ARGUMENTATIVE ESSAY
Ensuring High-Quality Prenatal and Postnatal Healthcare in America
The quality of prenatal and postnatal care is crucial for the health and well-being of both mothers and babies. Even though currently there are many initiatives and efforts aimed at improving maternal healthcare in the U.S., we face quite significant challenges. Here we will dive into current practices, hopefully pointing out the gaps in care and suggesting ways to improve the healthcare system for mothers. This essay will critique/examine current issues and approaches to them.
Government Initiatives and Their Impact:
Recent government initiatives, according to the White House's 2024 report recorded in the White House Newsroom, are trying with a seemingly large effort to tackle the maternal health crisis in the U.S. There are 22 points listed in the Newsroom article but some notable initiatives include working to establish federal standards for maternal emergency services, extend Medicaid coverage to 12 months postpartum, and promote doula/lactation services. They introduced a "Birthing Friendly" hospital designation and a National Maternal Mental Health Hotline. There is work to diversify perinatal healthcare providers, and expanding the "Hear Her" campaign. It seems to cover accessibility, awareness, and an emphasis on mental health.
While these efforts are commendable, one could have some concerns about how effectively they are being implemented. As we know, it takes a lot for these efforts to trickle down and it also needs publicity, visibility, funds, etc. Sarah Miller says “the success of extending Medicaid coverage hinges on state-level adoption and whether comprehensive services are provided to all eligible women.” (2023) Additionally, while promoting doula services and mental health support is a step in the right direction, these services' availability and affordability vary widely across the country.
Critics of government intervention argue that it can lead to inefficiencies and reduced quality of care. Although the jury is out how grounded that argument is. Additionally, with the severity of the maternal health crisis, these measures are clearly necessary, especially considering the potential benefits. The real challenge is ensuring these policies are implemented well and also reach the ones who need them most.
Media Influence on Perceptions of Childbirth:
Media has a complicated and yet linear history of childbirth portrayals. They strongly display a single-story narrative and lean into stereotypes and tropes. They have a big impact on how people view the birthing process, which can very likely influence healthcare practices. A study by Chiareli and Beutel collects it’s data from 111 different films depicting childbirth since the 1980s. They almost exclusively hold the same tropes and almost exclusively shows it as a highly medicalized, painful, and emotionally intense experience.
These portrayals can significantly shape societal expectations and norms, reinforcing a reliance on medical interventions that might not always be necessary. A documentary called “The Business of Being Born” (2008) highlights this process of medical interventions. It specifically details the phenomenon of one intervention leading to another, in many cases eventually causing the need for lifesaving interventions. They coined the term “the cascade of interventions.” Although the film has some level of bias (obvious in the movie title), it argues a side we don’t often hear, and the cascade of interventions has then been studied and widely accepted in concept by birthworkers. When the cascade of interventions becomes the norm, we become reliant on highly medicalized births likely out of fear.
When the cascade of interventions and stereotypes are depicted over and over again in film, it can affect both patients and healthcare providers. For example, expectant mothers might internalize these depictions, leading to increased anxiety or a preference for medical interventions. Similarly, healthcare providers might unconsciously follow these norms, limiting their openness to alternative birthing options like midwifery or home births.
While media isn't the only factor influencing healthcare practices, it plays a significant role in shaping cultural attitudes. Promoting a more diverse and accurate portrayal of childbirth could help people understand that there are various safe and effective birthing options available.
Implications of Untreated PMADs:
Untreated perinatal mood and anxiety disorders (PMADs) are always a significant concern, both for the individuals affected and for society. A study from Vermont estimated that untreated PMADs could cost the state up to $48 million annually per birth cohort, highlighting the economic and social toll of these conditions (Platt, et. al, 2024). This situation shows a need for serious and comprehensive mental health support during and after pregnancy.
Investing in mental health services for expectant and new mothers is not only ethically important but also a smart financial decision. Early intervention and treatment can prevent long-term issues for both mothers and children, reducing overall healthcare costs and improving quality of life. However, implementing these interventions requires funding, trained professionals, and accessible services, especially in underserved areas.
The Vermont study provides a valuable example, but applying its findings nationwide would require significant policy changes and investment in the healthcare infrastructure.The flaw in this study is obviously that we don’t know for sure if the data applies to the broader nation. They did address this in the studies report stating, “ We estimate that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child.”
Challenges Noted in National Reports:
Despite ongoing efforts, significant challenges in maternal and infant health persist, as highlighted by national reports like the March of Dimes' 2023 "report card." This report gave the U.S. a D+ grade for preterm birth rates, indicating persistent issues such as racial disparities and inadequate access to quality care. Dr. Elizabeth Cherot, March of Dimes President and CEO notes, “We have long known that many of the factors impacting poor outcomes for moms and babies… The fact is, we are not prioritizing the health of moms and babies in this country, and our systems, policies, and environments, as they stand today, continue to put families at great risk." These findings are concerning, especially given the U.S.'s status as a developed nation with advanced medical resources.
The report also noted a 3% increase in infant mortality, the highest rise in over two decades. This raises very critical questions about the effectiveness of current healthcare policies and practices, especially in addressing systemic issues affecting vulnerable populations. The racial disparities in maternal and infant health outcomes are troubling, exposing some deep-rooted inequities in the healthcare system and society in general.
Addressing these challenges requires a comprehensive approach that goes beyond just healthcare reforms. We need to first acknowledge and then tackle bigger social aspects of health, such as socioeconomic status, education, and access to resources. It’s also clear that more thought-out data collection, studies, and analysis are needed to understand the cause of these disparities better and develop interventions accordingly.
Racial Disparities:
It’s likely that one of the most concerning aspects of maternal healthcare in the U.S. is the persistent racial disparities in outcomes, even among affluent individuals. A comprehensive study covered in a New York Times (2023) article found that Black mothers, regardless of socioeconomic status, face significantly higher rates of maternal and infant mortality compared to their white counterparts.
A recent study by the National Bureau of Economic Research, which analyzed data from nearly all first-time births in California from 2007 to 2016, highlights significant racial disparities in infant mortality. The study found that "premature infants born to poor parents are more likely to die than those born into the richest families. Yet there is one group that doesn’t gain the same protection from being rich: Black mothers and babies" (Maya Rossin-Slater, 2023). This really highlights the unique challenges faced by Black mothers and infants, regardless of economic status. This disparity highlights the impact of systemic racism in healthcare, which cannot be mitigated solely by financial means or access to high-quality facilities.
Data from California, for instance, revealed that for every 100,000 births, 437 babies born to the wealthiest Black mothers die before their first birthday, compared to 173 babies born to the wealthiest white mothers. (National Bureau of Economic Research, 2023) These differences seem to clearly suggest that the healthcare system is failing to provide equal care to all women, showing the clear urgent need for specific and focused policies to address these inequities.
Efforts to reduce these disparities should include full and comprehensive training for healthcare providers on implicit bias, increased support for community-based healthcare models, and policies aimed at improving access to care for marginalized communities. There is undoubtedly a need for more research to understand the underlying causes of these disparities and to develop evidence-based strategies for addressing them, however I personally believe implicit bias cannot be overemphasized as an issue. There is a clear correlation there because money and economic status is not changing the stats.
Conclusion:
The state of prenatal and postnatal healthcare in the United States is a complex picture with quite significant challenges and disparities. Although recent government initiatives and reforms show a lot of promise, an incredible amount of work remains to ensure that all women receive the high-quality care they need. Media portrayals of childbirth, untreated maternal mental health, healthcare challenges, and severe racial disparities all contribute to a multifaceted problem that requires a comprehensive and evidence-based response.
Addressing these issues will require a serious effort from policymakers, healthcare providers, and in a broad sense, society. We can each do something about this by shifting the social conversations and valuing unbiased practices/academic studies. To summarize, I propose actions including expanding access to mental health services, promoting diverse and evidence-based portrayals of childbirth, implementing policies to reduce racial disparities, and investing in comprehensive healthcare reforms that prioritize maternal and infant health. By taking these steps, we can work towards a healthcare system that truly supports and protects the health and well-being of all mothers and their children.
References:
The White House. “The White House Blueprint for Addressing the Maternal Health Crisis: Two Years of Progress.” The White House, 10 July 2024, www.whitehouse.gov/briefing-room/statements-releases/2024/07/10/the-white-house-blueprint-for-addressing-the-maternal-health-crisis-two-years-of-progress/. Accessed 17 July 2024.
Chiareli, I.A., Beutel, A.M. What to Expect When You’re Delivering? How the Gender Structure is Reinforced Through Fictional Depictions of Childbirth. Gend. Issues 41, 14 (2024). https://doi-org.ezproxy1.lib.asu.edu/10.1007/s12147-024-09330-y
Centers for Disease Control and Prevention. (2022). Maternal Mortality Rates in the United States, 2022. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.htm. Accessed 2 August 2024.
Platt, I.S., Pendl-Robinson, E.L., Dehus, E. et al. Societal costs of untreated perinatal mood and anxiety disorders in Vermont. Arch Womens Ment Health 27, 585–594 (2024). https://doi-org.ezproxy1.lib.asu.edu/10.1007/s00737-024-01429-1
March of Dimes. “2023 March of Dimes Report Card Shows Modest Improvement in U.S. Preterm Birth Rate, Which Remains at Decade-Long High, Earning Nation D+ Grade.” Www.marchofdimes.org, 16 Nov. 2023, www.marchofdimes.org/about/news/2023-march-dimes-report-card-shows-modest-improvement-us-preterm-birth-rate. Accessed 17 July 2024.
Miller, Claire, et al. “Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds.” The New York Times, 12 Feb. 2023, www.nytimes.com/interactive/2023/02/12/upshot/child-maternal-mortality-rich-poor.html. Accessed 18 July 2024.
COURSE REFLECTION
How would you describe your writing process before and after this project? Has there been any changes? If so which ones?
I don't think my process changed in any revolutionary way, but the annotated bibliography is definitely something I'm keeping in my back pocket because it was so much easier to write my paper. I also feel like it allowed me to take on more of an academic tone because the sources were thoroughly intertwined due to the research and thought I had to put into it previously.
What part of the assignment presented the biggest learning curve for you? Why do you think this specific portion of the assignment was challenging? How did you work though that? What did you learn in the process?
I mean... does anyone like having massive papers looming over them? But in all seriousness, I was initially very intimidated by the annotated bibliography assignments but when I spent time to break down what it was asking, I realized it was designed purposely in stepping stone pattern which made the final assignment much easier. Sometimes you just have to bite the bullet and do it--even with crippling ADHD.
What part of the assignment allowed you to use your strengths? Think back to the research process, your annotated bibliography, outlining your argument, peer reviews, etc.
Honestly the annotation assignments were super fun and engaging. But I did learn a lot about my argumentative essay topic that's now in my mental archives. And although I had to focus my essay to just a few aspects of the problem, my research led me down some happy-accident rabbit holes that have helped me come in more informed to a subject I'm a bit of an activist about.
Thinking about the writing you do for work, for other classes, for leisure, what have you learned in this class that you can use in other writing situations?
Like I said, the annotated bibliography project was kind of a game-changer for me. It definitely helped my final paper (although my process for writing my final paper didn't really change, just felt easier.) Also, I sort of used a traditional layout for my outline, but there was an annotation assignment about all the different ways you can customize an outline to work for you specifically and it definitely has me ruminating. Maybe that can improve my process in the future.