Congress Fails to Adopt Maternity Care Quality Act

Yet U.S. women have a greater lifetime risk of pregnancy-related complications than those in 40 other countries
The Lund Report
January 5, 2011 -- Despite our nation’s wealth and advances in healthcare technology, women in the United States have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries, including every other industrialized nation.
The likelihood of a woman dying in childbirth in the U.S. is three times greater than in Spain, four times greater than in Germany, and five times greater than in Greece. Maternity care in the U.S. is underachieving, a predicament that does not reflect dollars invested since the U.S. spends more on healthcare per capita than any other country. 
More than a third of all women who give birth in the U.S – 1.7 million women each year –experience some form of complication that has a detrimental effect on their health.  In fact, according to the Centers for Disease Control and Prevention, approximately half of all maternal deaths in the U.S. are avoidable. What’s more, there are no federal requirements to report maternal deaths and U.S. authorities admit that the number of maternal deaths could be twice as high.
Congressman Eliot Engel (D-NY-17) introduced legislation, the Partnering to Improve Maternity Care Quality Act (H.R. 6437), to address the cracks in the U.S. maternity care system. The act aimed to improve the quality, health outcomes, and provide more value and efficiency for childbearing women and newborns covered by Medicaid and CHIP. However, no action was taken before Congress adjourned on December 23, and the act would need to be reintroduced by the next Congress.
“Every single person alive has been affected in one way or another by maternity care,” said Engel, a senior member of the House Energy and Commerce Committee’s Subcommittee on Health. “The beginning of life for newborns is fragile, even with technology today, and everything that we can do to better protect babies and their mothers are steps which should be taken. Maternity care has significant healthcare consequences – in both the short and long term – for the more than 80 percent of women who give birth. There are many conditions that relate directly to care during pregnancy and the point of birth that could be prevented from improved maternity care.  This legislation takes a huge leap forward in providing that care.”
The most tragic “healthcare consequence” related to care during pregnancy, or lack thereof, is the death of the newborn or the mother. Even in areas that have more economic wealth and access to resources, infant and maternal health may be vulnerable. For example, Lane County Oregon, home to the 3rd largest city in the state and a prestigious public university, has a high rate of fetal-infant mortality (8.25 per 1,000 births). Lane’s rate is higher than the state’s (8.2 per 1,000 births) and higher than the rate of other comparable counties and metropolitan areas in Oregon. In fact, only recently did Lane’s rate fare better than the national average.
Besides the health of mothers and newborns, the U.S. government has a bottom-line interest is seeing better outcomes in maternity care for the 4.2 million babies born each year in the U.S.; Medicaid pays the bill for over 40 percent of all maternal hospital stays. Furthermore, over half (or $39 billion) of the bills Medicaid receives for hospital discharges are for childbearing women and newborns. Potential savings or efficiencies, and the room for improvement on the rate of return for such an investment, makes this legislation a win-win. 
“Getting high-quality care in the earliest stages of life leads to healthier development in childhood. Likewise, responsible maternity care can prevent childbirth-related health problems for mothers.  Evidence-based reforms to the maternity care payment process could save healthcare dollars and improve quality of care,” said Rep. Sue Myrick (R-NC-09), the lead co-sponsor.
The Partnering to Improve Maternity Care Quality Act would:
  • Identify a set of national, evidence-based, quality consensus measures that assess processes, outcomes, and the value of maternity care provided to Medicaid and CHIP beneficiaries.
  • Adapt the Consumer Assessment of Healthcare Providers and Systems facility, provider, and health plan surveys to assess the experience of care of childbearing women and newborns;
  • Develop a standardized format for reporting to give feedback to providers and information to patients, purchasers, and policy makers, and request the voluntary reporting of maternity care quality measures;
  • Develop the initial maternity care Quality Data Set to enable electronic health records to routinely collect and report the maternity care quality measures;
  • Create a national demonstration project to identify and evaluate emerging payment reform mechanisms that support high-quality, high-value care (e.g., bundled payment for a full episode of care for women and newborns); and,
  • Authorize an Institute of Medicine report to identify a package of essential evidence-based maternity care services for childbearing women and newborns.
Endorsed by a number of maternity/baby advocates, including Childbirth Connection, the American College of Nurse-Midwives, the International Childbirth Education Association, and the Coalition for Improving Maternity Services, the bill does not lack for support.
“Childbirth Connection commends Representatives Engel and Myrick for their bipartisan leadership in introducing this legislation, which would provide essential, targeted federal support to improve the quality of our nation’s maternity care system,” said Childbirth Connection Executive Director Maureen Corry, MPH.   

For More Information

Lane County State's Top Fetal-Infant Mortality Rate



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In your box on the infant death rate in Lane County, I see you made an error which is quite frequently made about infant and perinatal death statistics.These rates are calculated per THOUSAND, not per HUNDRED as your writer assumed. The rate is closer to 8/1000, and not 8 out of one hundred! (Oregon statistical data is available online as a matter of public record.) Every death of a baby or child is tragic, and a preventable death is doubly so. We as a .society should do everything possible to assure the health of all citizens, and especially the mothers and babies who represent our future. It's important to be aware of the disparities in public health caused by lack of access to affordable medical care.But I think your readers will be relieved to realize hat the situation is not as dire as those mistaken statistics imply! Gail Hart, Oregon Midwife and Birth Issues researcher

One should also be cautious about making direct comparisons to other countries' outcomes, as often these are not adjusted for demographic diversity, i.e. Americans are a more genetically diverse bunch, and therefore can be expected to have more diverse medical outcomes than a country such as Japan, for example. However, access to care (since we are the only nation in our peer group to have a private health care system, rationed on the ability to pay) must also be viewed as a very plausible factor in any outcome disparities found (provided they are adjusted for demographics). The sooner we truly understand how our system performs relative to other systems, the sooner we can take concrete steps to improve it.