US maternal mortality rate soars: An example of capitalist barbarism
US maternal deaths rose by 40 percent in 2021, the latest year for which statistics are now available, according to a new report from the Centers for Disease Control and Prevention (CDC). The number of maternal deaths rose from 754 in 2019 to 861 in 2020 and 1,205 in 2021. The maternal mortality rate, at nearly 32 per 100,000 births, is back to where it was in 1965, a staggering regression of more than half a century.
Women who give birth today in the United States are nearly four times more likely to die than their own mothers were when they gave birth. The US maternal death rate hit its all-time low of 6.6 per 100,000 births in 1987. It was in single digits from 1978 to 2002, then rose steadily, doubling by 2017, then skyrocketed during the COVID-19 pandemic, nearly doubling again.
These figures, stemming from a report released Thursday by the National Center for Health Statistics, a unit of the CDC, are an indictment of American capitalism and the profit-based health care system, which denies adequate prenatal and postpartum medical treatment for millions of women, simply because they are poor or uninsured.
The United States is not only the worst-performing among the industrialized nations, in terms of maternal mortality, the difference is not even close. Women giving birth in the US are four times more likely to die than in Germany, France or Britain, and 10 times more likely to die than in the Netherlands or the Scandinavian countries. They are twice as likely to die as in China. According to the World Health Organization, these disparities predate the COVID pandemic: Maternal-mortality rates in the US rose 78 percent between 2000 and 2020, while dropping in most other countries.
The particular causes of death are varied, according to the CDC, although a majority are cardiovascular in origins, including cardiomyopathy (disease of the heart muscle), 11 percent; blood clots, 9 percent; high blood pressure, 8 percent; stroke, 7 percent; and other cardiac conditions, 15 percent. Infection and postpartum bleeding account for another 24 percent, while mental health issues, including drug overdoses and postpartum depression leading to suicide, are also a factor.
But it is the social causes of death that are the main issue. According to estimates by the CDC and other health authorities, 80 percent of maternal deaths are preventable with proper treatment. Many pregnant women, however, and even more so many women during the weeks and months after birth, do not receive proper treatment.
This lack of care has two basic causes. Women in rural areas are frequently living in what have been termed “obstetric deserts,” more than 25 miles away from a labor and delivery unit. According to the CDC, some 2 million women of childbearing age live in such conditions. This has been greatly exacerbated by the evisceration of rural health care in recent decades, with hundreds of rural hospitals and medical centers, generally smaller and poorly financed, being forced to close their doors.
Far more significant is the overall growth of poverty and the consequent social isolation throughout the whole of American society, to the point that urban and suburban women, living only a few miles and even a few blocks from a well-appointed hospital or a skilled provider, are unable to access the care they need because they lack health insurance and cannot afford the expense.
Both factors contribute to the much worse than average statistics in Southern states with impoverished rural populations, like Louisiana, Georgia, Alabama, Arkansas, Mississippi and Texas. It is clearly poverty and inequality which are the overriding factors in a heavily urban state like New Jersey, with one of the highest per capita incomes but the fourth-worst maternal mortality rate among the 50 states.
The CDC and other agencies have laid stress on the racial disparities in maternal mortality, and these are quite significant. Black women had a maternal death rate of 69.9 per 100,000 births, compared to 26.6 for white women and 28 for Hispanic women. Native American and Alaska Native women had a mortality rate over 50, and 90 percent of their deaths were considered preventable.
However, claims of “systemic racism” fail to explain why, if only white women were considered, the United States would still be the worst among the industrialized countries, and three times worse than any Western European country in terms of maternal mortality. The rate for white women in the United States is equivalent to the rate for Chinese women, who live in a country still mired in mass poverty, particularly for hundreds of millions in rural areas.
It is also the case that during the COVID pandemic, maternal mortality has risen more rapidly for white and Hispanic women than for black women, who were already at an abysmal level in terms of deaths during pregnancy, childbirth, or in the year afterward.
As with so many social indices in the United States, the breakdown along class lines is simply not reported. But there is little doubt that there is a direct correlation between income and maternal mortality. The mothers in the ruling elite only die in childbirth in the rarest of circumstances, when there are health care complications of an extreme or novel character that even the best medical care money can buy cannot resolve.
The effect of the income divide is exacerbated by the reactionary social policies of state and federal governments. Medicaid, the joint federal-state program providing health insurance for low-income families, drops expanded coverage for pregnant women 60 days after they give birth, although doctors advocate a much longer period of additional care and monitoring.
The “let it rip” COVID policy of the Trump and Biden administrations has worsened the crisis. Pregnant women, particularly if they are not vaccinated, are at a much higher risk of severe illness if they contract coronavirus. Moreover, the persistence of the pandemic, thanks to the rejection of any serious effort to suppress it, means that health care facilities have been overwhelmed with people sick with COVID, leaving fewer resources available for non-emergency treatment such as care for pregnant or postpartum women.
The systemic neglect of poor and working class women stands to be greatly exacerbated by the barbarous consequences of the fascistic campaign being waged against abortion rights. Under conditions where pregnancy is becoming more life-threatening, the ultra-right is seeking new laws and procedures to impose forced pregnancy, even for women who face significant dangers to their own health.
In the months since the Supreme Court overturned Roe v. Wade and stripped women of the constitutional right to terminate a pregnancy, dozens of states have enacted laws banning or restricting abortions, or making them more difficult to obtain.
The latest legal salvo is an effort to impose a nationwide ban on the sale of the medication mifepristone, a key component in the two-pill regimen that accounts for half of all abortions in the US.
Here the barbaric consequences of for-profit medicine intersect with the deliberate barbarism of a social outlook that harks back to the days when women were to be kept “barefoot and pregnant.”
The soaring rate of maternal mortality is a political alarm bell for the working class. The crisis of capitalism threatens the most dire consequences for humanity, even in this most basic of social functions, reproduction. Only the working class will fight for a policy that is vitally necessary to ensure safe and healthy pregnancy and childbirth, and social support for mother, child and the entire family afterward. This should include not only free and state-of-the-art medical care, but income support throughout pregnancy and paid maternity and paternity leave following it.
There Will Be No Soft Landing
Column: The high price of years of low interest rates
To recap: On March 8, Silicon Valley Bank of Santa Clara, California, announced that its balance sheet was weak. The bank held around $175 billion in deposits. They needed to raise capital, but its management had parked too much money in long-term government bonds. At the time of purchase, in a low-interest rate environment, those bonds had seemed safe. Then inflation arrived. Rates went up. Silicon Valley Bank was forced to sell the treasuries at a $1.8 billion loss.
The next day, March 9, panic began to spread. Ratings agencies downgraded Silicon Valley Bank’s credit. Its stock plunged. A run on the bank—with depositors demanding their money back—took off. On March 10, Silicon Valley Bank collapsed.
Silicon Valley Bank is the largest financial institution to go under since the Global Financial Crisis in 2008. Its sudden demise shocked investors into reexamining the financial sector. The largest banks may rest on firm capital cushions. What about regional banks? Fear of instability caused depositors to flee these midsized firms. Shareholders did too. Signature Bank of New York was caught in the whirlpool. It drowned.
To stop the contagion from spreading further, on Sunday, March 12, Treasury Secretary Janet Yellen, Martin Gruenberg of the Federal Deposit Insurance Corporation, and Federal Reserve chairman Jerome Powell made the following announcement: The federal government would guarantee deposits at Signature and Silicon Valley Bank. Until last weekend, the FDIC insured deposits up to $250,000. No longer. The ceiling was blown away in a cyclone of panic.
President Joe Biden was quick to assert that the backstop is different from the Troubled Assets Recovery Program, or TARP, the controversial bank bailout of 2008. The new Federal Reserve facility won’t support creditors or shareholders or executives, just depositors. And tax revenue won’t pay for the guarantee directly, an FDIC fee will—a fee levied on banks and passed on to consumers, who also happen to be taxpayers.
Biden and Yellen won’t say it’s a bailout. Of course it’s a bailout. In some ways this bailout is worse than in 2008. After all, Congress passed TARP. Congress is a bystander here. And TARP set economy-wide rules and qualifications. Biden’s intervention is discretionary and selective. When she appeared before Congress on March 16, Yellen admitted that the unlimited deposit guarantee doesn’t apply to every bank. It applies to systemically important banks. Who decides which bank is systemically important? She does. As circumstances dictate.
Yellen tried to sooth Congress. She tried to project strength. "I can reassure the members of the committee that our banking system is sound, and that Americans can feel confident that their deposits will be there when they need them," she told Senate Finance. "This week’s actions demonstrate our resolute commitment to ensure that our financial system remains strong and depositors’ savings remain safe."
Feel better?
Authorities have struck similar notes of confidence during previous emergencies—the pandemic, the crash of 2008, the first hours of September 11, 2001. Subsequent events proved them wrong. Yellen and Biden may end up looking just as foolish. They are playing Whack-A-Mole, concentrating on financial varmints as they pop up. They should be addressing underlying causes.
The chaos in the banking system is the result of decades of low to zero interest rates and $6 trillion in fiscal stimulus since 2020. That flood of money and credit produced the worst inflation in four decades. In 2022 the Federal Reserve began raising interest rates to restore price stability. The Fed should have acted sooner. It waited because it assumed that inflation would be temporary.
That assumption was false. The Fed’s complacency made the situation worse. By the time it started raising rates, inflation expectations were fixed. The past year of Fed hikes may have slowed inflation. What they haven’t done is kill it.
Biden, Yellen, and the Federal Reserve want a "soft landing." They are after a magic formula that will quell inflation and avoid a recession. They will be disappointed. No one likes inflation: It lowers the standard of living. But the Federal Reserve’s solution—a contraction of the money supply through higher interest rates—is nasty too. High interest rates can cause a recession. Or something worse.
Now Biden and the Fed are caught in a stimulus trap: Higher interest rates increase the likelihood of financial instability, while keeping rates pat—or cutting them—will prolong the inflation. Doing nothing will perpetuate the current mix of declining standards of living amidst periodic chaos.
Biden has ruled out other options. Supply-side measures such as deregulating energy and reducing means-tested income transfers are off the table. Legal immigration won't be made easier. Trade barriers won’t be reduced.
Biden, Yellen, and Powell have gifted America with another "emergency" measure that will last long after the crisis subsides. Republicans are eager for a piece of the action—why do Gavin Newsom and Silicon Valley tech giants get this guarantee, while midsized banks in rural areas do not?
Rather than limit and sunset the deposit backstop, enforce market discipline, and reassert the Fed’s commitment to price stability, the same team that brought America the worst inflation in a generation is entangling itself further in a key sector of the economy. It would be foolish to trust in their judgment. Look at the record. Practical wisdom is scarce in an administration populated by academics and partisan fixers.
Soft landing? Afraid not. Brace for impact.
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