A few years ago I came across a quote attributed to one of the misogynist Catholic saints, though I can’t remember which. He said that a woman’s role was to bear lots of children, and it didn’t matter if she died in the process because “that’s what she’s there for.” I haven’t been able to locate that quote recently. Perhaps a reader can direct me to it.

The so-called saint died centuries ago but the attitude is still with us, and not only among Catholic theologians and politicians like JD Vance.

Today I’ll be talking about women’s health care, maternity care in particular, and comparing how such care is manifested in two very different countries.

Overview

In general, women get worse care than men. According to the World Economic Forum, “Historically, the medical system’s approach has been more of a patriarchal investigation into the human body, with data and results stemming from male-only testing and trials…including female participants in clinical studies only started in the late 1980s and was only made mandatory in the US in 1993…resources are often disproportionately allocated to diseases that primarily affect men.”

Things haven’t changed much in the 21st century. I have a copy of Atlas of Human Anatomy, third edition, published in 2003. Still, that recently, all the drawings are of men—the “standard” human—except for a few showing the female reproductive system.

We fare better in some places than others. Per a chart showing maternal mortality in 2020, covering 186 countries, women faced the lowest risk in Belarus—an estimated one maternal death in 100,000 live births. Norway and Poland were next, with two such deaths. The United States had 21, worse than all the rest of the developed countries, worse even than Russia (14) or Saudi Arabia (16). At least we can say we’re doing a little better than Iran (22) or China (23).

In 2020 the absolute worst place to give birth was South Sudan (1,223 maternal deaths per 100,000 live births). No surprise, after decades of civil war and an ongoing drought and famine. Afghanistan, then still at war with the United States, was the eighth worst (620).

Afghanistan

One would think that the end of the U.S.-Afghan war in 2021 would mean an improved life for all. Alas, not so. Last week I was horrified, but not surprised, that Afghanistan’s so-called Supreme Leader has issued a new decree against women. Previous decrees included the requirements to wear a burka covering everything including the eyes, not to leave their neighborhood without a male guardian, not to speak or sing where men can hear them, not to attend school beyond sixth grade. Now women will no longer be allowed to train as doctors, nurses, or midwives.

Since men are not allowed to touch women outside their own families, the Taliban allowed girls to study medicine, so that they could treat women—until this month, when female students in nursing and midwifery programs were told to go home and not return. One teacher told her student that the institute was closed until further notice.

This means that there is no medical care for Afghan women. None at all. According to a December 2023 statement from Stéphane Dujarric, spokesman for the U.N. Secretary-General, “Afghanistan is one of the most dangerous places for a woman to give birth, with one woman dying every two hours.”

United States

Maternal care is getting worse in the United States as well. The World Economic Forum cites a 2020 study published by the Centers for Disease Control, which said said that four out of five pregnancy-related deaths are preventable, and Black women are almost three times more likely to die from a pregnancy-related cause than white women.

And we pay more than any other nation for the privilege. For example, cost of a normal delivery in Japan is $3,200;  in the UK it is $2,300. In the United States it is $30,000.

As readers will know, since the Dobbs decision in June 2022, women in GOP-controlled states who were miscarrying, hemorrhaging, or in sepsis have died because they couldn’t get medical care. Hospitals turn them away for fear of being prosecuted under new laws. Emergency department doctors are afraid to treat them, for fear of losing their licenses and being imprisoned. In Texas, for example, they could be sentenced to 99 years.

OB-GYNs are leaving those states, and medical students seeking residencies in this field are going elsewhere. In Idaho, 25% of OB-GYNs have either left the state or retired. Per a survey of Texas OB-GYNs, 44% are retiring, leaving the state, going into another area of medicine, or leaving medicine altogether.

Even before the Dobbs decision, American women were losing access to gynecological and maternity care—not because of opposition to abortion, but because such care doesn’t turn a profit.

According to the New York Times, “Over 500 hospitals have closed their labor and delivery departments [between 2010 and 2022], according to a large new study, leaving most rural hospitals and more than a third of urban hospitals without obstetric care.” Why? Two reasons: First, obstetric care loses money despite what they charge for delivering a baby. Hospitals prefer to dump them and keep the profitable departments. “Running a labor and delivery unit can be exceptionally costly because it requires round-the-clock coverage from specialists who can assist in cesarean sections or other medical emergencies. Hospitals are typically paid a flat rate for each baby delivered, no matter how much a particular delivery may have cost.”

Second, there is a nationwide nursing shortage. The New York Times adds that “an estimated 100,000 nurses left the work force during the coronavirus pandemic.”  But it’s not just the pandemic. The median annual salary for an RN in 2022 was $81,220.  That same year, the CEO of Kaiser—a massive “non-profit” hospital and HMO complex—received $13,697,450.  Thirty other Kaiser executives had salaries in the millions.

One of them, Arlene Peasnell, senior VP in charge of HR and labor relations, particularly deserves notice. In October 2023 Kaiser nurses, pharmacists, and ER technicians staged a three-day strike. One issue was pay and the other was a staff shortage, requiring existing employees to work to exhaustion. At that time, Ms. Peasnell complained that the workers were overpaid. She received $1,316,567 that year.

The union did win a decent pay raise after that strike, plus the requirement that Kaiser invests in “job training programs…and other workforce development efforts to ensure an adequate supply of new employees for the future.”

According to the Chamber of Commerce, the United States has an “extreme” nursing shortage, which is projected to continue at least until 2032. “Inadequate levels of nursing staff contribute to errors and elevated mortality rates, along with heightened burnout and dissatisfaction among nurses.” As a result we’ve had dozens of hospital closures, particularly in rural areas—as well as closures of departments such as labor and delivery.

There’s also an extreme shortage of nurse educators. The Chamber notes that nursing programs turn away tens of thousands of qualified applicants every year, simply because there aren’t enough educators to train them.

A Triple Whammy

In sum, large numbers of women around the world are dying in childbirth due to the cruelty of patriarchal religion, the male-centered focus on medical research and treatment, and, in the United States, the greed of the health insurance industry.

Pressure from feminist groups and women in the medical field can do a great deal to save lives. And perhaps the recent execution of that United Healthcare CEO will lead to significant changes. One can only hope.