Writing from his jail cell, Mumia Abu-Jamal pointed out that, “The truth is White Americans have sculpted and supported an edifice of utter separation –for centuries. And today, we still dwell in two very different worlds and head-spaces: one of privilege and another of privation.” In his communication Abu – Jamal had moved from recalling playwright Jean Genet and his “Theater of the Absurd” to commentary on racism – “as we witness the decay of capitalism – its utter dog-eat-dog ruthlessness.”
The former Black Panther, a political prisoner for years, thus goes to the core of a society where new or expectant mothers are dying at rates far in excess of contemporary international norms. Maternal deaths in the United States and in Texas, discussed recently in the professional journal “Obstetrics & Gynecology,” became a news story in late August.
The report showed that in Texas the maternal mortality ratio (MMR) had moved from 17.7 deaths in 2000 to 35.8 deaths in 2014. The MMR refers to the number of women per 100,000 live births who die during their pregnancy or within 42 days afterwards and who die from causes related to childbirth.
“Obstetrics & Gynecology” observed that MMRs have been rising in the United States for years and that the MMR for 2014 was 23.8. This was “at a time when the World Health Organization reports that 157 of 183 countries studied had decreases in maternal mortality between 2000 and 2013.”
The Centers for Disease Control (CDC) documented a rise in the MMR from 7.2 in 1987, to 14.5 in 2000, and to 17.8 in 2011. In world rankings, the U. S. MMR for 2010 fell 48 places below Estonia’s MMR, which was then the world’s most favorable. It was a year when 31 countries demonstrated MMRs of 10 or less. The United States in 2015 ranked 61st in the world in maternal health generally, according to the The Save the Children organization.
The study in “Obstetrics and Gynecology” indicated maternal deaths have long been under-reported due to flawed data collection by U. S. public health agencies. Improved methods now, for example, yield a national MMR for 2000 of 18.8, instead of 14.5.
Noting a worldwide 45 percent drop in maternal mortality, the New York Times exclaimed September 4 that “America’s record is unconscionable.” Indeed, that old adage about “motherhood and apple pie” being sacrosanct no longer applies, at least in regard to the first. Motherhood is in trouble.
By way of explanation, there is frequent resort to blaming the victim and her circumstances; she is obese, for example; encounters violence; uses drugs; has mental health problems; or suffers from this or that other illness. Mumia Abu-Jamal would have been looking elsewhere for whys and wherefores, and an abundance of facts are readily at hand.
The Centers for Disease Control reported that for 2012 white women suffered 11.8 deaths per 100,000 live births in 2012 while the MMR for black mothers that year was 41.1. The MMR for women of other races was 15.7. In another report, “In Georgia, in 2010, 2011 and 2012, the rate of maternal mortality for white women was 14 per 100,000 live births … For African American women, it was 49 per 100,000.” Yet another study concludes that black mothers’ fourfold greater risk of death in comparison with white mothers persists “even when controlling for age, socioeconomic status and education.”
Racism has contributed mightily to the burgeoning U. S. epidemic of maternal deaths. Racism shows up in many ways, but taken as a whole they’ve made it so that “46 percent of maternal deaths among African-American women [were] preventable compared with 33 percent of such deaths among white women.”
One manifestation is that medical evaluations of African – Americans are often incomplete and/or incompetent. Another is that poor people, black people included, suffer more illnesses than higher –income people do, including heart disease, a leading cause of maternal death. Also, “bias, prejudice and stereotyping by health care providers contribute to delivering lower-quality care.”
And black women’s lack of access to health care often causes them to delay medical care during pregnancy, or go without. Either way, their risk of death from pregnancy -related complications increases. States refusing to extend Medicaid coverage as provided for under the Affordable Care Act is one leading cause of reduced access today. The closing down of women’s health-care facilities is another, a prime example being the attack on Planned Parenthood offices in Texas.
In 2010, Amnesty International issued a report that strongly condemned U. S. governmental policies regarding maternal health. Titled “Deadly Delivery, the Maternal Health Care Crisis in the USA,” it insisted that, “Discrimination is costing lives… [W]omen face barriers to care, especially women of color, those living in poverty, Native American and immigrant women.” An Amnesty International spokesperson denounced both a “haphazard approach to maternal care” that is “scandalous and disgraceful,” and a lack of “political will.”
Importantly, the Amnesty International report portrays both black and white women as victims of discrimination based on social class. Women are dying because they are black, or because they are poor, or both. After all, white women giving birth in the United States are much more likely to die than their counterparts in dozens of other countries.
“Women of color are at least twice as likely as white women to be living in poverty,” the report says. It mentions other class – determined impediments to U. S. mothers’ survival, including: language barriers, shortages of health-care resources and of specialists in rural areas and inner cities, educational disparities, and lack of insurance coverage due to poverty. Food shortages would be another.
According to Amnesty International, “Health insurance companies’ primary responsibility is to shareholders and decisions about health care coverage and services may be inﬂuenced by ﬁnancial concerns rather than driven by an assessment of the beneﬁt to the public and to the individual.” The idea is that mothers without resources may not get care.
Racial discrimination and class discrimination may of course overlap. A prevailing line of U.S. thought is to belittle the fact of social-class distinctions, and in that vein, as pointed out by critics such as public health expert Vicente Navarro, not a few academicians and officials use race as a proxy for class. Class dynamics may indeed be operating in both the scenario posed by Mumia Abu-Jamal and in the current maternal-health catastrophe. But in the latter instance, racial oppression also grinds away, and with disastrous consequences.
The American Public Health Association was very clear in 2011: “Preventable maternal mortality is associated with the violation of a variety of human rights, including the mother’s right to life, the right to freedom from discrimination, and the right to health and quality health care.” The Association’s statement quoted Mahmoud Fathalla, past president of the International Federation of Obstetricians and Gynecologist. He declared that, “Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.”
He was saying, in other words, that women’s lives don’t matter. And we think it takes a capitalist society for women’s lives not to matter, one that turns a blind eye to racial oppression and turns away from protecting the most vulnerable.