by Sita Dandiker and Tabitha Wilson

Introduction

 

As defined by the World Health Organization (WHO), “Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” This is the definition used for international maternal mortality comparisons. The United Nations made a Millennium Development Goal for a 75 percent reduction in maternal mortality from 1990-2015 and most countries have been able to commit to that goal. More specifically, maternal mortality rates in developed nations have fallen dramatically. However, there have been rising mortality rates in the United States, at an estimated 700-900 deaths every year. American mothers’ maternal mortality number has doubled from 2000-2014. This paper is seeking to analyze the reasons for such high maternal mortality rates with a Feminist critique through three main sections: Institutionalization in the healthcare industry, polarization and stratification in labor and delivery, and finally questioning/envisioning, valuing the devalued, and integrating.

Section I: Institutionalization in the Healthcare Industry

The inequality paradigm describes institutionalization as, “Each inequality is structured into social institutions, which in turn, reproduce it. The law is key to the institutionalization of the inequality paradigm…Another key economic institution which reproduces the inequality paradigm is the structuring of firms as narrowly profit motivated (which reproduces class and the man/nature inequality), and the structuring of a job hierarchy where whites and men and the educated monopolize the highest paid jobs…”. This concept can be applied to the United States’ healthcare system where a private sector system limits available care while maintaining health care disparities among poor people, rural communities, women, and ethnic and racial minorities.

Comparing the United States to similarly developed and wealthy countries indicates how successful the United States is at providing care to its people. The United Kingdom will be used as a model for comparison because the United States has the largest private sector health care system and the United Kingdom has the largest public sector health care system in the world. In addition, the United States and United Kingdom have a similar racial makeup and diversity, as well as a close GDP per capita. A WHO study concluded that the United Kingdom is ranked higher in financial fairness compared to the United States because the United Kingdom is based on a national tax-based system versus the private risk-based financing in the United States’ system; in the United Kingdom, a percentage of an individual’s income that goes to their care is equal. The British system is free through access, but it is paid for through taxation. No person is turned away from treatment. Gaps in insurance coverage and financial barriers are what make the United States’s system the most inaccessible. Otherwise, it is common for insured Americans and employers to pay a part of the medical care costs. In addition, insurance company coverage can vary depending on the package or company and all services and procedures may not be covered. This is true if an American has health care insurance, yet around 45 million Americans under the age of 65 lack insurance coverage. Patients who cannot afford medical services simply do not receive the care they may desperately need. Public insurance programs like Medicare and Medicaid do provide some health care services to  United States residents, but the programs are limited to people over the age of 65, those with a severe disability, or those meeting a certain low-income standard. Medicaid increases access to care, but usually does not cover specialist care. This is a result of Medicaid paying low fees to physicians, who then can choose to accept or deny Medicaid patients. For example, 76 percent of American orthopedists denied appointments to a Medicaid-insured child with a fracture; while only 18 percent of orthopedists denied a child with private insurance. Varying access to medical care through insurance coverage and financial barriers is a major contributor for disparities in health status.

The United States’ economic inequality has been increasing, and in direct correlation, so has inequalities in health care. The life expectancy gap between the richest and poorest 1 percent of Americans is 10:1 years for women and 14:6 years for men. The United States’ healthcare system recreates and sustains inequality among care. Poverty can lead to worse health outcomes and the socioeconomic profile of patients can affect the quality of care they may receive. A 1984 study found that uninsured patients were at a higher risk of receiving below standard medical care than insured patients, a ratio of 2:35. For example, poor Americans are exposed to more dangerous drug complications. 27 percent of low-income Medicare patients with dementia, hip or pelvic fractures, or chronic renal failure received contradicting medications compared to 16 percent of high-income Americans. In addition, healthcare takes a larger share of income from the poor than from the wealthy. This reinforces and can increase inequalities in disposable income. Those with lower incomes may only have access to unhealthy sanitary and dietary practices or service utilization, caused by systemic disadvantages.These systemic factors generate poor people’s increased chance of poor health outcomes, which leads to diminished income due to loss of wages, costs of healthcare, and greater vulnerability to catastrophic illness. The results of diminished income reinforces a cycle of poverty and limited access to healthcare.

Access to care can also be heavily influenced by geography. Most physicians are concentrated in cities and wealthy suburban towns. Access is continuing to decrease; The United States Government Accountability Office reported that 64 rural hospitals closed between 2013 and 2017. As a result, rural communities do not have as easy accessibility to primary and specialty care. In 2013, rural residents had 55.1 primary physicians available per 100,000 residents whereas urban residents had 79.3 primary care physicians per 100,000 residents. The National Rural Health Association reports that there are only 30 specialists for every 100,000 residents in rural communities compared to 263 specialists for every 100,000 urban residents.  Many rural and southern states do not have enough family planning resources. In a University of Minnesota School of Public Health study, researchers found that 54 percent  of rural counties did not have a hospital with obstetrics in 2014. In addition, Texas implemented funding cuts on family planning clinics. These closings led to an increase in unwanted pregnancies. This is problematic especially in cases like women in Lubbock who are more than 250 miles away from the nearest abortion clinic. Rural populations who may live on farms, ranches, reservations, and frontiers typically have to travel long distances to even reach a primary care provider. As a result, an initial appointment may mean taking hours away from work which can lead to people delaying or avoiding care. Also, the further the populations, the longer it would take for emergency medical services to reach the communities. The lack of funding and resources is worrisome because according to the Centers for Disease Control and Prevention (CDC), heart disease, cancer, unintentional injury, chronic respiratory diseases, and stroke are higher in rural communities. As a result, rural communities have an especially high death rate at about 830.5 deaths for per 100,000 rural residents whereas urban residents had a death rate of about 704.3 per 100,000 residents in 2014. Rural health disparities have become a growing problem due to funding cuts and less resources.

American women also have less accessibility to health care. Women are at a disadvantage because they have a larger amount of health care needs, like reproductive care, compared to men. For example, in 2013, women with employer-sponsored coverage paid $233 more for out-of-pocket charges compared to men. These costs can become detrimental especially since women’s incomes are already on average lower than men. The limited insurance coverage and high costs maintains financial inequalities between men and women. Also, the United States medical system has gender biases. A 2000 study in The New England Journal of Medicine found that women are seven times more likely to be misdiagnosed and discharged in the middle of having a heart attack in comparison to men. This misdiagnosis and lack of proper care is due to the fact that medical concepts have historically been studied on male subjects and male physiology. Women can have different symptoms than men, yet there still is not enough research to understand the difference.

Unequal access to care and institutional racism steers and maintains health-care quality disparities for racial and ethnic minorities. For example, African-Americans frequently live closer to high quality hospitals compared to white patients but they are less likely to have their surgeries at these hospitals. Risk factors for poor health are emphasized in many racial and ethnic minorities but these risks are even more pronounced because minorities tend to be found in lower socioeconomic classes. Bernabei et al. (1998) conducted a treatment study analyzing the use of pain management among 13,625 elderly and minority cancer patients admitted to nursing homes following cancer treatment. It was found that 26 percent  of patients who experienced daily pain received no pain medication. After controlling for variables like gender, cognitive status, communication skills, indicators of disease severity, being bedridden, number of diagnoses, and use of other medications, the authors found that African Americans were 63 percent  likely to be untreated compared to their white counterparts. Another study looked at the use of prenatal care among civilian and military populations. Barfield et al. (1996) found that prenatal care utilization was lower for black patients than white patients in both military and civilian populations. Even after controlling for variables like age, marital status, education, income, site of prenatal care, type of payment, maternal health behaviors, when trimester care began, and prior adverse pregnancy outcomes, it was found that white women reported more instances of given information on alcohol and smoking risks compared to African-American women. Even the importance of breast-feeding was more commonly advised to white women. Most active military and veterans are given a military health care system that incorporates medical care into retirement. This study is interesting to examine because it shows that even with access to care, African American women are at a disadvantage. Reasons for these health inequalities, specifically for African American women, are due to the cumulative historic and present discrimination. Racism plays a large role in low minority health status as it is maintained through institutional discrimination where policies, practices, and procedures are at the cost of African Americans’ health. Consistent results from many studies show that racial and ethnic minority patients are found to receive less and lower quality healthcare despite access-related factors like insurance status, and other socioeconomic and geographic variables.

Overall, there is a lack of nationalized, standardized healthcare within the United States and the lack of structure reinforces inequalities between patients.

 

Section II: Polarization & Stratification in Labor & Delivery

 

After completing pregnancy with little to no standards on prenatal care due to the lack of a nationalized health care system, expecting mothers then must endure more inequalities within the healthcare system during labor and delivery. Women are most at risk during the labor and delivery, with most maternal deaths occurring the delivery or shortly after. The compounded inequalities experienced within this short amount of time places a large stress on the mother, who is not given routine care. Overall, this lack of care and patient autonomy creates an environment which women fall to victim to, often dying of very preventable causes.

As a result of the medical practice viewing pregnancy and birth as inherently non-natural and “pathologic,” women increasingly began to give birth in hospitals. This is a fairly recent phenomenon, with the majority of women giving birth in hospitals only between 1945-1950. Home births attended by a midwife were the previous average for women of all backgrounds. As the campaigns for public health continued with the increased construction of hospitals and other medical facilities, the validity of the midwifery profession was repeatedly attacked. Midwives were told by medical “professionals” that they were unqualified and lacked sufficient medical training and that doctors were better tasked to handle the “pathologic” birth. American midwives at this time were more often Black and/or low income thus their experience and input was not as valued as white male doctors, who were viewed as smarter and well-intentioned, a hallmark of the contemporary paternalistic paradigm. While infant mortality, as well as maternal mortality were severe problems that needed to be addressed and remedied, doctors chose to solely handle the birthing processes instead of modernly training midwives or incorporating them to a lesser extent. We can see racial and gendered polarization in early obstetricians which still continues today. Midwives, and other more informal birthing assistants, were less chosen by women of status who didn’t want to appear uncultured, ultimately trickling down to common women. With doctors solely attending over labor and delivery, the birthing sphere transferred from the informal space of the home to the formalized, medicated space of the hospital.

 In 2014, virtually all American women gave birth in hospitals, with only 2 percent of women choosing an at home birth or other alternative form of delivery. This is a stark contrast to other developed nations, in the Netherlands, 20 percent of births are at home, and in the United Kingdom the majority of births occur in birthing centers for lower-risk pregnancies attended by a midwife. American women are the least likely to seek these alternative less-medicated forms of delivery due to their overall lack of choice in the birthing process. American women also have little choice in which hospital they give birth in; rural areas have fewer hospitals, which can be a long drive away. Other class boundaries dictate which hospitals become accessible, as those who are uninsured or have lower coverage may not be able to afford a hospital with quality care. Even women with locality and class privilege may find themselves with care that they do not personally feel comfortable with.

The polarization of healthcare provider and patient during the labor and delivery process begins long before labor contractions are felt. Doctors usually recommend cesarean section delivery, even to women who have low-risk pregnancies and could complete an uncomplicated natural birth. This stems from the aforementioned thought that the medical community views pregnancy and birth as a pathological disease that requires stringent medical intervention. Cesarean section, or c-section, deliveries have aided in the successful deliveries of multiple births, premature births, and other high risk pregnancies where natural delivery would not have been possible. However, 1 in 3 births in America are now performed by cesarean sections, while the estimated medically necessary amount of procedures is 10 to 15 percent overall. Even if women prefer a natural birth, they are likely to be convinced otherwise by healthcare providers who ultimately have power over their patients and their health. The popularity of cesarean sections also contributes to the profit of the healthcare system; as the average c-section surgery costs around $15,000, while a natural birth costs almost half the amount at around $9,000. Doctors’ misguided values about pregnancy and perhaps ulterior motives concerning profit lead them to over-prescribe the procedure to women who ultimately do not need it. Women may also choose to undergo the procedure with an aversion to labor pains, or the flexibility in being able to schedule their delivery day, which provides an advantage to women who cannot unexpectedly commute to their nearest hospital or women with commitments that they cannot escape.

Upon arrival to the hospital site, whether planned or unplanned, women are then escorted to the maternity ward where they will give birth. The removal of the birthing process from the informal sphere of the home to the formalized setting of the hospital limits the amount of physical support a woman can have, as the majority of hospitals impose a three person limit in the delivery room. Besides the newborn’s father, who may or may not be a supportive force, there is little room to have an encouraging presence to have the birthing process be a positive experience. Women are then offered pain management options, which only consists of the local anaesthetic of the epidural. Epidurals are mandatory for c-sections, as it is a surgical procedure, and many women chose the epidural which is administered to the spinal cord, effectively numbing the body’s lower half. If administered improperly, the epidural can result in permanent disability and excess spinal fluid resulting in brain swelling. Many women do not enjoy taking these severe risks, although they are small and infrequent, but do not want to face labor pains completely unmedicated, and most conventional pain management tools interfere with the newborn or birthing process. While it might seem that the epidural is the only option for successful pain management, there are a variety of pain management tools used in more natural birthing methods and abroad. Nitrous oxide, or more commonly referred to as “gas and air,” is an analgesic that reduces anxiety and pain and is commonly used in the United Kingdom and other European countries as an alternative to the epidural. In the United States, it is commonly used during dental procedures and other outpatient surgeries. Nitrous oxide has not been shown to affect the newborn or mother and has other benefits in that it is self-administered by the woman, allowing her to be in control of her pain management. Because it is an analgesic, it does not reduce sensitivity to the lower body, allowing the woman to more easily “bear down” during delivery and have free motion during labor. The epidural can render a woman temporarily unable to walk, which can cause anxiety in some. There are also natural pain management options, such as hot water baths, breathing techniques and movement to reduce pain and anxiety. The hospital environment limits exploration in these natural alternatives, and American doctors should allow for other medical alternatives to the epidural.

Questioning and self-advocacy are usually not allowed for in this paradigm. Doctors operate within the inequality paradigm and have power over their patients. They are viewed as ultimately more knowledgeable about someone’s body, although they are not experiencing and feeling what the actual individual feels. Western doctors are also inclined to reject more natural forms of medicine and treatment, and place value on medication and procedures than other forms of treatment a patient would like to explore at no medical detriment. In addition, doctors, even obstetricians and gynecologists, are more likely to be male, thus playing into the male/female stratification. Men in authority feel that they have a better grasp on the female reproductive system. Women doctors and patients themselves have internalized a certain capacity about gendered roles and authority and do not seek to question medical processes and procedures, even when concerning their own life and that of their child’s. Women in America are advised against having an alternative birth, even when it is medically safe to do so. Instead, they are likely to be advised to have an over-medicated c-section birth when not necessary, introducing surgical risks that may have to be addressed later on. Race is also another factor involved in this stratification of doctor/patient. Stereotypically, non-white races are not seen as intelligent; as either an inherent feature of the race, or due to possible recent immigration status. Doctors may spend less time explaining key care concepts to non-white patients or not entertain valid questions. For Black women, self-advocacy is not viewed as a positive trait of self-respect and inquisitiveness, but rather as anger, or purposefully causing trouble with authority figures. Self-advocacy is more likely to go unheard by doctors and other healthcare providers or even escalate anxiety by causing a verbal altercation between the patient and hospital staff. Although most of the birthing process is optional and with plenty alternatives for women with lower risk pregnancies, even in practice in other respected and developed, nations, the American medical community takes the current process as standard and doesn’t tolerate self-advocacy from women, especially Black women.

Delivery is when the medical attention shifts from the expecting mother to the newborn child. Over the last few decades, the worldwide standard on infant mortality has vastly improved, and America stands with its fellow Western developed nations as having one of the lowest infant mortality rates worldwide. In an elevated risk situation, doctors can navigate complicated surgeries to ensure a safe delivery. Natural deliveries without complications are relatively straightforward. However, the moments after delivery are the most crucial for women, and have the largest margin of error. Healthcare providers are now tasked with not only the care of the mother, but also her newborn child as well. In America, a large emphasis has been placed on the care of the newborn, often neglecting the mother in turn. While this can be traced back to more practical reasons such as the lack of staffing or the public awareness of infant mortality; there is a more theoretical sexist rationale that women serve as vessels for newborn children and are not viewed as autonomous beings. This type of rationale is most seen in right wing pro-life arguments, but also carries into the mainstream as well. As society, we view fetuses and newborn babies as such helpless entities that we forget that the pregnant women or new mother can also be in compromising situations as well. Doctors, nurses, and the small set of loved ones present turn their attention to the newborn, often missing vital checks that should be performed on the mother. The mother herself is also occupied with her newborn baby, and as she has just went through an extremely stressful process, is not necessarily as in tune with her body and feelings as she would be normally. The most common problems faced during or shortly after delivery are complications due to preeclampsia and internal bleeding. Preeclampsia is the development of high blood pressure during gestation or shortly after delivery, and in severe cases can lead to eclampsia or HELLP (Hemolysis, Elevated Liver enzymes, Low platelets) syndrome; placing the woman at risk for heart attack and stroke. While most cases of preeclampsia are diagnosed before delivery, the condition can develop during delivery or shortly after, reinforcing the need for doctors to routinely monitor mothers after delivery. Because there is no standard on postnatal care, women often fall through the cracks of the system and problems are not recognized until more fatal. Similarly women can face internal bleeding as a complication from delivery, which routine checks can diagnose and draw attention to the situation before more serious complications can arise. As doctors turn their attention to the newborn with a lack of routine vital checks on the mother, problems remain undiagnosed and not taken care of. This is where we can see a sharp contrast in the postpartum care in the United States and the United Kingdom; the United Kingdom has standards that dictate that women should have vital checks routinely every few hours and have a lower blood pressure cutoff for diagnosing preeclampsia/eclampsia, averting more serious issues.

Race is also a factor in delivery and postpartum complications. In lieu of standardized routine checks, doctors and nurses rely on patient feedback to detect issues. However, not all patient feedback is received with the same weight. Black women are perceived by health care professionals to be able to sustain more pain, and as a result, healthcare providers can often undervalue the pain that these women report, leading to false recommendations and not providing enough adequate care and medication. This also increases the stratification between doctors/patients and deeply divides the birthing experience by race. This factor, in combination with the other aforementioned factors make Black women more susceptible to maternal mortality than their other racial counterparts, despite income level. There are also racially related stressors that impact the body and psychological state of Black women, which may also negatively affect pregnancy and the birthing process. Black women can report early signs of internal bleeding and high blood pressure complications and then are dismissed until these prove fatal. Having standardized care and ensuring that doctors check for any and all symptoms can help alleviate this racial disparity, as the United Kingdom’s maternal mortality rate is similar for all races. Doctors should also be aware that different racial-ethnic groups have different risk factors for certain diseases.

 

Section III: Questioning/Envisioning, Valuing the Devalued, and Integrating

 

A large portion of why the United States has such a high maternal mortality rate is that within the medical community, and in society as a whole, we fail to value the traditionally devalued. Childbirth and mothering are not viewed as important responsibilities that need to be celebrated and supported. The birthing process is seen as a means to an end, exemplified by the lack of care given to mothers after delivery and the focus on the newborn. The removal of the birthing process from the informal to formal sphere has also left women without much needed support. A paradigm shift is needed to view pregnancy and delivery as an important process that women should feel comfortable at all times in, instead of a pathologic disease that needs medical treatment.

While medical intervention in pregnancy is sometimes necessary for the health of the mother or fetus, there has been a trend to overprescribe intervention in what is a normal and natural process. From the medically necessary 10-15 percent of pregnancies that actually require cesarean section, there is an observed rate of approximately 30 percent of deliveries that result in c-sections. Doctors and other healthcare providers should encourage more natural options of delivery when possible, reducing complications from surgery and also allowing women to not be confined to the physical space of the hospital. Alternative methods of birth should be explored by the American medical community; such as adapting maternity wards to have a more informal feel or opening birthing centers similar to those in the United Kingdom, which would allow expecting mothers to have more physical support present and reduce the anxiety of being in a hospital environment. Healthcare staff in any birthing space also need to be trained to have an increased bedside manner and be more aware of women’s emotional cues. Healthcare providers need to educate women from early on to empower them in their choices, allowing for greater self-autonomy. In this capacity, midwives should be reintroduced to the birthing process in the United States. Midwives can serve as a valuable mediator between doctors and patients, taking on the tasks of educating pregnant women and providing clarity and emotional support when necessary. This also reintroduces personal care into the birthing sphere, and midwives can also help accommodate women of certain groups who may feel less comfortable talking to a doctor.  

Pregnant women and new mothers also need to be valued by the medical community. This translates to making sure that all women receive the same standardized care and that there is routine care for a woman’s health before, during, and after pregnancy. Healthcare staff needs to understand that women are also at risk for medical complications and that this is not only a sensitive time for the fetus or newborn baby. To combat internal biases, women should have routine blood pressure checks during and after delivery, and healthcare staff should investigate all claims of discomfort, ensuring that certain claims are not investigated over others. Care also must be sustained after discharge, and recommendations should change that women check in with a healthcare professional before the currently recommended 4-6 weeks postpartum visit. Care professionals should be trained to recognize postpartum depression and help women receive the help and support they need, while using supportive language with patients. Childbirth can be a traumatic experience for women and the proper care and resources should be made available. As a society, we need to ensure that women are supported during this process and encourage women to make choices that best support them and their lifestyle.  

It will also be important for mothers and their care work to be respected and addressed in outside of the hospital. According to the Organization for Economic Cooperation and Development (OECD), the United States is the only country in the developed world that does not require employers to offer paid leave for mothers following childbirth. The only federal law guaranteeing maternity leave in the United States is unpaid. In addition, the Family and Medical Leave Act will also protect a mother’s job for up to 12 weeks following a childbirth or adoption. The United Kingdom gives new mothers up to 39 weeks of paid leave. It is time for the United States government to mandate mandatory paid leave policies prior and post partum. This time will be important mothers to get proper care and education during their pregnancy and prior to giving birth. Studies have found that women who did not take leave before childbirth were four times more likely to have a c-section compared to women who did take leave prior to delivering. Furthermore, women without prenatal leave are more likely to give birth prematurely or deliver small-for-gestational-age babies. This time will also be important for mothers who need time to recover both physically and mentally from childbirth. More importantly, this pregnant mother policy would allow mothers to make ends meet which would help finance their own medical costs and the health care costs for their baby.

A broad approach is needed to address disparate access to and use of healthcare services is needed to seriously address disparities in health status; The United States can integrate care to allow low-income people to have access to high quality care. There are many pathways to achieve a more accessible health care system. It is essential for the government, insurance companies, and patients to focus on the support for preventative health care methods. Preventative health care can help avoid or immediately treat diseases before the patient’s health becomes critical. Routine appointments like counseling, screening, wellness visits, or prenatal care can improve health and reduce costs. By catching something early on, patients may have no insurance copays or other out-of-pocket costs for certain appointments and will not have to worry as much about the possibility of extensive and expensive medical care costs. The United Kingdom’s health care system has less variation in health outcomes across its population. Barbara Starfield and Liyu Shi conducted global comparative policy studies and the researchers concluded that the United Kingdom is the country that has made the most progress in developing primary care which is one factor that explains why it is able to deliver universal and comprehensive health care for a lower level of spending compared to the United States.

Another strategy to increase access to high quality medical care can be to make Medicare and Medicaid payments continue to and eventually completely focus on quality. This pay for performance idea would be an initiative with the goal of improving efficiency and value of health care. The government would provide financial incentives and disincentives to healthcare providers based on performance. Health care providers tend to receive more money for critical conditions like treating a diabetic patient with kidney failure compared to working long term with a patient to try prevent kidney failure though better blood glucose control. The pay for performance program would promote profit driven institutions to promote preventative care; Doctors would be rewarded for improving health outcomes. As a result, even low income patients who have limited care will be able to experience the same medical care as high income patients.

After extensively researching the maternal mortality rate and its causes, we realized a need to promote the information that we have collected to better educate women and their allies on how to best solve this issue. We wanted to create tools that can empower women and promote self-advocacy and the advocacy of others. While we have found and presented alarming statistics throughout this paper, many women, including pregnant women do not know that the maternal mortality rate in the United States is so high. After collectively brainstorming on the most efficient and accessible way to deliver this information, we decided that we wanted to educate our immediate Wellesley community through a lecture given by a knowledgeable healthcare professional and/or professor and also create an infographic to be shared on social media to educate a larger community. This is how we personally plan to use feminist transformations on the data we have collected.

Education is large first step in solving this rather large problem. Education empowers individuals and encourages them to behave differently. Many women, and especially women of color, have had negative or traumatic experiences surrounding birth in this country. Too often these women are not validated and feel isolated in their experiences. Highlighting that this is, in fact, a very large issue that this country is facing gives validity to these traumatic experiences and lets women know that they are not alone in their experiences and that this is a larger systematic issue rather than a personal one. Women who have had negative birth experiences can believe that it is their personal responsibility that they didn’t have a more positive experience. Women can also feel shame based on the delivery method selected and education can empower women in their choices, especially reducing the shame and stigma associated with more natural deliveries. Increasing awareness also promotes self-advocacy and advocacy for others. Women can feel more warranted in asking their healthcare providers questions surrounding their care during pregnancy and delivery, and also understand that they do not have to cooperate with healthcare providers if they feel uncomfortable doing so. Bringing attention to the issue also encourages others to advocate for pregnant friends and loved ones. Others can make sure that their expecting loved ones’ concerns are heard by healthcare providers and provide additional emotional and physical support if possible. Education can help close the polarized gap and promote more men becoming involved in their pregnant partners’ journey.

The lecture will be important to inform Wellesley College students about the state of maternal health. Our peers will learn what they can do and how they can prepare themselves for future experiences..

As members of the Lecture Society at Wellesley College we would like to invite some local experts on maternal mortality to visit and speak about maternal health and what work is currently being done to help mediate the dramatic maternal mortality rates in the United States.

One potential lecturer could be Dr. Neel Shah who is an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, and director of the Delivery Decisions Initiative at Harvard’s Ariadne Labs. Also, Dr. Shah founded Costs of Care, a global NGO that curates insights from clinicians to help delivery systems provide better care.e would be a great speaker on the status of maternal mortality today, including some of his own experiences. In 2017, Dr. Shah also co-founded the March for Moms Association, a coalition of 20 leading organizations, to increase public and private investment in the wellbeing of mothers. Dr. Shah would be able to talk about what women can do to help other women and help create a more accessible maternal health care structure.

Harvard T.H. Chan School of Public Health’s Ana Langer could be another option for a lecturer. Dr. Langer is a Professor of the Practice of Public Health and the Coordinator of the Dean’s Special Initiative on Women and Health. She is a physician specializing in pediatrics and neonatology, and a reproductive health expert. Dr. Langer is mostly known for her work in reproductive and maternal health and the imp improvement of quality of healthcare for women and families. In 2015, Dr. Langer published Women and Health: A key to sustainable development. Her paper analyzes women’s health along life cycles and its connections with social determinants. She also covers topics such as how women commonly play critical roles as health care givers and contribute to the development of communities and nations. Dr. Langer would be a great lecturer who would be able to talk about her research, her own personal experiences, and the importance of women and mothers in growing societies.