ABOUT MY WORK:
In one of the most advanced countries in the international sphere, it’s difficult to comprehend why the United States has an alarmingly high rate of maternal mortality. Specifically within the state of Texas, 14.6 deaths are accounted per every 100,000 live births (Johansen 2019). Furthermore, for black women in Texas, the number jumps to 27.8 per 100,000, suggesting race and location may have an effect on maternal mortality rates. In my work, I seek to expose the injustices surrounding pregnancy and childbirth in various areas within the city of Austin, attributing zip code to the rate of maternal mortality. By taking a feminist approach while incorporating a unique take on geographic political economy, my work shapes the issue of maternal mortality in a more holistic way with geographical location being the driving force of circumstance. Drawing upon analysis done by scholars in the field, I establish a baseline understanding of where maternal mortality rates stem from: socioeconomic inequity and possibly racial capitalism. Proceeding this analysis, I continue by citing Dr. Melinda Lopez, a doctor and professor at Dell Medical School in Austin, Texas about her views on maternal mortality and what the source could be. The findings of this study will likely be one that further exposes the maternal mortality problem in Texas, creating a sound correlation between geographic location and quality, or lack thereof, of maternal care.
For the purposes of my research, maternal mortality is defined by the World Health Organization as, "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."
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NOTE: I believe it is important to acknowledge that the model of capitalism that I base my analysis on is void of any ethical logic. Ethics is grounded in moral obligation, and nothing about capitalism through the political economy framework follows that model. If anything, capitalism is a lack of morality, thus it could be understood that the crux of my research stems from a lack of ethical principles found within the healthcare system that are rooted in society.
TAKE A TOUR THROUGH AUSTIN:
The map depicts the birthing centers located in the Austin area. As noted in the virtual tour, these centers are located on the western half of I-35, where the wealthier reside. Is this coincidental? Birthing centers are about half the cost of a regular hospital birth. Their location away from lower income areas that could potentially benefit from them signals a direct correlation between socioeconomic status and accessibility to healthcare.
THE FACTS:
The Centers for Disease Control published a study that looked into the maternal mortality crisis in the United States as a whole. The study concluded that, "Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2016, the pregnancy-related mortality ratios were: 42.4 deaths per 100,000 live births for black non-Hispanic women, 30.4 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women, 14.1 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women, 13.0 deaths per 100,000 live births for white non-Hispanic women, and 11.3 deaths per 100,000 live births for Hispanic women."​
“Pregnancy Mortality Surveillance System.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Oct. 2019, www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm#causes.
Texas assembled a Maternal Mortality and Morbidity Task Force in 2018 to ease outrage over the mortality rate. Their report concluded that Texas’ level of mortality was on par with other states, but this report is in the context of the 2012 maternal mortality rate in Texas. They did conclude, however, that even in 2012 race played a factor in the percentage of maternal deaths.
"Black women were affected by pregnancy-related death more than any other race or ethnicity... the pregnancy related rate for Non-Hispanic Black women was 2.3 times higher than the rate for Non-Hispanic White women."
-MMTF Joint Report 2018
PROFESSIONAL ASSESSMENT:
Dr. Melinda Lopez is an affiliate faculty in the Department of Women's Health at Dell Medical School in Austin, Texas. The American College of Obstetricians and Gynecologists fellow currently works as the director of reproductive health at People's Community Clinic. In her eight years of practice in Women's Health, Lopez estimates 95% of her patients identify with a minority background. Her office is located in the far north Austin area, on the east half of I-35. This location could be an indicator of her patient populous.
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In May 2019, a PBS report cited that Texas' maternal mortality rate was 14.6 per every 100,000 live births. Contributions to the increasing rate at which women face maternal mortality in Texas include "barriers to access to primary healthcare and nutritional information as well as access to contraception," according to Dr. Lopez. Moreover, she identified that by improving "access to contraception... primary healthcare outside of pregnancy... [and] weight loss programs that work," a possible solution to the cycle of maternal mortality could be found. All of these disparities are things known to inhibit individuals of lower socioeconomic status, and given the coinciding location of her clinic, it's not difficult to understand why. During her practice, Dr. Lopez has also been able to identify areas of reform for her clinic, including "funding for tubal ligations and immediate postpartum long-acting contraception access, as well as gynecological surgical treatment options."
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FEMININE CHALLENGES:
Historically, various studies and analysis done by scholars have come to confirm the gendered disparities in access to healthcare. Because of the power structures displayed in the 21st Century, it's not hard to understand why women are directly impacted by their limited accessibility. When considering maternal mortality, women who are disadvantaged do not have easy access to commodities such as transportation. A lack of transportation can directly hinder how women are taken to find medical care. When considering geographical disparities, the location of hospitals on the opposite side of I-35 would prove to be a challenge for expecting mothers.
Rizer, Claire. “Coalition Pushes for Reduction in Gender Disparities in Health Care Research.” American Heart Association , 2016, newsarchive.heart.org/coalition-pushes-for-reduction-in-gender-disparities-in-health-care-research/.
"Gender norms may further have a direct impact on the use of maternal health service by limiting women׳s mobility and access to employment opportunities or resource management, lowering their self-esteem and creating an environment of fear and stress."
- Adjwanou et al
CONCLUSION:
When assessing maternal mortality, the feminist and political economist perspectives that I based my research off of proved to further expound on the geographical disparities that are causing the high rates of death in the Austin-Metro area. First, by visualizing the discrepancy in access to health care through a virtual tour and map depiction, I was able to conclude that medical centers tended to be built on the Western half of Interstate 35, the road that divides Austin's regular and high end standards of living and the low end ones. I then cited a CDC study that concluded that minority individuals, specifically Black women, were more likely to be susceptible to maternal mortality in the United States. The political economy perspective invests in the empirically proven assumption that minority women are structurally disadvantaged in the United States on the basis of class. In connection with geographical location, an interview with local Dr. Melinda Lopez of Dell Medical School and People's Community Clinic, I was able to conclude that the location of her clinic (on the Eastern half of I-35), led to her lack of resources and the list of barriers to quality care in the prevention of maternal mortality. By attributing the power structure of race with geography, I further entrenched the idea that location shapes the level of healthcare that one may attain.
Finally, by incorporating a feminist approach, I compare the power structure of maternal and paternal in immediate access to healthcare and was able to show that disadvantaged women have less immediate access to care when it is needed.
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Overall, my research was able to solidify that geographic location could very well have an overbearing impact on the quality of healthcare attained and the maternal mortality rate in Austin, Texas.