There is a rural area in Mpumalanga Province, South Africa where the maternal mortality rate more than doubled from 2011 to 2012. Why are women so at risk for dying during childbirth in this province? The reasons are complex and inter-related but many factors can be addressed by the provincial Minister of Health. And we are demanding that he does. SEE THE REST OF THIS POST
Earlier this month we wrote about the right to universal access to health care in the context of the Susan G. Komen Foundation’s decision to defund Planned Parenthood. Yet again this month, women’s health rights are being used as a political football.
The reversal of the Komen Foundation’s decision, in response to public outcry, only amplifies our newest concerns: the voices of affected people must play a role in all policy decisions.
I’m sure you’ve seen the now-infamous photo of an all-male witness panel at the February 17 hearing on contraception and religious freedom, held by the House Committee on Oversight and Government Reform. The Democratic minority nominated a woman for this panel—an average woman with experience of the implications of insurance companies denying coverage of birth control. She was denied as a witness by the majority GOP, apparently because she was deemed unqualified to speak to the issue. Two women were witnesses on the second panel, one a female physician.
On September 6th, I posted a blog concerning what I considered bad reporting by many in the mainstream media, ‘Palmer Report Did Not Find Gaza Blockade Legal Despite Media Headlines’.
Amnesty International recently signed on to a joint open letter to members of the MiddleEast Quartet — an important mediating body in the peace process that includes the United States, the United Nations, the European Union and Russia — with almost two dozen other human rights and humanitarian organizations in regards to the Palmer commission’s report on the 2010 flotilla incident and the continued closure of Gaza.
By Kim Lanegran, Amnesty USA Country Specialist for Sierra Leone
It’s been a little over a year since the government of Sierra Leone launched its groundbreaking free healthcare program for children and pregnant women.
While we’re thrilled about the good news — more women now receive pre and post-natal health care, over 39,000 women delivered their babies in health care facilities, and many lives have been saved — there is still a lot to be done.
Amnesty International’s new report on the Free Health Policy finds that free adequate care is simply not being delivered.
This guest blog post is by Anja Rudiger, director of the Human Right to Health Program at the National Economic and Social Rights Initiative
Six months ago the United States almost got universal health insurance. Advocates celebrating the passage of the federal health reform law argued that this was as good as it gets. While it was understood that the optimistically named Patient Protection and Affordable Care Act (PPACA) emerged as the result of political compromises, many applauded it as a step toward finally realizing the human right to health care in the United States. After all, the bar had been set quite low: because the United States produces poor health outcomes and shocking health disparities despite the highest health care spending in the world – driven by a for-profit health industry – the only way the country could go was forward. Or so it was hoped.
Yet six months later we awake to news of children’s coverage dropped, sick kids being charged more, skyrocketing insurance premiums, employers’ shifting costs to workers, and insurers defending paper-shuffling as essential medical expenses.
Everyone knew from the start that the reform would not be fully universal, with the Congressional Budget Office predicting 23 million people to remain uninsured, nor equitable, with access to care dependent on the payment of premiums, co-pays, and deductibles, nor accountable, with for-profit insurers setting prices and limiting access to doctors and services. Yet many had hoped that a little bit of universality would go a long way toward getting improvements for some. By the same token, the principle of “equity” was deemed just slightly too ambitious when insurance companies could simply be subsidized for selling their products to those working low-wage jobs.
As far as accountability goes, it was considered safer to keep the enemy – our beloved insurance companies – as close as possible, rather than unnecessarily antagonizing it. If the reform stuck to a market-based insurance system – so went the reasoning – access could be within reach of more people without causing disruptions to those benefiting from the status quo.
Except that some rather painful “market disruptions” are upon us now, with insurers dropping policies and raising rates in droves. But once again, advocates cling to their optimism; after all, the bulk of the reforms won’t come into effect until 2014, and once we plow through this disruptive period, all the pieces will fall into place. Or will they?
Amnesty International released a disturbing new report today detailing the crumbling state of health care in North Korea. The report paints a bleak picture of barely-functioning hospitals void of medicines and epidemics brought on by malnutrition.
In addition, our researchers found that the North Korean government has been unable to feed its people and, in violation of international law, has refused to cooperate fully with the international community to receive food aid.
Even though North Korea claims to provide healthcare for all, the latest estimate from the World Health Organization shows that North Korea spent less on healthcare than any other country in the world – under US$1 per person per year in total. In fact, many witnesses have stated that they have had to pay for all services since the 1990s, with doctors usually paid in cigarettes, alcohol or food for the most basic consults, and taking cash for tests or surgery. Because North Korea has failed to provide for the most basic health and survival needs of its people, many North Koreans bypass doctors altogether, going straight to the markets to buy medicine, self-medicating according to their own guesswork or the advice of market vendors.
Thousands are estimated to have starved to death in North Korea as recently as February this year after a botched currency revaluation. Crippling food shortages, exacerbated by government policies in North Korea, have caused widespread illness as well as people are forced to survive on “wild foods” such as grass and tree bark. Hwang, a 24-year-old man from Hwasung, North Hamgyong province, was homeless and lived alone from the age of nine. Foraging for wild foods was his only option to avoid starvation.
“I ate several different kinds of wild foods, such as neung-jae, which is a wild grass found in the fields. It’s poisonous – your face swells up the next day. Other kinds of grass and some mushrooms are also poisonous so you could die if you picked the wrong one,”
On April 14th, 2010, over 60 hill staff and concerned activists came out for a congressional health briefing titled “Does the New Health Care Reform Law Address Barriers Women Face When Seeking Maternal Health Care?” hosted by Congressman John Conyers (D-MI), chairman of the House Committee on Judiciary. At the request of Chairman Conyers, the briefing featured our very own Nan Strauss, Amnesty International USA’s lead researcher on our most recent report Deadly Delivery: The Maternal Health Crisis, as well as two Congressional Research Service (CRS) specialists on Medicaid.
Nan’s compelling presentation on the maternal health care crisis highlighted that while significantly needed strides were made with the passage of health care reform, the magnitude of the maternal health crisis in the U.S. continues to claim the lives of 2 – 3 women every day. Using individual stories as well as global statistics, Nan explained that in the United States:
- Two to three women die every day of complications resulting from pregnancy or childbirth
- Maternal deaths in the US are more likely than in 40 other countries
- Black women are nearly four times more likely to die than white women. In high-risk pregnancies, these disparities increase dramatically
- Many inner city hospitals are chronically understaffed. Again, women of color are more likely to seek care at understaffed hospitals than white women
- Nearly half of maternal deaths and ‘near-misses’ could have been prevented with better access to good quality maternal health care
- Although health care reform has many provisions that will help women, such as ending discriminatory insurance practices based upon ‘pre-existing conditions,’ many of the underlying conditions responsible for the appalling rates of maternal deaths in the US, continue to exist
As the next step after health care reform, she said, Amnesty International is calling for the establishment of an Office of Maternal Health within the Department of Health and Human Services.
You can take action here by writing to Secretary of Health and Human Services, Kathleen Sebelius, and asking her to work with President Obama to establish an Office of Maternal Health.
Mona Luxion contributed to this post.
By Cynthia Walsh, Field Organizer for Amnesty International USA
Pregnant with my first child! Excitedly, I began immediately searching for a nurse midwife who would guide me and serve as my health advocate throughout my pregnancy.
Living in West Africa as a Peace Corps Volunteer for a time, I had several wonderful encounters with Traditional Birth Attendants or TBA’s. The TBA’s that I worked with were a small group of dedicated women ranging in age from early 30’s to mid 60’s who assumed the role of everything from family counselor, marriage intermediary, women’s advocate, family planner, nutrition counselor, pre-natal care provider to birth attendant in their small respective villages. Often these villages are located days’ journey by foot from any sort of rural health clinic so the presence of a TBA is critical to the life or death of pregnant women and her unborn children.
In the United States, my own personal experience with my nurse midwife “Judy” was more than I could have imagined and I definitely felt as though I was fully engaged and informed in all phases of my prenatal care, delivery, and post-partum recovery.
Please take urgent action on this very important piece of legislation – the Massachusetts Midwifery Bill – Senate 2341. The Health Care Finance Committee must vote by Wednesday, April 28. Without passage, 1.4 million families in the state will still not have the kind of access to midwives that families in many other states do.
Take a moment NOW to call your MA legislators and let them know that the Midwifery Bill is important to you.
By Rachel Ward, Managing Director, Research Unit
News coverage of the study published in The Lancet about declining maternal deaths worldwide largely ignored the appalling fact that the United States has shown no improvement in the rate of maternal deaths for two decades.
Progress in reducing maternal deaths around the world should be applauded.
Yet even if we accept the study’s conclusion that there has been some progress on reversing maternal deaths worldwide, this should not lead us to the wrong conclusion — that the problem is solved.
Far from it.
Women are still dying worldwide at an appalling rate — a woman dies every minute and a half worldwide, according to the figures published in The Lancet.
Most of these deaths, we know, can be prevented. This study should strengthen our resolve to develop strategies to expand upon the progress so that the right to safe childbirth is protected for all women everywhere.
In the United States, the Lancet study shows that maternal deaths are on the rise. The recent Amnesty International study we co-authored, Deadly Delivery: The Maternal Health Care Crisis in the USA, shows that the maternal death rate has shown no improvement in the United States in more than two decades, and in fact, the death rate is going up. This is a disgrace. And the rate is climbing, despite the fact that hospitalization related to pregnancy and childbirth costs some $86 billion a year — the highest hospitalization costs of any area of medicine.
Amidst the celebrations of a ‘historical moment,’ a healthy dose of realism seems in order as we assess the new Patient Protection and Affordable Care Act and the related reconciliation measures. What is seen as a crucial victory for the Obama Administration has been won on the backs of many grassroots activists struggling for health care as a human right and a public good, including women’s and immigrants’ rights groups. The lengthy health reform process has mobilized many millions of people, some new to political activism and many others veterans of the long struggle for universal health care in the United States. This political moment presented a prime opportunity for finally ending the commercialization of one of our most fundamental needs, health care. The failure to seize this opportunity will haunt us for years to come.
What is now touted as the most far-reaching social legislation in almost half a century in fact bears no resemblance to the landmark Medicare Act of 1965, which instituted a fully public insurance system with contributions shared equitably by everyone, in solidarity with older people. Instead of expanding Medicare to everyone, this new law formally affirms and solidifies the private, market-based system in which health care is the domain of a for-profit industry propped up by substantial public subsidies.
Human rights standards do not tolerate the inequities inevitably linked to a reliance on market competition to meet human needs. Yet this legislation also contains some important improvements to health care access for poor people. The Medicaid expansion and the additional funding for community health centers are very welcome and long overdue, but could have been adopted as stand-alone measures. As such, they are indeed cause for celebration, yet most pundits seem to care precious little about these provisions of the new law, despite the fact that the Medicaid expansion will account for at least half of the newly insured population. Instead, all favorable attention is showered on the subsidized expansion of the private, for-profit health insurance industry.
Yet it is precisely this aspect of the new law — market-based health insurance reform — that entrenches the treatment of health care as a commodity by locking us into a market mechanism that sells access to health care based on a person’s ability to pay rather than their health needs. Public subsidies for pricey (and not price controlled) insurance products are intended to mitigate the inequities inherent in a for-profit system, while leaving no illusion that coverage will continue to be stratified and access to care out of reach for many. This volatile combination of at-will pricing by insurance corporations and the promise of subsidies to match prices also renders the system financially unsustainable for individuals and government alike.
In sum, the new health law fails to meet the key human rights standards of universality, equity, and accountability. Rather than guaranteeing universal health care, the law excludes many millions of people from access to coverage and care. Instead of ensuring that care is available for those who need it, the law makes access contingent on the purchase of private insurance. And rather than holding the private sector accountable for protecting the right to health, the law permits the industry’s focus on their bottom line. Health care is treated as commodity, not as a universal right and a public good shared equitably by all.
Many grassroots activists and their academic and advocacy allies, including the National Economic and Social Rights Initiative, have challenged this prevailing policy paradigm and presented solid evidence that health care financing and management through market relationships is unable to meet everyone’s health needs. In all other high-income countries, health systems are highly redistributive in economic terms, funded collectively through cross-subsidization with a common pool that includes all, not limited to residual public programs for certain groups. Yet Democrats in Congress and the White House did their best to silence these voices and insisted on a market-based approach despite their own better knowledge — the President himself admitted as much when he remarked that a single payer public insurance system would be necessary to achieve universal coverage. But this was not the route pursued by our legislators, and so a workable solution was jettisoned in favor of an ideological approach approved by the health care industry.
We can turn this moment into a historical one if we take it as a new beginning, not an end, for a human right to health care movement in the United States. Grassroots campaigns are well underway for universal health care at the state and even local level, for example in California, Vermont, and Montana. By using the human rights framework to guide us, we can build a broad-based movement that inspires solidarity for sharing the public goods required to meet our fundamental needs.