Motherhood in America: The Dystopian Future is Now

Save the Children, a non-profit that works internationally to raise money and advocate for children's health and educational opportunities, just came out with it's annual State of the World's Mothers Report. For those of us living in the United States, it looks pretty dismal.

In 2000, 2004, and once again in 2006, the U.S. was listed as one of the top 10 countries in which to be a mother in the world. We've slowly dropped in rank and are listed in the 2014 report at 31st. This rating is mainly a measure of something we in public health call "maternal mortality" which is the polite way of saying "how likely it is that any given woman will die while pregnant."

Seriously. Let's rewind a second and unpack that. In measuring how likely a woman is going to die during the 40weeks of pregnancy or immediately following birth. That could be because of an illegal or otherwise botched abortion. That could be due because she had an unluckily attached placenta that took over her uterus. That could be due to high blood pressure or blood clotting, both common in pregnancy. That could be due to infection, sexually transmitted or otherwise. It could be due to her violent partner. Any reason really.

Now that we're out of the Downton Abbey days of medical mystery, people rarely think about death when they see the two little pink lines on that home pregnancy test, but the maternal mortality rate in the U.S. has been rising. Back in 1990, it was around 12.4 women out of every 100,000 who would die. Today, it's 18.5 per 100,000.

To give you an idea of what those numbers look like, imagine the city of Chicago, which is approximately 2.7 million people. Assume that half are women, so that's 1.35 million people. The difference between a rate of 12.4 and 18.5 is 6.1  extra women dying per 100,000. In Chicago, that 82 women. 82 extra deaths. Now, because math, this does not mean that there were actually 250 maternal deaths in Chicago in 2014 because this is a statistic that looks at risk over life time, but I find that numbers make more sense when they are to scale. Each year, approximately 700 pregnant women die in the United States - seeing as how few women are pregnant at any given time (somewhere around 2% of women), that's a lot.

So why is this? Why when the U.S. outspends most of the world on health care do we have a maternal mortality rate that rivals Chile's? I have a theory.


First off, let's look at who is having children. Is it healthy, gainfully employed, women in committed partnerships between the ages of 22 and 35? NOPE! Those women are for the most part (myself excluded) entirely too smart to have kids. And, because they are gainfully employed, they have access to birth control and use it.

So, wait a minute. Too smart to have children during the time when it is statistically most likely that they and their baby will have the healthiest possible outcome? That doesn't make sense. Unless of course you look at the punitive laws and labor regulations in the U.S. regarding parental leave and maternal rights. You can be fired from your job for being pregnant in the United States of America in 2014. Sure, your employer can't say that's why, but thanks to our backward state legislatures, most states put the burden of proof on the employee and man, it is so easy to cook up reasons to fire someone if you don't want to have to deal with them any more. So, why would an employer not want to deal with a pregnant lady? Well for one thing, pregnant ladies are experiencing a huge tax on their bodies. In the best case scenario this just means that toward the end, she'll need to sit down more and that she can't lift heavy things anymore. But that is the best case. Furthermore, American labor laws put the burden of maternity leave on the mother and employer.

When I went on maternity leave, I took 12 weeks FMLA unpaid. During this time, I used up all of my vacation/sick days and took advantage of a short term disability policy that I bought. I still went some time without pay, which sucked, but Boybee and I saved for a long time to make it work. The fact that we could is a huge privilege for which I am incredibly grateful. But what about my employer? They were stuck paying out all of my benefit time all at once - which hits them hard in the old bank account - and on top of that, they had to find a part-time temp to replace some of my essential functions that other people just didn't have the time to do. For a small non-profit like the one I work for, that is a huge cost.

Luckily for me, my boss agrees that I am worth it and for serious, my cute Babybee has lent her cherubic face to many of our promotional materials gratis in return. Boybee took his 2 weeks vacation and then... that was it. He could have taken FMLA too but it would have been unpaid and we're not made out of money.

Our policies punish employers who hire women and punishes families who choose to have children. So, a smart woman, who cares about her job and financial future would be wise to wait to put her job at risk until after she's well established. For most, that means after she's 35 (or even 40) when the health risks start to jump for mom and baby.

Not only do these policy encourage women to delay childrearing, they encourage educated, wealthy, intelligent women to forgo it entirely. Not that there is anything wrong with choosing not to have kids! On the contrary, I fully believe that only people who really want to be parents should ever have kids in the first place (it's hard work and if you screw it up, you ruin a person!). But, let's go back to statistics.

Remember those 100,000 pregnant ladies of whom we're counting the risk of death? Fewer of them are educated. Fewer of them are employed. Fewer of them have access to basic health care. And we know, that fewer of them intended to get pregnant in the first place. No job means no health insurance. No health insurance means no birth control. No birth control means two pink lines on that home pregnancy test.

So, now, we have a pool of mainly poor women, with little to no access to health care, facing unintended pregnancies. They put on their Big Girl Panties and they deal. So what if they never really wanted to be a mom? Those types of choices are left to rich women who can afford birth control (including abortions, which start at over $600 - more than a month's rent around here). So what if being pregnant means that they lose their jobs? They're grown women and they have the moral fiber to make it work. I commend them for it. Seriously, I work with these women every day and they floor me with their strength, their fortitude, their determination. For the most part, I don't worry about their children - these kids have strong moms who make it work. But... we know that unintended children are at a higher risk for abuse and neglect, and we know that these kids are coming into an increasingly stratified society and they are starting out as have-nots.

But mostly? I worry about those moms. Those moms who can't afford their prenatal vitamins or nutritious food, or even, enough food. I worry about those moms who don't have the time or transportation to get to their prenatal care appointments - the appointments where they find out if you placenta is trying to eat you from the inside or if your blood pressure is going to get so high that you have seizures and lose kidney function. I worry about those moms who do make it to those appointments but who only get 5 minutes with a rushed resident who looks at them and says "you're fine."

I worry because it's those women who are dying. I don't know about you, but I am having Metropolis-esque visions of a downtrodden undersociety, forced to bear children and die for it while we privileged few control our fertility and profit off their cheap labor (yes, pun intended - I'm a bad person).