of ability to take off time from work and...
Lack of access to prenatal care is a factor to consider, especially if you live in more rural areas or those lacking public transportation. Add in a lack of ability to take off time from work and funds to pay for these Healthcare services, and it results in medical concerns not being addressed until time of birth. There can also be underlying health conditions that affect birth outcomes because the same individuals who cannot seek prenatal care most likely can't access regular Healthcare either.
The Maternal Mortality rate is a big enough concern that the Department of Health actually has it as a topic to address for their Healthy People 2030 Goals. So the US government is aware, but unfortunately many of their ratings for the most concerning items are "getting worse."
We also can't ignore the fact that restricting abortion access also is a factor at play in mortality rates. The Common Wealth Fundhas found:
That maternal death rates were 62 percent higher in 2020 in abortion-restriction states than in abortion-access states (28.8 vs. 17.8 per 100,000 births).
Even more disturbing:
Note this is only dealing with date up to 2019 and not beyond.
The maternal mortality rate was increasing nearly twice as fast in states with abortion restrictions.
Those who are more economically inclined to seek abortion most likely have overlaps with those who lack funds or access to prenatal care.
True, but the data in the original article only deals with data up to 2019. So while this increase is large, it's not even accounting for the restriction on abortion, which I agree will push it...
We also can't ignore the fact that restricting abortion access also is a factor at play in mortality rates
True, but the data in the original article only deals with data up to 2019. So while this increase is large, it's not even accounting for the restriction on abortion, which I agree will push it higher.
Thanks for calling that specific out! My bad for not using clearer language to note that statistic. I've gone back and edited my comment to help call that out :)
Thanks for calling that specific out! My bad for not using clearer language to note that statistic. I've gone back and edited my comment to help call that out :)
This is also a point I want to hone in on. Choosing not to utilize it is a factor and it's there for a multitude of reasons. They distrust the government, so if you tell them the government is...
Anecdotally, in my region, I see a LOT of pregnant women who have access to care, but choose not to utilize it. Maybe this is due to lingering distrust from COVID, trending stuff on social media, or cost. A majority of my area are government insurance, so copays are likely not the reason, but maybe unable to take time off or transportation issues.
This is also a point I want to hone in on. Choosing not to utilize it is a factor and it's there for a multitude of reasons. They distrust the government, so if you tell them the government is providing aid they'll look at it funny and ask "what's the catch?" The mistrust of the government is its own topic as they get fed propaganda too and a lot of conservative, conspiracy theory bullshit, flows downhill and ends up in their phones anyway. Not to mention information on previous years of actual government directed racism treating the black community as lab rats. Distrust in the government is warranted. Many in the black community would like things to change and they tend to vote for the party that promises socio-economic reform, but the current state of those social programs mean less educated citizens and less educated voters. Lack of education means lack of critical thinking which is already in short supply across the country.
I posted elsewhere about the distrust the black community has in healthcare professionals as well. The burnt out healthcare worker wrongfully blames their burnout on the influx of patients to the ER or NICU rather then the for profit, non profit, business modal controlled by insurance companies and pharmaceutical companies. The nurse role is a catchall for what used to be compartmentalized roles and medschool + residencies both doctors and nurses go through is outdated, toxic, and breeds arrogance and narcissism not to mention frustration and anger which then gets taken out on the already ignorant patient walking through their doors.
It shouldn't be like this. These deaths are unavoidable and a lot of hurt feelings on either side are also avoidable and stem to political causes. It's sad all around.
Your other points on transportation and time off are true as well. The glorification of "the grind" and "the hustle" and a "side hustle" are symptoms of profit at all costs capitalism feeding us kool-aid to make the medicine go down. There's people with serious and alarming conditions that will not take off of work out of fear of being fired. Transportation is always an issue as well, but that rounds out three departments that are failing in this country: the DOH, the DOT, and the DOE.
DOD is fine though. DOA is also fine as an industry but the food in this country is broken and unequal. It's quite an exercise to eat healthy in this country without paying large amounts.
Very well said. I especially like how you bring up the burnout and cynicism that residency and medical school breed. I went to a very good school and residency with very little toxicity. But I'm...
Very well said. I especially like how you bring up the burnout and cynicism that residency and medical school breed. I went to a very good school and residency with very little toxicity. But I'm still burnt out and cynical.
distrust the black community has in healthcare professionals
I feel this so much. I'm white. I specialize in limited access, underprivileged, inner city population. Overcoming this is a massive hurdle for me, and I occasionally am completely unable to.
Do Americans have access to midwife services? In Canada there is a (mostly, depends on the province) regulated body of midwives, and people can choose to either utilize (no cost) a doctor or a...
Anecdotally, in my region, I see a LOT of pregnant women who have access to care, but choose not to utilize it. Maybe this is due to lingering distrust from COVID, trending stuff on social media, or cost.
Do Americans have access to midwife services?
In Canada there is a (mostly, depends on the province) regulated body of midwives, and people can choose to either utilize (no cost) a doctor or a midwife for their pregnancy/birth. People of course choose midwives for a variety of reasons but I think they also capture the 'lingering distrust' crowd fairly well, I don't think there are many births that happen outside these two bodies.
We do have a very robust midwife service. It varies based on state, but every state has done component of this. The difference is whether or not they are overseen by an actual doctor. We're...
We do have a very robust midwife service. It varies based on state, but every state has done component of this. The difference is whether or not they are overseen by an actual doctor.
We're delving into a personal and professional bias here. Search "mid-level encroachment" and you'll find a lot of discussion. I've been personally impacted by poor mid-level management. I'm going to try to keep my bias out, though.
With regards to cost, regardless of whether or not the midwife is being overseen by a doctor, usually the "cost" (what is billed to insurance) is the exact same as if they were seen by a doctor. Might be different actual billing if self-pay, but usually those in the situation that this would pertain don't have the knowledge of the system to pursue this avenue. But there is no such thing as no cost.
Interesting, thanks. What I was trying to say, (in a not very clear fashion), was that families in Canada don't have to pay for midwives, they are paid for by the government in the same manner as...
Interesting, thanks.
But there is no such thing as no cost.
What I was trying to say, (in a not very clear fashion), was that families in Canada don't have to pay for midwives, they are paid for by the government in the same manner as a doctor overseeing a pregnancy is. So there is no cost barrier in using either service.
Re-reading your comment now, you did say doctors or midwife at no cost, and I read that as doctor at cost or midwife for no cost. So cost wise, there's no difference between the two? If so, it's...
they are paid for by the government
Re-reading your comment now, you did say doctors or midwife at no cost, and I read that as doctor at cost or midwife for no cost. So cost wise, there's no difference between the two? If so, it's similar here.
Although, anecdotally, I fought tooth and nail for a doctor to be involved instead of a midwife, to no avail. I've heard that to be the case in several areas.
Correct. For an individual patient or generally? From what I understand, here there is a pretty good integration of midwifery into the medical system, and they'll refer you to a physician as...
So cost wise, there's no difference between the two?
Correct.
I fought tooth and nail for a doctor to be involved instead of a midwife, to no avail. I've heard that to be the case in several areas.
For an individual patient or generally? From what I understand, here there is a pretty good integration of midwifery into the medical system, and they'll refer you to a physician as required. We used a doctor for our kids and the experience was great, well as great as it can be anyways. Doctors are definitely more my speed than midwives, but I could see how midwives could be helpful for people with low trust in the medical system.
More personal details than I was wanting to discuss, but I'll give specifics. My wife was pregnant, we saw an OB clinic within our hospital. Midwives throughout, which I didn't mind because it was...
For an individual patient or generally
More personal details than I was wanting to discuss, but I'll give specifics. My wife was pregnant, we saw an OB clinic within our hospital. Midwives throughout, which I didn't mind because it was uncomplicated. Then mid third trimester, a small complication came up. They brushed it and my concerns away multiple times. I eventually requested to have a doctor involved, and they "spoke with the doctor" who refused to see us. I ended up having to call in a professional favor to get a doctor involved, and that finally got things moving. I was frustrated it took so long, but in the end it was the right thing to do because we got it addressed and the birth went relatively smoothly.
I'd say 'it depends,' rather than declaring universally robust. In PA, midwives were the exception, not the rule. There's some good laws there (midwives must be RN's), but you're not likely to be...
I'd say 'it depends,' rather than declaring universally robust. In PA, midwives were the exception, not the rule. There's some good laws there (midwives must be RN's), but you're not likely to be referred to a midwife by your doctor. There were less than 5 midwife practices serving the Philadelphia region when we were pregnant < 10 years ago, and some couples coming in from closer to Baltimore.
The default birth option in the USA is C-section. That's not to say natural birth isn't tried first, but many in-hospital births do things that make things miserable for mom (no eating during labor) in service of making a future C-section easier. Making the C section easier is a higher priority than having a safe, easy natural childbirth.
A lot of people write off C sections as no big deal, but they are major abdominal surguries. I would be shocked if maternal mortality rates and c-section rates were not almost directly proportional.
I am prone to hyperbole, yes. I've been heavily involved in healthcare for 10 years in 3 different states, and midwives are quite prevalent in my experience. But that's only 3/50th of the US, and...
I'd say 'it depends,
I am prone to hyperbole, yes. I've been heavily involved in healthcare for 10 years in 3 different states, and midwives are quite prevalent in my experience. But that's only 3/50th of the US, and lower income clinics, so my perspective is obviously skewed.
A lot of people write off C sections as no big deal
Preach. I've heard many friends say they want to do C-section because it's easier. I've also seen lots of botched elective C-sections who wish they had not gone that route. It's not a decision to be taken lightly.
Australia and the US have almost identical rates of c sections (32%) but vastly different maternal mortality. 5 per 100,000 live births in australia vs 33 per 100,000 in the US. I don’t think...
Australia and the US have almost identical rates of c sections (32%) but vastly different maternal mortality. 5 per 100,000 live births in australia vs 33 per 100,000 in the US.
I don’t think you’re totally wrong - the cascade of interventions leading to c section and the environments of labour that you talked about is almost certainly part of the picture, and I think there is strong evidence that midwife-led births lead to better outcomes (which is probably down to fewer interventions and more focus on natural birthing positions), but this seems to be a multi-factorial issue and probably requires an overhaul of the whole system.
I was specifically referring to US, sorry if I was unclear. But yes, American healthcare is so utterly broken. Nobody likes it, but its like this weird prisoners dillema that everyone is worried...
I was specifically referring to US, sorry if I was unclear.
But yes, American healthcare is so utterly broken. Nobody likes it, but its like this weird prisoners dillema that everyone is worried it'll end up worse somehow.
Oh yes I understood, I was just using australia as a comparison to show that the c section rate can’t be the whole picture, otherwise you would see similar MMR here. I think that’s true of a lot...
Oh yes I understood, I was just using australia as a comparison to show that the c section rate can’t be the whole picture, otherwise you would see similar MMR here.
I think that’s true of a lot of government systems and even the system of government itself! It’s hard to change things, a lot of people prefer the devil they know to the one they don’t. But when we reach a point where significant harm is being done, it’s time to try!
This reminds me of the absurd noise levels found in a typical hospital room. You have people recovering from major medical events like birth and serious surgeries. Sleep is an essential component...
The default birth option in the USA is C-section. That's not to say natural birth isn't tried first, but many in-hospital births do things that make things miserable for mom (no eating during labor) in service of making a future C-section easier. Making the C section easier is a higher priority than having a safe, easy natural childbirth.
This reminds me of the absurd noise levels found in a typical hospital room. You have people recovering from major medical events like birth and serious surgeries. Sleep is an essential component of health and recovery. But then the whole environment is built with zero consideration for sleep. Lots of monitors constantly beeping. Things are designed for the staff to do their job with the least amount of labor possible, rather than the quality of recovery possible.
The funny thing is, Finland had this problem back in the early 20th century, and solved this problem with, among other things, the äitiyspakkaus, or maternity package[1]. These maternity packages...
Anecdotally, in my region, I see a LOT of pregnant women who have access to care, but choose not to utilize it. Maybe this is due to lingering distrust from COVID, trending stuff on social media, or cost. A majority of my area are government insurance, so copays are likely not the reason, but maybe unable to take time off or transportation issues.
The funny thing is, Finland had this problem back in the early 20th century, and solved this problem with, among other things, the äitiyspakkaus, or maternity package[1].
The history of the Finnish maternity package begins at a time when Finnish maternal-infant mortality rates were remarkably elevated, even for the time period, with deaths being attributed to issues such as starvation, infection, poor sanitation, exposure to the harsh climate, and poverty.
These maternity packages started out as a volounteer thing shortly after we became independent, but by 1949 became legislated and tied to a requirement to actually visit a physician. This requirement stills stands to this day in an amended form.
in 1949 parliament approved the amended maternity grant in which 1) the maternity grant became a universal benefit to anyone living in Finland, or those working on Finnish ships (whether citizens or asylum seekers) regardless of income and 2) an expectant mother must have a check-up and receive advice at a doctor, midwife, or municipal healthcare center appointment before receiving the maternity grant.
Its silly to say, but the US could look at what Finland did a hundred years ago, and take some ideas.
Very interesting. I have multiple thoughts on this. Firstly, we have a similar thing here with regards to health insurance, since this is a string tied to literally everything in USA life....
These maternity packages
Very interesting. I have multiple thoughts on this.
Firstly, we have a similar thing here with regards to health insurance, since this is a string tied to literally everything in USA life. Government insurance has multiple different aspects and levels, each with qualifiers, usually income requirements. In my region, a pregnant woman is qualified for the highest level of insurance, regardless of multiple other factors. No requirement to see a doctor, though, to get the insurance. On top of that, there are multiple multi-sex homeless shelters, one woman's shelter, and one family/pregnant woman shelter in my area. The family/pregnant shelter is far nicer than the rest, because of more money, more security, which has bred a "nicer" clientele over the years. The anecdote revolving around this is that I know a woman who is perpetually pregnant to continue to live in the nice homeless shelter and receive the insurance. She's ~G12P10 or something. She does forfeit her children shortly after birth to CPS. While it shouldn't prevent utilization for others, I can see people like her gaming that system. I like that the modern box has supplies, though!
Next, the structure of reimbursement for OBGYNs on government insurance in my area is also very tricky. The OBGYNs are paid a single lump sum for prenatal and perinatal care, each paid out by the event of childbirth. If the woman gives birth at home or in the ambulance on the way in? No pay for any care. Now, the government is reviewing records from 5-10 years ago and clawing back the lump sum payment for women who didn't receive prenatal care. This is obviously causing many of the practices to shut down and go broke, because it equates to millions of dollars.
That sounds mindboggingly complicated! Here, no one needs any insurance. You’re just covered, full stop. No matter if you’re a billionaire or a homeless person, you give birth in the same...
That sounds mindboggingly complicated!
Here, no one needs any insurance. You’re just covered, full stop. No matter if you’re a billionaire or a homeless person, you give birth in the same hospital.
Maybe there’s some ultra secret and special clinic for very rich? But I’ve not heard of any.
OBGYNs here who deal with pregnancies work for the local health area (SOTE), and get paid a salary. The SOTE area receive funding from the state and municipal taxes. That money goes into two buckets, for preventative health care, and ICU/Specialist care.
Patients pay nothing at all for pregnancy related care visits, for normal care there’s an administrative fee for visiting a doctor or emergency room (like 20? Eur). However there’s a max cap on the annual amount of 600 - and even this is paid for by social services if you can’t. Same deal with prescriptions.
Parking at most hospitals is free or quite cheap. Those I’ve been to even have level 2 Ev chargers.
Sounds like a dream. Our system is mindbogglingly complicated indeed. It's intentionally that way to maximize insurance and corporate profits and the expense of the poor, although maybe not...
Sounds like a dream. Our system is mindbogglingly complicated indeed. It's intentionally that way to maximize insurance and corporate profits and the expense of the poor, although maybe not intentionally at their expense.
We technically don't have different clinics or hospitals for poor or rich, but it's functionally that way because the "rich clinics" won't take the government insurance (read: poor insurance). Same with hospitals. Parking costs $5/day or more. I've seen 2 EV chargers at my hospitals (I have worked at 8 locally), and those 2 were doctor-only parking. And then ER visits are ~$500 for walking in the door.
No dice, unfortunately. I tried a few others as well, like LibraryGenesis to no avail. Maybe because this was released yesterday, it will show up in time.
No dice, unfortunately. I tried a few others as well, like LibraryGenesis to no avail. Maybe because this was released yesterday, it will show up in time.
All of the above. We have a medical care system that favored the wealthy. You have to have money to have any hope of getting care, and it not putting you into a lifelong debt. It's absolutely...
All of the above.
We have a medical care system that favored the wealthy. You have to have money to have any hope of getting care, and it not putting you into a lifelong debt. It's absolutely disgusting.
Millions of people (myself included) do not get the medical care needed, simply because we don't want to go broke doing it. What's the point of being healthy if all your money goes to some insurance company or clinic?
There is, and always has been, a problem with systemic racism in this country. It's been shown, and proven, time and time again. It's a very odd thing that 13% of the population make up almost 60% of our prison population, and are also disproportionally poor, hungry, and uneducated. It stems from that systemic racism.
We have actual food deserts in this country, in the middle of cities, where folks best options are corner stores that MIGHT have fresh meat, produce, and dairy. And if they do, it's going to be at a cost that's higher than it normally would be, and likely poor quality. The other options are high in fat/sugar, empty calories, processed foods.
This country has also dismantled it's mental health care since the 70s. There is carry little government subsidized programs that aren't a requirement of some criminal conviction for drug use. Which, drug use in of itself should never be a criminal conviction. But it's the number one charge of the incarcerated in America.
The truth is, the countries politics and leaders do not give a shit about it, because none of that changes.
The "Richest country" is only the richest when you lump in the top wealthy with the rest of us. Remove that top 1-2%, and that median "Wealth" drops dramatically.
And it's all because we vote against our own interests, for the most part. Because our politicians are really good at saying, "Oh, it's not the systems.... It's the poeple taking advantage of those systems that are the problem" while making laws that enrich the already wealthy, and keep the poor poor.
There is no middle class anymore.
All of these lead to mortality rates continuing to grow, unless you have the money to pay your health care provider, go to the dentist, going to your therapist, etc......
The cast majority of us do not have that luxury. So we just die
US based non-white and former medical tech here. There are a lot of failure points in the US healthcare system from the top-down. If you live near a major city or a well developed area, you may...
US based non-white and former medical tech here. There are a lot of failure points in the US healthcare system from the top-down.
If you live near a major city or a well developed area, you may take for granted the programs and quality of healthcare around you. It's shameful to realize that it's not like that for much of the US. If you aren't located in an at minimum "middle-class" area, most likely there isn't enough wealth in your local economy to fund many of the social programs that seek to support and educate women and their families regarding this.
The system favors the wealthy and disparages those who aren't. Many don't get the care they need because they simply can't afford it even if it is at greater risk to their life. And even if you do have insurance, it's sadly not uncommon to worry incessantly/have to fight them to ensure coverage while undergoing medical treatment.
When the article mentions systemic racism, is this hyperbole or is there some merit to the claim?
As someone who has worked in both hospital and private clinic settings, all it takes is one "racist, sexist, etc." healthcare professional to write a patient as being "difficult" in their chart and that is going to be the first impression for many healthcare workers before they even meet the patient. Systemic racism has always been a problem in this country and ethnic bias doesn't get better in a primarily white dominated field. Many minorities have historically been suspicious of seeking medical treatment and I honestly can't blame them. A doctor is a doctor no matter the color until you receive poor treatment just one time.
I've been keeping a close eye on these articles about maternity deaths - a subset of this is also that black women have a higher rate of maternal deaths. As a black woman, it's very troubling to...
I've been keeping a close eye on these articles about maternity deaths - a subset of this is also that black women have a higher rate of maternal deaths. As a black woman, it's very troubling to see the overall rise. A lot of it is health care access and the state of our health system. Another aspect of it for black women is being heard.
It was very eye-opening for me to read that Serena Williams almost died with her daughter because she was not being listened to; she had to advocate for herself. Even as a black educated woman with access to healthcare, you are still not being heard - and that to me ties to systemic racism.
The way medical staff operate and how you get a range of care for a multitude of reasons is something I can attest to as well. Part of the reason is burnout. Hospitals need funding and that means...
The way medical staff operate and how you get a range of care for a multitude of reasons is something I can attest to as well. Part of the reason is burnout. Hospitals need funding and that means kissing ass and cutting corners. There used to be many positions below the doctor to handle all sorts of tasks, but now that's been absorbed by nurses who do too much and get paid too little. Doctors aren't safe either as they came from a toxic residency where you cut your teeth on how long you can work without sleep like it's some badge of honor. The hyper competitive nature of their positions coupled with the immense stress during residencies lead to a lot of arrogance and narcissism as the ones who made it through naturally feel they're above all others who didn't suffer like they did.
The whole thing is damaged from the top down. To get care in this country is to watch a comedy. The most common way to get health insurance is to go through an employer for some reason, followed by paying for it out of pocket if you're wealthy enough, followed by jumping through various hoops and bureaucratic nonsense to get medicaid / medicare. It's nice once you get it, but maintaining it isn't easy either.
Then you have to find stuff in network which is another exercise in hilarity. Then you hope your medicine is covered as insurance companies will fight tooth and nail to not cover things they (not healthcare professionals) deem not necessary.
This is all without even bringing up the warranted general mistrust the black community has against the healthcare industry and then the often times aggressive and dismissive attitudes these burnt out healthcare workers have. I can't think of any other way to stack the deck harder against lower socio-economic class citizens. Not to mention a lot of political bias then starts to leek through as the healthcare worker starts to blame their burnout on the wrong thing. Instead of pointing the finger at the very institution that treats them like free labor while the board of directors of their "non-profit" ride around new BMWs and take lavish vacations, they point it at the influx of people flooding the ER and at all the new pregnancies for the reason why they're burnt out. Then the micro-aggressions come out, religious beliefs, political beliefs and so forth.
But why do people allow this to happen? Watching the US from outside, it appears the poorest 50% of the country are all just accepting that the politicians slowly but steadily lower their life...
But why do people allow this to happen? Watching the US from outside, it appears the poorest 50% of the country are all just accepting that the politicians slowly but steadily lower their life standard?
I'd love others to chime in, here, but from what I see... Those of a lower socioeconomic status are frequently exhausted by just existing and they feel they cannot change the politics that impact...
I'd love others to chime in, here, but from what I see... Those of a lower socioeconomic status are frequently exhausted by just existing and they feel they cannot change the politics that impact them. It's a big system and one that they have little power over. They just stop focusing on politics at all because it feels hopeless.
I can only speak on my personal experiences but as someone in the middle class living in a southern state in the U.S., my spouse and I feel hopeless when it comes to many things, like voting for...
I can only speak on my personal experiences but as someone in the middle class living in a southern state in the U.S., my spouse and I feel hopeless when it comes to many things, like voting for example. Our area is predominantly conservative, with many who identify as "right wing". The way the lines are drawn here, our non-conservative vote literally doesn't count. With inflation and property tax hikes, we feel like we're being priced out of our lives. We're a biracial married couple and many people in this community believe that our marriage is wrong. We both work in hospitality so we're often viewed as "the help" despite my spouse having a culinary arts degree and lots of experience. I'm not complaining, just wanting to express a few of the pressures we deal with. And yes, along with everything else that's weighing on us, these issues combine to create apathy, hopelessness and exhaustion. We feel like specks of dirt in a giant cog. Maybe we'd feel differently if we didn't live where we do but moving isn't feasible. I really do feel like we have no voice in this community.
Thanks for a very interesting reply! I'm sorry to hear what you and your partner go through, and it's insane that some people still hold those opinions. It's easy to understand how that whole...
Thanks for a very interesting reply! I'm sorry to hear what you and your partner go through, and it's insane that some people still hold those opinions. It's easy to understand how that whole situation can create apathy, yeah.
How do you think the voting system could be changed so that your vote would count, too? More representatives per county, each party getting representatives according to the election results?
Thank you. It's hard to answer that because the area I live in is growing but still somewhat rural, so there's a fair amount of people who wish to keep things the way they've always been. There's...
Thank you. It's hard to answer that because the area I live in is growing but still somewhat rural, so there's a fair amount of people who wish to keep things the way they've always been. There's also a strong "brotherhood" presence here, too. I really feel like the only remedy is eliminating gerrymandering altogether. Not really counting on that happening though.
Some of them vote against their own interests because those politicians also promise them an end to abortion, gay marriage, and other social issues fueled by religion. Others are apathetic and too...
Some of them vote against their own interests because those politicians also promise them an end to abortion, gay marriage, and other social issues fueled by religion. Others are apathetic and too beaten down by the system to have much interest and vote the way their peers/family/favorite media tell them to. Some poor folks genuinely believe we need to enact policies to benefit the rich because they see themselves being one of those rich people someday. In other cases, it's racism: "I don't want to pay taxes that will fund programs benefitting 'welfare queens' and lazy people in the cities, they should work hard like I do."
I wasn't born in the US but have lived here for about 20 years now. There's a lot of things, but one of the biggest things I've noticed is that it's very easy for the politician and the wealthy to...
I wasn't born in the US but have lived here for about 20 years now. There's a lot of things, but one of the biggest things I've noticed is that it's very easy for the politician and the wealthy to create divisions among us. Instead of all of us banding together and working to make improvements, we are intentionally divided even within those poorest 50% by race, religion, ideology, etc.
An example was the recent Affirmative action with Schools that was repealed by the Supreme Court, I just found it sadly ironic that the face of that lawsuit was a minority - an Asian American, supported by a White Conservative group. It's ironic also because a good percentage of people who get into these elite schools are legacy white students.
It's easy to create division among your poor to keep them distracted and encourage the selfish mindset each group has.
This right here is an interesting question that doesn't lead to where you think it does. At first glance, this question assigns blame to the people and implies that, should the people vote and be...
This right here is an interesting question that doesn't lead to where you think it does. At first glance, this question assigns blame to the people and implies that, should the people vote and be engaged, these issues would be rectified. The question also implies good faith response from the politicians that would just do as their constituents ask in a 1:1 ratio.
We all see laws being passed that favor corporations over people. We all see social programs constantly being shut down by the SCOTUS and being "checked and balanced" by congress. What we're seeing is our hopes and dreams, our solutions, being shot down left and right for reasons we don't understand, yet if you have enough money to buy a senator, or to lobby for corporate interests, or say "God" enough times there's a good chance your "solution" will go through congress without issue.
Losing faith in the system benefits one party and losing faith is a design choice by said party. It's effective. Making it difficult to get engaged in politics also benefits one party that has a lot of quiet, peace, and time to be engaged in local politics. Understanding the rigged rules of gerrymandering and circuit courts also benefits one party, the other party has voters that have failed education and can't ever hope to understand what a court does, much less what judge shopping is.
I guess to summarize, the reason why people "allow this to happen" is because the US political system is busted from the top down. Whether people vote or not, the country is controlled by special interests, there's money and bias in government, and it's going in the same direction and has been for a while: it benefits and works for the rich and fails the poor. The illusion is that somehow engaging and voting in the system is going to magically change everything. By not voting we're speeding things up to an absolute dystopia, by voting we offer up resistance. If all of us voted we may have gotten somewhere half a century ago, but education and voting rights didn't even come about until recently.
This country is for the white, the wealthy, and the religious. If you're not any of those things you can come here to make them money and maybe have a life, but don't expect much else.
As a non-white childfree woman in the south, this is a tough topic because it's hard to speak without getting emotional. I think in the recent past, systemic racism played a part in the healthcare...
As a non-white childfree woman in the south, this is a tough topic because it's hard to speak without getting emotional. I think in the recent past, systemic racism played a part in the healthcare disparity but lately it feels like there's been a shift and now it just feels like a war on the uterus, no matter what your race/ethnicity. Lack of abortion access for many now means more people are facing pregnancies they didn't plan and that's having a very negative impact on their mental health at minimum. In addition, I feel as though the article overlooks the judgements and shame that occurrs in these situations. For example, where I live, it's not unusual for a young woman to go to a facility that says they offer assistance but instead hands you religious material and shames you for your choices. If someone were feeling ashamed in any way over their pregnancy, which is quite common, they'll likely avoid places that they fear will just denigrate them. Even when these places offer financial assistance, for some people, the negativity and disdain isn't worth the help. It's not like this everywhere but it definitely happens in some areas.
The mental health damage a broken Healthcare system has on people is a toll that feeds back into the system to harm the individual elsewhere down the line. It doesn't help that mental health is...
The mental health damage a broken Healthcare system has on people is a toll that feeds back into the system to harm the individual elsewhere down the line. It doesn't help that mental health is considered a psuedo science in many circles and not a real medical field in others. Even among Healthcare professionals, they'd rather invest time and money on research rooted in materialism rather than acknowledge that some things can't be reached with chemicals. Some things are an issue of points of view, reasoning, purpose, community and so forth.
The lack of a robust mental health system contributes to pain and suffering on both sides of this conversation and continues the vicious cycle. The patient suffers multiple times.
I was just arguing with someone else on this very same issue and they asked for sources to backup the claim that mental health is in a terrible state and we're in a mental health crisis in this country.
Just wild stuff. They couldn't believe many of us are clinically depressed and anxious and most of us should be in therapy.
I applaud your bravery in having that discussion. I don't think I would've been able to do it! I especially agree with your statement that a broken MH system can further harm an individual. People...
I applaud your bravery in having that discussion. I don't think I would've been able to do it! I especially agree with your statement that a broken MH system can further harm an individual. People seeking care are at a very vulnerable point in their lives and having someone who was meant to help them cause harm instead can be pretty traumatizing. I've had MH professionals say some pretty unprofessional things to me. I've also seen what people go through who are forced to experience county or state funded mental wards and that is a package of trauma all by itself. This is why I'm a big supporter of mental health care reform. I'm especially focused on improved mental health care for minority women.
To say nothing of places that are downright evil: they try to be all kind and supportive and be your friend and promise all kinds of resources, and then once you're far enough along that it's...
To say nothing of places that are downright evil: they try to be all kind and supportive and be your friend and promise all kinds of resources, and then once you're far enough along that it's illegal to abort they show their true colours and turn their backs on you. I tried to volunteer at one and they told me unless I come down hard on the prolife side I can't volunteer there.
Apparently there are equivalent on the other side too; once you decide not to abort they don't have anything else for you and if you're not staunchly pro choice you can't volunteer there. I don't live in America so I haven't personally encountered these - as far as I know planned parenthood provides all kinds of good things for every stage of family planning or planning for no family. But I heard etcetc.
No doubt each are trying to protect women and/or baby from harm from the other side. but that's so sad that we can't just agree on loving the woman in a time of need and support her choice even if we can't find it in ourselves to celebrate her choice.
There are good places that will support a woman no matter which way they end up choosing, and recognize that there is potential for sadness and hurt and injuries and regret no matter what happens. I hope they become the main expectations one day and everyone has quality support no matter what they choose and where they live
I'm not sure if the trend is continuing post COVID, but the US maternal death rate has been increasing while in California it has been decreasing. It's just that other states don't care enough to...
I'm not sure if the trend is continuing post COVID, but the US maternal death rate has been increasing while in California it has been decreasing. It's just that other states don't care enough to adopt policies that have been proven to work. They're fine with these people dying every year.
Well the poor can't fund anything and they won't do anything so if they die who cares? Can't even protest without permits and in safe spaces. We've been neutered in this country and didn't even...
Well the poor can't fund anything and they won't do anything so if they die who cares? Can't even protest without permits and in safe spaces.
We've been neutered in this country and didn't even know it. The entire US political machine will have a fit if one person breaks a glass window in protest, but France has no problem burning it all down.
I really do believe the only thing left for us to do is, well, take a note or two from France, but that would mean a lot of people who are already tight with bills and family will suffer and that's a hard thing to ask of them. Many don't want to have their already fragile lives be upset anymore. Many are afraid to make it all burn and rightfully so. Many are afraid of what the police will do and they should be.
That's how we're kept docile. Essentially it's "we're going to use and abuse you and if you even think of fighting back we're going to squash you".
It's a sad article, but very telling regardless. The root causes for this can be debated, but the bottom line is most of these deaths could have been prevented.
For anyone not in the US reading this, I posted this article to add to the pile for visibility's sake to draw attention. To some of you, this may be shocking as your own countries don't have these issues on this scale and the age old observation of an apparent Paradox, "the US is the wealthiest nation on earth, why is this happening?" may nag at you.
I assure you, it nags at us too. To some of us, the solutions are apparent: make healthcare more readily available, fund the mental health system, fund education, revamp the strategy to handle drug abuse (currently it's to lock them up) and other common sense items.
We are met with opposition at the very mention of these solutions. The opposition doesn't provide solutions, they just stonewall progress with seldom a reason at best and at worst with contrived reasons that tie in taxes, the economy, equity, and sometimes even religion. And they get their way.
I'd like to invite conversation on what this article talks about.
Is it as simple as lack of social programs? Is it our medical industry as a whole?
When the article mentions systemic racism, is this hyperbole or is there some merit to the claim?
If you're foreign to the US, I welcome your opinion. If you're a citizen, I welcome all opinions and hope we can have a more neutral and civilized discussion. It would be a nice change of pace having come from Reddit at its lowest.
Here are my takes as a German:
Both, really, as well as some other coinciding factors: Healthcare access and quality being wealth dependent, combined with barely any social security systems naturally mean that poor people will have worse health statistics.
Whatever ethnicities make up that economic strata will hence suffer the most from the economic downturns the US has experienced the last 20 years.
Childbirth is among the most dangerous experiences a person can have. It absolutely shocked me when I first learnt how common births at home are in the US. It's almost unthinkable here. If anything goes wrong (which can happen very quickly), I'd want mother and child to be as close to intensive care as possible.
Couple that with shoddy sex education and criminalisation of abortions, and you are raising the chances even more (poor people often receive worse education in general, so they know even less about contraception, and sex is fun and you can do it for free => even more pregnancies, many of them unwanted/unplanned, potentially making a family poor)
Add to all that the lack of proper parental leave, or medical leave in general, mix it with the lack of social security already mentioned, and you have fresh parents being forced to work way to soon, putting them under even more financial and emotional stress (as if new parents aren't stressed enough as it is), potentially having to forgo even more necessary healthcare because they simply can't afford it, either directly monetarily or because they can't take the time off at work.
With all those factors (and many more that I missed or was to lazy to mention) it's little wonder you have child mortality rates I'd expect to see in 3rd world countries.
I have many criticism for the general concept of systemic racism and what is often considered to be it, but in this case I simply think you don't need that assumption. There are disproportionately many poor POC overall, so they as a group are more affected by situations that affect poor people in general.
Potential solutions could be as "simple" (conceptionally, not politically) as ensuring everybody has free and easy access to healthcare, a robust social security system that makes it possible to break out of the poverty spiral, decoupling school funding from property taxes (thus preventing education quality being overly tied to ones economic situation), and better sex education combined with better access to contraception across the board.
For a last bit of irony, implementing those changes would not just cost less, but make both the government and businesses more money. Healthy people are productive people.
Which to me means this is not a problem of Late Stage CapitalismTM , as one can read so often on the internet nowadays, but an ideological stance of "the poor do not deserve help!"
On the subject of systemic racism. There is a large portion of the black population that do not trust doctors or the Healthcare system because doctors and other providers do not listen to them about their issues and provide substandard care.
Another large portion of distrust comes from the horrendous acts done to black people in the medical field. Namely the "Tuskegee Study of Untreated Syphilis in the Negro Male" A.K.A. the Tuskegee experiment. They continued to not treat these men for Syphilis for 25 years AFTER penicillin had become widely available and was the accepted as the standard treatment for the disease. Actively denying the United States Army from treating men from the study who were drafted. There was no education on STD's given to the men in the study leading to 40 of their wives contracting Syphilis and 19 children being infected by birth.
There was a class action lawsuit which was settled out of court for $10 million...in 1974 two years after the study ended.
In essence the medical community in America has been fucking BRUTAL towards any non-white community and it is a systemic problem that is present in every medical discipline and was instilled in the system at its inception. This, imo, rightfully has caused distrust in the medical community for a large portion of non-white peoples and unfortunately that leads to them not seeking care and in this case pre/post natal care.
We're definitely in agreement that this is a bad thing in the US, but it's worth noting that abortion after 12 weeks is also illegal in Germany and is still punishable with prison time. Abortion prior to 12 weeks requires a doctor to sign off that you received counseling at least three days prior to the procedure. Up until 2019 it was illegal for doctors to advertise that they provided abortions (such as listing it on their websites) and until last year they were banned from giving medical detail (such as whether they offered medical or surgical abortion or if they only offered abortion prior to a certain number of weeks). German health insurance (public or private ime) also doesn't cover contraceptives for adults.
On the whole, my healthcare in Germany is MILES better than it was in the US and costs me way less. I'm staying here and not moving back to the US for a huge number of reasons, that included. But in terms of abortion and contraception, German law is more restrictive than the red state I grew up in (though they are currently in court trying to make the law worse back in my home state so who knows for how long).
Another good example of systemic racism in the USA, perhaps one of the simplist and most profound, is housing discrimination.
Redlining was fully legal in the USA until 1962, 1968 for private banks. Redlining is explicitly discriminating against minority neighborhoods. So white families had easy access to mortgages when minorities didn't. The typical mortgage in the USA is a 30 year, so that's less than 2 generations of home ownership removed from explicitly being allowed to deny brown people loans.
Considering that home ownership is the almost-exclusive method of wealthbuilding for the majority of the population, that is a one huge lingering burden on why minorities are so disproportionately poor in the USA. We'd need a 100+ years of minority-favoring policy to tilt those scales back, even if all the actual racist laws are gone. Right now, anything financially rewarding homeowners is disproportionally rewarding white people. And that is an example of how colorblind law still has systemic racism.
Seems as though its a flaw we're not able to address with our economic system, where those who are behind can never actually catch up, and American history was significantly about putting black people and native americans behind everyone else.
There is a solution, it's called 'reparations.' But that word can make otherwise reasonable white moderates froth at the mouth.
And broadly, just eliminating most incentives that benefit from ownership and reducing wealth inequality will help. Bringing back 90%+ taxes on high earners and adding wealth taxes would be a good start.
I love the idea of reparations, but the practicality of it is far more complex than reality would allow for. For that reason, I feel it is not the prudent course of action. A far more realistic way to accomplish this would be to raise up all the poor, regardless of ancestry, such that there is only bickering coming from the wealthy whom are being taxed at a higher rate. The concept of a Universal Basic Income has long been my favored method by which to accomplish this. Of course, any system by which we amend our economic inequality needs to be paid for by those who have benefited the most-- the wealthy.
I think that's more the excuse, rather than the reason, even if it is still an aspect of it. Universal healthcare is a popular idea in the US, with more than 50% of the population supporting it. In spite of that though, neither party is making any serious effort to implement it. US politicians are dependent on corporate money to get elected for the most part, so looking at the corporate interests can be illuminating.
First, there are the companies directly profiting off the current system. They definitely don't want things to change, and will lobby hard to keep it that way. Then there are the companies that don't give healthcare benefits to most of their employees. A universal healthcare system would almost surely increase the taxes they pay, so they're going to be against it too. Finally, there are the companies that do provide healthcare to their workers. This is generally done as an incentive to get and keep talent. If that incentive is gone though, they'll probably have to pay for some other incentive, so it's debatable whether they'd save any money at all.
I think it's good to talk about some of the intangible benefits corporations gain from the current system too. Setting up an employee healthcare system is an additional hurdle for new companies, benefitting existing ones and reducing future competition. The other big thing is it increases worker precarity. Healthcare is a demanding need; quite a lot of treatments can't wait, and recurring costs are common. Putting workers in a position where they lose medical treatment if they stop working, whether directly through employer insurance or by losing the means to pay for their own insurance, increases the leverage companies have in negotiations.
So overall, it's a system where companies generally don't want universal healthcare, and some relying on the lack for their business model. Politicians don't want it, because they need that corporate money to get elected. "The poor do not deserve help", often with rascist dog whistling about exactly which poor people they're talking about, is how the politicians sell it to the people.
"but an ideological stance of 'the poor do not deserve help!' "
Which we have a lot of that here too. very much pull yourself up by your bootstraps kinda thing. But yes, especially amongst the republicans there is the attitude that if you are poor you must have done something to deserve it. And therefore why should we pay for your shortcomings? I see it from my republican parents all the time (and they'll complain when they can't get help because of all the stuff their politicians put in place to prevent it and complain that "honest working people" can't get help and those freeloaders keep abusing welfare. There is very much this fear that if they help others through government only freeloading lazy people will profit and it will just get abused).
US doctor here, not OBGYN but tangentially related.
Tried to access the underlying article that was actually published instead of a journalist's interpretation, but anything beyond the abstract is behind a large paywall. Classic JAMA.
You discuss access to healthcare, and I agree completely. What I wanted to see was if this increase was related to decreased access to medical care, or if those with access to adequate health care also had an increase in MMR.
Anecdotally, in my region, I see a LOT of pregnant women who have access to care, but choose not to utilize it. Maybe this is due to lingering distrust from COVID, trending stuff on social media, or cost. A majority of my area are government insurance, so copays are likely not the reason, but maybe unable to take time off or transportation issues.
I think another thing to consider is the opaqueness of the systems that people need to use in order to even access information about these services, let alone apply for them. Some of them don't have an internet presence; some of them ONLY have an internet presence. If you're in a socioeconomic situation where you don't have time to take off work to go find services (which you mentioned), or if you don't have access to the internet, those services become unavailable very quickly. Knowing where to look and how to find services is a skill that not everyone acquires.
Absolutely correct. We have a full time position dedicated to helping patients navigate this. Even that's not enough, sometimes. It's unfortunate that the "it's
extensiveexpensive to be poor" adage rings true again.Lack of access to prenatal care is a factor to consider, especially if you live in more rural areas or those lacking public transportation. Add in a lack of ability to take off time from work and funds to pay for these Healthcare services, and it results in medical concerns not being addressed until time of birth. There can also be underlying health conditions that affect birth outcomes because the same individuals who cannot seek prenatal care most likely can't access regular Healthcare either.
The Maternal Mortality rate is a big enough concern that the Department of Health actually has it as a topic to address for their Healthy People 2030 Goals. So the US government is aware, but unfortunately many of their ratings for the most concerning items are "getting worse."
We also can't ignore the fact that restricting abortion access also is a factor at play in mortality rates. The Common Wealth Fundhas found:
Even more disturbing:
Those who are more economically inclined to seek abortion most likely have overlaps with those who lack funds or access to prenatal care.
True, but the data in the original article only deals with data up to 2019. So while this increase is large, it's not even accounting for the restriction on abortion, which I agree will push it higher.
Thanks for calling that specific out! My bad for not using clearer language to note that statistic. I've gone back and edited my comment to help call that out :)
This is also a point I want to hone in on. Choosing not to utilize it is a factor and it's there for a multitude of reasons. They distrust the government, so if you tell them the government is providing aid they'll look at it funny and ask "what's the catch?" The mistrust of the government is its own topic as they get fed propaganda too and a lot of conservative, conspiracy theory bullshit, flows downhill and ends up in their phones anyway. Not to mention information on previous years of actual government directed racism treating the black community as lab rats. Distrust in the government is warranted. Many in the black community would like things to change and they tend to vote for the party that promises socio-economic reform, but the current state of those social programs mean less educated citizens and less educated voters. Lack of education means lack of critical thinking which is already in short supply across the country.
I posted elsewhere about the distrust the black community has in healthcare professionals as well. The burnt out healthcare worker wrongfully blames their burnout on the influx of patients to the ER or NICU rather then the for profit, non profit, business modal controlled by insurance companies and pharmaceutical companies. The nurse role is a catchall for what used to be compartmentalized roles and medschool + residencies both doctors and nurses go through is outdated, toxic, and breeds arrogance and narcissism not to mention frustration and anger which then gets taken out on the already ignorant patient walking through their doors.
It shouldn't be like this. These deaths are unavoidable and a lot of hurt feelings on either side are also avoidable and stem to political causes. It's sad all around.
Your other points on transportation and time off are true as well. The glorification of "the grind" and "the hustle" and a "side hustle" are symptoms of profit at all costs capitalism feeding us kool-aid to make the medicine go down. There's people with serious and alarming conditions that will not take off of work out of fear of being fired. Transportation is always an issue as well, but that rounds out three departments that are failing in this country: the DOH, the DOT, and the DOE.
DOD is fine though. DOA is also fine as an industry but the food in this country is broken and unequal. It's quite an exercise to eat healthy in this country without paying large amounts.
Very well said. I especially like how you bring up the burnout and cynicism that residency and medical school breed. I went to a very good school and residency with very little toxicity. But I'm still burnt out and cynical.
I feel this so much. I'm white. I specialize in limited access, underprivileged, inner city population. Overcoming this is a massive hurdle for me, and I occasionally am completely unable to.
Do Americans have access to midwife services?
In Canada there is a (mostly, depends on the province) regulated body of midwives, and people can choose to either utilize (no cost) a doctor or a midwife for their pregnancy/birth. People of course choose midwives for a variety of reasons but I think they also capture the 'lingering distrust' crowd fairly well, I don't think there are many births that happen outside these two bodies.
We do have a very robust midwife service. It varies based on state, but every state has done component of this. The difference is whether or not they are overseen by an actual doctor.
We're delving into a personal and professional bias here. Search "mid-level encroachment" and you'll find a lot of discussion. I've been personally impacted by poor mid-level management. I'm going to try to keep my bias out, though.
With regards to cost, regardless of whether or not the midwife is being overseen by a doctor, usually the "cost" (what is billed to insurance) is the exact same as if they were seen by a doctor. Might be different actual billing if self-pay, but usually those in the situation that this would pertain don't have the knowledge of the system to pursue this avenue. But there is no such thing as no cost.
Interesting, thanks.
What I was trying to say, (in a not very clear fashion), was that families in Canada don't have to pay for midwives, they are paid for by the government in the same manner as a doctor overseeing a pregnancy is. So there is no cost barrier in using either service.
Re-reading your comment now, you did say doctors or midwife at no cost, and I read that as doctor at cost or midwife for no cost. So cost wise, there's no difference between the two? If so, it's similar here.
Although, anecdotally, I fought tooth and nail for a doctor to be involved instead of a midwife, to no avail. I've heard that to be the case in several areas.
Correct.
For an individual patient or generally? From what I understand, here there is a pretty good integration of midwifery into the medical system, and they'll refer you to a physician as required. We used a doctor for our kids and the experience was great, well as great as it can be anyways. Doctors are definitely more my speed than midwives, but I could see how midwives could be helpful for people with low trust in the medical system.
More personal details than I was wanting to discuss, but I'll give specifics. My wife was pregnant, we saw an OB clinic within our hospital. Midwives throughout, which I didn't mind because it was uncomplicated. Then mid third trimester, a small complication came up. They brushed it and my concerns away multiple times. I eventually requested to have a doctor involved, and they "spoke with the doctor" who refused to see us. I ended up having to call in a professional favor to get a doctor involved, and that finally got things moving. I was frustrated it took so long, but in the end it was the right thing to do because we got it addressed and the birth went relatively smoothly.
I'd say 'it depends,' rather than declaring universally robust. In PA, midwives were the exception, not the rule. There's some good laws there (midwives must be RN's), but you're not likely to be referred to a midwife by your doctor. There were less than 5 midwife practices serving the Philadelphia region when we were pregnant < 10 years ago, and some couples coming in from closer to Baltimore.
The default birth option in the USA is C-section. That's not to say natural birth isn't tried first, but many in-hospital births do things that make things miserable for mom (no eating during labor) in service of making a future C-section easier. Making the C section easier is a higher priority than having a safe, easy natural childbirth.
A lot of people write off C sections as no big deal, but they are major abdominal surguries. I would be shocked if maternal mortality rates and c-section rates were not almost directly proportional.
I am prone to hyperbole, yes. I've been heavily involved in healthcare for 10 years in 3 different states, and midwives are quite prevalent in my experience. But that's only 3/50th of the US, and lower income clinics, so my perspective is obviously skewed.
Preach. I've heard many friends say they want to do C-section because it's easier. I've also seen lots of botched elective C-sections who wish they had not gone that route. It's not a decision to be taken lightly.
Australia and the US have almost identical rates of c sections (32%) but vastly different maternal mortality. 5 per 100,000 live births in australia vs 33 per 100,000 in the US.
I don’t think you’re totally wrong - the cascade of interventions leading to c section and the environments of labour that you talked about is almost certainly part of the picture, and I think there is strong evidence that midwife-led births lead to better outcomes (which is probably down to fewer interventions and more focus on natural birthing positions), but this seems to be a multi-factorial issue and probably requires an overhaul of the whole system.
I was specifically referring to US, sorry if I was unclear.
But yes, American healthcare is so utterly broken. Nobody likes it, but its like this weird prisoners dillema that everyone is worried it'll end up worse somehow.
Oh yes I understood, I was just using australia as a comparison to show that the c section rate can’t be the whole picture, otherwise you would see similar MMR here.
I think that’s true of a lot of government systems and even the system of government itself! It’s hard to change things, a lot of people prefer the devil they know to the one they don’t. But when we reach a point where significant harm is being done, it’s time to try!
This reminds me of the absurd noise levels found in a typical hospital room. You have people recovering from major medical events like birth and serious surgeries. Sleep is an essential component of health and recovery. But then the whole environment is built with zero consideration for sleep. Lots of monitors constantly beeping. Things are designed for the staff to do their job with the least amount of labor possible, rather than the quality of recovery possible.
The funny thing is, Finland had this problem back in the early 20th century, and solved this problem with, among other things, the äitiyspakkaus, or maternity package[1].
These maternity packages started out as a volounteer thing shortly after we became independent, but by 1949 became legislated and tied to a requirement to actually visit a physician. This requirement stills stands to this day in an amended form.
Its silly to say, but the US could look at what Finland did a hundred years ago, and take some ideas.
[1]https://en.wikipedia.org/wiki/Maternity_package#History
Very interesting. I have multiple thoughts on this.
Firstly, we have a similar thing here with regards to health insurance, since this is a string tied to literally everything in USA life. Government insurance has multiple different aspects and levels, each with qualifiers, usually income requirements. In my region, a pregnant woman is qualified for the highest level of insurance, regardless of multiple other factors. No requirement to see a doctor, though, to get the insurance. On top of that, there are multiple multi-sex homeless shelters, one woman's shelter, and one family/pregnant woman shelter in my area. The family/pregnant shelter is far nicer than the rest, because of more money, more security, which has bred a "nicer" clientele over the years. The anecdote revolving around this is that I know a woman who is perpetually pregnant to continue to live in the nice homeless shelter and receive the insurance. She's ~G12P10 or something. She does forfeit her children shortly after birth to CPS. While it shouldn't prevent utilization for others, I can see people like her gaming that system. I like that the modern box has supplies, though!
Next, the structure of reimbursement for OBGYNs on government insurance in my area is also very tricky. The OBGYNs are paid a single lump sum for prenatal and perinatal care, each paid out by the event of childbirth. If the woman gives birth at home or in the ambulance on the way in? No pay for any care. Now, the government is reviewing records from 5-10 years ago and clawing back the lump sum payment for women who didn't receive prenatal care. This is obviously causing many of the practices to shut down and go broke, because it equates to millions of dollars.
That sounds mindboggingly complicated!
Here, no one needs any insurance. You’re just covered, full stop. No matter if you’re a billionaire or a homeless person, you give birth in the same hospital.
Maybe there’s some ultra secret and special clinic for very rich? But I’ve not heard of any.
OBGYNs here who deal with pregnancies work for the local health area (SOTE), and get paid a salary. The SOTE area receive funding from the state and municipal taxes. That money goes into two buckets, for preventative health care, and ICU/Specialist care.
Patients pay nothing at all for pregnancy related care visits, for normal care there’s an administrative fee for visiting a doctor or emergency room (like 20? Eur). However there’s a max cap on the annual amount of 600 - and even this is paid for by social services if you can’t. Same deal with prescriptions.
Parking at most hospitals is free or quite cheap. Those I’ve been to even have level 2 Ev chargers.
Sounds like a dream. Our system is mindbogglingly complicated indeed. It's intentionally that way to maximize insurance and corporate profits and the expense of the poor, although maybe not intentionally at their expense.
We technically don't have different clinics or hospitals for poor or rich, but it's functionally that way because the "rich clinics" won't take the government insurance (read: poor insurance). Same with hospitals. Parking costs $5/day or more. I've seen 2 EV chargers at my hospitals (I have worked at 8 locally), and those 2 were doctor-only parking. And then ER visits are ~$500 for walking in the door.
Scihub is your friend. Paste in DOI or URL, recieve document. It is very rare for it to not work. I would love to hear your take.
No dice, unfortunately. I tried a few others as well, like LibraryGenesis to no avail. Maybe because this was released yesterday, it will show up in time.
All of the above.
We have a medical care system that favored the wealthy. You have to have money to have any hope of getting care, and it not putting you into a lifelong debt. It's absolutely disgusting.
Millions of people (myself included) do not get the medical care needed, simply because we don't want to go broke doing it. What's the point of being healthy if all your money goes to some insurance company or clinic?
There is, and always has been, a problem with systemic racism in this country. It's been shown, and proven, time and time again. It's a very odd thing that 13% of the population make up almost 60% of our prison population, and are also disproportionally poor, hungry, and uneducated. It stems from that systemic racism.
We have actual food deserts in this country, in the middle of cities, where folks best options are corner stores that MIGHT have fresh meat, produce, and dairy. And if they do, it's going to be at a cost that's higher than it normally would be, and likely poor quality. The other options are high in fat/sugar, empty calories, processed foods.
This country has also dismantled it's mental health care since the 70s. There is carry little government subsidized programs that aren't a requirement of some criminal conviction for drug use. Which, drug use in of itself should never be a criminal conviction. But it's the number one charge of the incarcerated in America.
The truth is, the countries politics and leaders do not give a shit about it, because none of that changes.
The "Richest country" is only the richest when you lump in the top wealthy with the rest of us. Remove that top 1-2%, and that median "Wealth" drops dramatically.
And it's all because we vote against our own interests, for the most part. Because our politicians are really good at saying, "Oh, it's not the systems.... It's the poeple taking advantage of those systems that are the problem" while making laws that enrich the already wealthy, and keep the poor poor.
There is no middle class anymore.
All of these lead to mortality rates continuing to grow, unless you have the money to pay your health care provider, go to the dentist, going to your therapist, etc......
The cast majority of us do not have that luxury. So we just die
US based non-white and former medical tech here. There are a lot of failure points in the US healthcare system from the top-down.
If you live near a major city or a well developed area, you may take for granted the programs and quality of healthcare around you. It's shameful to realize that it's not like that for much of the US. If you aren't located in an at minimum "middle-class" area, most likely there isn't enough wealth in your local economy to fund many of the social programs that seek to support and educate women and their families regarding this.
The system favors the wealthy and disparages those who aren't. Many don't get the care they need because they simply can't afford it even if it is at greater risk to their life. And even if you do have insurance, it's sadly not uncommon to worry incessantly/have to fight them to ensure coverage while undergoing medical treatment.
As someone who has worked in both hospital and private clinic settings, all it takes is one "racist, sexist, etc." healthcare professional to write a patient as being "difficult" in their chart and that is going to be the first impression for many healthcare workers before they even meet the patient. Systemic racism has always been a problem in this country and ethnic bias doesn't get better in a primarily white dominated field. Many minorities have historically been suspicious of seeking medical treatment and I honestly can't blame them. A doctor is a doctor no matter the color until you receive poor treatment just one time.
I've been keeping a close eye on these articles about maternity deaths - a subset of this is also that black women have a higher rate of maternal deaths. As a black woman, it's very troubling to see the overall rise. A lot of it is health care access and the state of our health system. Another aspect of it for black women is being heard.
It was very eye-opening for me to read that Serena Williams almost died with her daughter because she was not being listened to; she had to advocate for herself. Even as a black educated woman with access to healthcare, you are still not being heard - and that to me ties to systemic racism.
The way medical staff operate and how you get a range of care for a multitude of reasons is something I can attest to as well. Part of the reason is burnout. Hospitals need funding and that means kissing ass and cutting corners. There used to be many positions below the doctor to handle all sorts of tasks, but now that's been absorbed by nurses who do too much and get paid too little. Doctors aren't safe either as they came from a toxic residency where you cut your teeth on how long you can work without sleep like it's some badge of honor. The hyper competitive nature of their positions coupled with the immense stress during residencies lead to a lot of arrogance and narcissism as the ones who made it through naturally feel they're above all others who didn't suffer like they did.
The whole thing is damaged from the top down. To get care in this country is to watch a comedy. The most common way to get health insurance is to go through an employer for some reason, followed by paying for it out of pocket if you're wealthy enough, followed by jumping through various hoops and bureaucratic nonsense to get medicaid / medicare. It's nice once you get it, but maintaining it isn't easy either.
Then you have to find stuff in network which is another exercise in hilarity. Then you hope your medicine is covered as insurance companies will fight tooth and nail to not cover things they (not healthcare professionals) deem not necessary.
This is all without even bringing up the warranted general mistrust the black community has against the healthcare industry and then the often times aggressive and dismissive attitudes these burnt out healthcare workers have. I can't think of any other way to stack the deck harder against lower socio-economic class citizens. Not to mention a lot of political bias then starts to leek through as the healthcare worker starts to blame their burnout on the wrong thing. Instead of pointing the finger at the very institution that treats them like free labor while the board of directors of their "non-profit" ride around new BMWs and take lavish vacations, they point it at the influx of people flooding the ER and at all the new pregnancies for the reason why they're burnt out. Then the micro-aggressions come out, religious beliefs, political beliefs and so forth.
It's. a. joke.
But why do people allow this to happen? Watching the US from outside, it appears the poorest 50% of the country are all just accepting that the politicians slowly but steadily lower their life standard?
I'd love others to chime in, here, but from what I see... Those of a lower socioeconomic status are frequently exhausted by just existing and they feel they cannot change the politics that impact them. It's a big system and one that they have little power over. They just stop focusing on politics at all because it feels hopeless.
I can only speak on my personal experiences but as someone in the middle class living in a southern state in the U.S., my spouse and I feel hopeless when it comes to many things, like voting for example. Our area is predominantly conservative, with many who identify as "right wing". The way the lines are drawn here, our non-conservative vote literally doesn't count. With inflation and property tax hikes, we feel like we're being priced out of our lives. We're a biracial married couple and many people in this community believe that our marriage is wrong. We both work in hospitality so we're often viewed as "the help" despite my spouse having a culinary arts degree and lots of experience. I'm not complaining, just wanting to express a few of the pressures we deal with. And yes, along with everything else that's weighing on us, these issues combine to create apathy, hopelessness and exhaustion. We feel like specks of dirt in a giant cog. Maybe we'd feel differently if we didn't live where we do but moving isn't feasible. I really do feel like we have no voice in this community.
Thanks for a very interesting reply! I'm sorry to hear what you and your partner go through, and it's insane that some people still hold those opinions. It's easy to understand how that whole situation can create apathy, yeah.
How do you think the voting system could be changed so that your vote would count, too? More representatives per county, each party getting representatives according to the election results?
Thank you. It's hard to answer that because the area I live in is growing but still somewhat rural, so there's a fair amount of people who wish to keep things the way they've always been. There's also a strong "brotherhood" presence here, too. I really feel like the only remedy is eliminating gerrymandering altogether. Not really counting on that happening though.
Some of them vote against their own interests because those politicians also promise them an end to abortion, gay marriage, and other social issues fueled by religion. Others are apathetic and too beaten down by the system to have much interest and vote the way their peers/family/favorite media tell them to. Some poor folks genuinely believe we need to enact policies to benefit the rich because they see themselves being one of those rich people someday. In other cases, it's racism: "I don't want to pay taxes that will fund programs benefitting 'welfare queens' and lazy people in the cities, they should work hard like I do."
I wasn't born in the US but have lived here for about 20 years now. There's a lot of things, but one of the biggest things I've noticed is that it's very easy for the politician and the wealthy to create divisions among us. Instead of all of us banding together and working to make improvements, we are intentionally divided even within those poorest 50% by race, religion, ideology, etc.
An example was the recent Affirmative action with Schools that was repealed by the Supreme Court, I just found it sadly ironic that the face of that lawsuit was a minority - an Asian American, supported by a White Conservative group. It's ironic also because a good percentage of people who get into these elite schools are legacy white students.
It's easy to create division among your poor to keep them distracted and encourage the selfish mindset each group has.
This right here is an interesting question that doesn't lead to where you think it does. At first glance, this question assigns blame to the people and implies that, should the people vote and be engaged, these issues would be rectified. The question also implies good faith response from the politicians that would just do as their constituents ask in a 1:1 ratio.
We all see laws being passed that favor corporations over people. We all see social programs constantly being shut down by the SCOTUS and being "checked and balanced" by congress. What we're seeing is our hopes and dreams, our solutions, being shot down left and right for reasons we don't understand, yet if you have enough money to buy a senator, or to lobby for corporate interests, or say "God" enough times there's a good chance your "solution" will go through congress without issue.
Losing faith in the system benefits one party and losing faith is a design choice by said party. It's effective. Making it difficult to get engaged in politics also benefits one party that has a lot of quiet, peace, and time to be engaged in local politics. Understanding the rigged rules of gerrymandering and circuit courts also benefits one party, the other party has voters that have failed education and can't ever hope to understand what a court does, much less what judge shopping is.
I guess to summarize, the reason why people "allow this to happen" is because the US political system is busted from the top down. Whether people vote or not, the country is controlled by special interests, there's money and bias in government, and it's going in the same direction and has been for a while: it benefits and works for the rich and fails the poor. The illusion is that somehow engaging and voting in the system is going to magically change everything. By not voting we're speeding things up to an absolute dystopia, by voting we offer up resistance. If all of us voted we may have gotten somewhere half a century ago, but education and voting rights didn't even come about until recently.
This country is for the white, the wealthy, and the religious. If you're not any of those things you can come here to make them money and maybe have a life, but don't expect much else.
As a non-white childfree woman in the south, this is a tough topic because it's hard to speak without getting emotional. I think in the recent past, systemic racism played a part in the healthcare disparity but lately it feels like there's been a shift and now it just feels like a war on the uterus, no matter what your race/ethnicity. Lack of abortion access for many now means more people are facing pregnancies they didn't plan and that's having a very negative impact on their mental health at minimum. In addition, I feel as though the article overlooks the judgements and shame that occurrs in these situations. For example, where I live, it's not unusual for a young woman to go to a facility that says they offer assistance but instead hands you religious material and shames you for your choices. If someone were feeling ashamed in any way over their pregnancy, which is quite common, they'll likely avoid places that they fear will just denigrate them. Even when these places offer financial assistance, for some people, the negativity and disdain isn't worth the help. It's not like this everywhere but it definitely happens in some areas.
The mental health damage a broken Healthcare system has on people is a toll that feeds back into the system to harm the individual elsewhere down the line. It doesn't help that mental health is considered a psuedo science in many circles and not a real medical field in others. Even among Healthcare professionals, they'd rather invest time and money on research rooted in materialism rather than acknowledge that some things can't be reached with chemicals. Some things are an issue of points of view, reasoning, purpose, community and so forth.
The lack of a robust mental health system contributes to pain and suffering on both sides of this conversation and continues the vicious cycle. The patient suffers multiple times.
I was just arguing with someone else on this very same issue and they asked for sources to backup the claim that mental health is in a terrible state and we're in a mental health crisis in this country.
Just wild stuff. They couldn't believe many of us are clinically depressed and anxious and most of us should be in therapy.
I applaud your bravery in having that discussion. I don't think I would've been able to do it! I especially agree with your statement that a broken MH system can further harm an individual. People seeking care are at a very vulnerable point in their lives and having someone who was meant to help them cause harm instead can be pretty traumatizing. I've had MH professionals say some pretty unprofessional things to me. I've also seen what people go through who are forced to experience county or state funded mental wards and that is a package of trauma all by itself. This is why I'm a big supporter of mental health care reform. I'm especially focused on improved mental health care for minority women.
This is sadly all too common everywhere, and in some states its actually encouraged.
To say nothing of places that are downright evil: they try to be all kind and supportive and be your friend and promise all kinds of resources, and then once you're far enough along that it's illegal to abort they show their true colours and turn their backs on you. I tried to volunteer at one and they told me unless I come down hard on the prolife side I can't volunteer there.
Apparently there are equivalent on the other side too; once you decide not to abort they don't have anything else for you and if you're not staunchly pro choice you can't volunteer there. I don't live in America so I haven't personally encountered these - as far as I know planned parenthood provides all kinds of good things for every stage of family planning or planning for no family. But I heard etcetc.
No doubt each are trying to protect women and/or baby from harm from the other side. but that's so sad that we can't just agree on loving the woman in a time of need and support her choice even if we can't find it in ourselves to celebrate her choice.
There are good places that will support a woman no matter which way they end up choosing, and recognize that there is potential for sadness and hurt and injuries and regret no matter what happens. I hope they become the main expectations one day and everyone has quality support no matter what they choose and where they live
I'm not sure if the trend is continuing post COVID, but the US maternal death rate has been increasing while in California it has been decreasing. It's just that other states don't care enough to adopt policies that have been proven to work. They're fine with these people dying every year.
https://www.npr.org/2018/07/29/632702896/to-keep-women-from-dying-in-childbirth-look-to-california
Well the poor can't fund anything and they won't do anything so if they die who cares? Can't even protest without permits and in safe spaces.
We've been neutered in this country and didn't even know it. The entire US political machine will have a fit if one person breaks a glass window in protest, but France has no problem burning it all down.
I really do believe the only thing left for us to do is, well, take a note or two from France, but that would mean a lot of people who are already tight with bills and family will suffer and that's a hard thing to ask of them. Many don't want to have their already fragile lives be upset anymore. Many are afraid to make it all burn and rightfully so. Many are afraid of what the police will do and they should be.
That's how we're kept docile. Essentially it's "we're going to use and abuse you and if you even think of fighting back we're going to squash you".