Despite Progress Maternal Mortality Remains a Crisis

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.


Posted in USA

Why the Health Reform Law Fails to Meet Human Rights Standards

Originally posted to Huffington Post

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.

Posted in USA

First step for the Right to Health Care in the US?

On Sunday night, after more than a year of debate, the U.S. House of Representatives passed Health Care Reform legislation. No, the bill was not the one that most human rights advocates wanted to see. And yes, there will be plenty of work to do to ensure that the right to health care is fully met in the United States. But the fact that the Patient Protection and Affordable Care act will soon become the law of the land marks a recognition of how poor our current “profits-before-patients” health care system really is.

Human rights advocates now have their work cut out for them at the federal and state levels to make sure that 2010 marks the beginning of a way out – towards a system where no one is denied care based on an inability to pay and where the government is held accountable for making sure that the system works.

Earlier this month, Amnesty International published Deadly Delivery: The Maternal Health Care Crisis in the USA, which finds that despite spending more per person than any other country on health care, the U.S. ranks behind 40 other countries when it comes to women dying in pregnancy or child birth. The report documents barriers to access in the provision of maternal health care around the country.

Among the horror stories in that report is the case of Starla Darling, a 27-year-old who was close to her due date when she learned that the Ohio cookie plant where she had worked for eight years was going to be closed down and that her health insurance would expire just three days later. Faced with the prospect of paying thousands of dollars in medical bills, Starla asked her caregiver to induce labor two days before her insurance was set to expire. Ultimately, Starla had to have a C-section. To add insult to injury, the insurance company denied her claim as it was so close to the end of her employer-provided insurance coverage, and left her with nearly $18,000 in medical bills. (Robert Pear reported Starla’s story for The New York Times.)

Starla’s story – and those of hundreds like her – are indicative of a larger problem. Private insurance companies use a business model that relies on not providing care. Those who need to access health care are a cost to insurance companies, and like any business, they work to minimize their costs and maximize their profits.


Posted in USA

"Deadly Delivery" in the News

iStock_000003008516SmallLast Friday, Amnesty International launched Deadly Delivery, the new report highlighting the shocking rates of preventable maternal deaths in the United States. The media has been paying attention.

On Wednesday, viewers of Good Morning America saw our researcher Nan Strauss talk about Caesarian sections in the United States. Jennifer Block wrote an article about the report at, and Colum Lynch at the Washington Post cited our report and quoted Amnesty Executive Director Larry Cox in an article on maternal mortality worldwide. CNN picked up the story as well, with an article that detailed Amnesty’s call to action, and included comments from supportive health care professionals around the country. The Guardian, one of the UK’s leading dailies, ran an article on Friday highlighting Amnesty’s role in calling out the violations of women’s human rights in the United States. State media outlets are running the story too, particularly in states that are hard-hit by the maternal health care crisis (like Louisiana) . Here at Human Rights Now, we kicked off coverage with a post from Alicia Yamin, a world expert on maternal mortality and human rights and a special adviser to our Demand Dignity Campaign.

If you haven’t already, make sure to take action and call on Secretary Sebelius to create an Office of Maternal Health to safeguard women’s right to safe childbirth in the United States!

Mona Luxion contributed to this post.

A Maternal Mortality FAIL in the U.S.

By Alicia Ely Yamin

mothersilocontrast-copyWhile the Republicans cynically stall efforts on health reform to gain political advantage and the Democrats wrangle over special deals, too many people continue to die in this country because they lack access to care. A report released today from Amnesty International highlights the scandalous fact that every day in the richest country in the world 2 to 3 women die in pregnancy and childbirth.

As Deadly Delivery: THE MATERNAL HEALTH CARE CRISIS IN THE USA notes, the U.S. “spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 40 other countries. “ For example, the likelihood of a woman dying in childbirth in the U.S. is five times greater than in Greece.

Perhaps even more scandalous, “African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years.”

Amnesty’s report rightly asserts that this is not just a public health scandal; it reflects widespread violations of women’s human rights, including the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. Patterns of marginalization and exclusion in this society are exacerbated by a discriminatory and dysfunctional health system.

Throughout the health care reform debates, there has been scarcely a mention of health care being a fundamental human right. But the fact is that the U.S. is the only industrialized nation in the world that does not recognize a legal entitlement to health care.


Posted in USA

Health Care Reform: Back to Human Rights Basics

In a turbulent week in U.S. politics that saw the president abandoning his promise of universal health insurance and the Supreme Court elevating corporate spending in elections to a human right – protected as free speech in the same way as human speech – human rights activists should take solace in the fact that giving up pretensions can be the first step to real change.

This is particularly important for human right to health care activists who have long been dismayed with market-based health care proposals that blatantly fail to satisfy basic human rights standards. There was perhaps only one policy measure the U.S. needed even less than the opening of floodgates for vast new corporate political spending, and that was a health “reform” bill funneling millions of new customers to the for-profit insurance industry and billions in subsidies into the coffers of the…wait for it…very same industry. If this bill, in its Senate and House versions, now appears threatened by the Democrats’ loss of one Massachusetts Senate seat, a new opportunity has emerged to call for simple but meaningful health reform measures based on human rights.

Many activists and advocacy organizations, including Amnesty, have consistently pointed to the fundamental flaw underlying the approach adopted by health reformers in DC, and urged them to treat health care as a human right, not a commodity. Yet the reform bills failed to meet the human rights principles of universality, equity, and accountability. Rather than guaranteeing universal health care, they excluded many millions of people from access to coverage and care. Instead of ensuring that care would be available for those who need it, the bills made access for most people contingent on their ability to purchase a private insurance plan. And rather than holding the private sector accountable for protecting the right to health, the bills perpetuated the industry’s focus on their bottom line.

The rapidly faltering popularity of this market-based approach creates a new opening for demanding simple but systemic policy changes that move the U.S. system toward treating health care as a public good shared equitably by all. A Medicare-like public health insurance program for everyone in the U.S. could guarantee progressively financed, publicly accountable, and fiscally sustainable universal coverage. Therefore, building on the success of Medicare and expanding it to more and more people below the age of 65 can be a key component of a rights-based reform strategy. It is equally important to secure and expand the health rights of poor and low-income people through guaranteed public coverage provided by Medicaid and the Children’s Health Insurance Program (CHIP). Without a progressive expansion of publicly financed and administered health care, it will remain virtually impossible to ensure that people’s health needs are prioritized over market incentives to deny access to care.


The Human Right to Health Care in Vermont

Rally at the Vermont State House in Montpelier.

Rally at the Vermont State House in Montpelier.

Communities across the country are demanding the human right to health care, while Congress is tweaking its latest version of health insurance legislation that continues to treat health care as a commodity.

This unacceptable discrepancy between public will and corporate power in Washington, DC, is being challenged by state-based campaigns for the human right to health care. Activists in states such as California and Vermont have their eyes on a prize much grander than anything Congress is willing to consider: single payer health care at state level. So it’s no coincidence that it is Vermont’s U.S. Senator Bernie Sanders (I) who seeks to change the health bill under discussion in the U.S. Senate by introducing an amendment that would make it easier for states to go it alone and implement a Medicare-for-All, publicly financed health care system in their state.

Vermont is ready for it, and activists think they could even manage without such federal assistance. Over the past few months, the Vermont Workers’ Center’s campaign has organized a series of People’s Forums across the state with the involvement of over 70 state legislators and more than 800 Vermonters. Participants affirmed the importance of establishing a universal, equitable and accountable healthcare system in Vermont. Bekah Mandell, a forum facilitator and campaign activist, summarizes their mood: “Ordinary Vermonters will continue to put pressure on their elected representatives until we win this fundamental human right. It is clear to us, now, that we can win, and we will win.”

On January 6, the first working day of the 2010 legislative session, the Vermont Workers’ Center will deliver thousands of signed postcards demanding health care as a human right. The legislative leadership announced at a recent People’s Forum that hearings on a single payer bill will begin on January 12. SEE THE REST OF THIS POST

Dollars and cents of new health care legislation

Patients not profitWhile protesters have been occupying House Speaker Pelosi’s office, demanding a health care system that serves “Patients not Profit”, the House of Representatives is preparing to vote on the market-based health care bill introduced last week by Speaker Pelosi. It is not expected that the House leadership will allow a lengthy floor discussion, but the most recent news reports suggest that the promised vote on Rep. Anthony Weiner’s (D-NY) single payer amendment may be allowed. Meanwhile, Speaker Pelosi has presented the leadership’s additions to the bill in a so-called Manager’s Amendment, stating that this would strengthen provisions for “excluding insurers who put profits over patients from an affordable marketplace that will serve tens of millions of Americans.”

Does that mean the protesters demands have been met? Is this health care bill bringing us closer to realizing our human right to health care? Let’s recall that according to international legal standards, the human right to health requires that “health facilities, goods and services must be affordable for all. Payment for health-care services…has to be based on the principle of equity.”

The House bill aims to achieve affordability by subsidizing the purchase of an insurance policy for those earning between 150% and 400% of the federal poverty level, provided they don’t have employer-based insurance. In practice, this means someone with an income at the upper end of this scale would pay $5300 a year in premiums and up to $2000 a year in cost-sharing, amounting to around 17% of their income. At the bottom end of the scale, health care costs would be around 6-7% of a person’s income – which is still higher than a general income tax increase proposed by single payer health insurance bills.  Many immigrants would get no support at all, and anyone unable to afford such an insurance plan would be subject to a penalty payment, since everyone will be mandated to purchase insurance.   SEE THE REST OF THIS POST

Beyond the Market: Health Care as a Civil or Human Right?

A dramatic disconnect between principles and policies has hampered current U.S. health care reform efforts. This became obvious when candidate Obama declared health care to be a right and then proceeded to treat it as a commodity when negotiating with insurance companies a requirement for individuals to buy a commercial health insurance product.

Similarly, early on in the debate the president championed the principle of universality by promising some form of health coverage – if not necessarily health care – for 46 million uninsured people, only to lower the policy goal to 30 million American citizens in his speech before Congress, excluding many immigrants and low-income people. Since then, further policy provisions that restrict access to health coverage for immigrants – documented and undocumented – and reduce affordability for lower-income people have appeared in the health care bill adopted by the Senate Finance Committee. SEE THE REST OF THIS POST

A Medicare-like Public Plan For All: Still Crucial

Over the weekend, the Obama administration may have weakened its support for a “public option” as one part of the health care package emerging from Washington.

On Sunday, Health and Human Services Secretary Sebelius told CNN that a public option is not “essential”, a day after President Obama, at a town hall meeting in Colorado, said that a public option is “just one sliver” of reform. Major media outlets wrote up what they saw as a shift in position: “Key Feature Of Obama Health Plan May Be Out”, blared the Washington Post; “‘Public Option’ in Health Plan May Be Dropped”, said the New York Times. But some commentators, like liberal bloggers Jonathan Cohn and Ezra Klein, voiced doubts that this represented a substantive change in administration policy.

Whether or not the Obama camp has changed positions, the real Washington action on health care right now isn’t at the White House — it’s further down Pennsylvania Avenue, at the Capitol. With House staffers now reconciling the three versions of its bill, the key battleground is the Senate. The Senate Finance Committee remains locked in negotiations on its version of the mainstream health care package, and now says it will pass its bill by September 15; merging that piece of legislation with the very different Health, Education, Labor and Pensions Committee bill will be a contentious process.

And no matter what way the winds of political calculation are currently blowing in Washington, the human rights position hasn’t changed. A Medicare-like public plan for all remains crucial for realizing the human right to health care in the the United States. Health care is a public good, not a commodity. Public financing and administration is the best vehicle for care that’s truly accessible and accountable. Setting up a new Medicare-like public plan in the current round of reform is a key aim for human right to health care advocates.

Senators Baucus, Dodd and Reid — the Finance chair, the HELP vice chair, and the Senate majority leader — need to support a public plan. Urge them to do that today!