As the U.S. maternal mortality rate continues to increase, the new health care law could offer improvements in preventative care for women. Yet, definitive answers to why more American mothers are dying remain scarce

Credit: Celine Vignal on Flickr, under Creative Commons 2.0 (CC BY-NC-SA 2.0)

(WOMENSENEWS)--The future of pregnant women in the United States will significantly change Aug. 1.

That is when the new health care law, the Affordable Care Act, will require insurance providers and Medicaid to cover clinical preventative services for women, including pre-natal care, all without charging a co-pay, co-insurance or a deductible.

Under the new guidelines, millions of women will gain access to health care services for free, including well-woman preventative care visits and screenings for gestational diabetes and sexually transmitted infections. These guidelines do not include maternity care or simply any service the doctor orders. However, starting in 2014, all maternity care will be covered by all new individual, small business and government exchange plans.

"This will provide an extraordinary opportunity to improve women's health not only during pregnancy but before, between and beyond pregnancy, and across the life course," said Dr. Michael C. Lu, the associate administrator of the Maternal and Child Health Bureau of the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services.

Not only will preventative care be provided next year without cost to women, under the new health care law, $125 million will go this year to the Maternal, Infant and Early Childhood Home Visiting Program to expand maternal and newborn support for mothers at home.

The changes are being introduced amid a wealth of data indicating that the number of mothers dying in America during or shortly after pregnancy is consistently growing. The rate of maternal mortality in the United States has more than doubled, rising from 6.6 deaths per 100,000 live births in 1987 to 16. 1 per 100,000 live births in 2009 the highest among developed nations, Lu's agency reports.

Various studies have attributed higher risk of maternal death to race, income, region, C-section rates, obesity-related problems and chronic disease. States where poverty exceeded 18 percent, the immigrant population exceeded 15 percent and the C-section rate exceeded 33 percent had 77 percent, 33 percent and 21 percent higher risks of maternal mortality, respectively, a 2007 report by Gopal K. Singh of the Health Resources and Services Administration indicated.

Read more:

U.S. Health Law May Curb Rising Maternal Deaths

WASHINGTON - After years of shipping data-processing, accounting and other back-office work abroad, some health care companies are starting to shift clinical services and decision-making on medical care overseas, primarily to India and the Philippines.

Some of the jobs being sent abroad include so-called pre-service nursing, where nurses at insurance companies, for example, help assess patient needs and determine treatment methods.

Outsourcing such tasks goes beyond earlier steps by health care companies to farm out reading of X-rays and other diagnostic tests to health professionals overseas. Those previous efforts were often done out of necessity, to meet overnight demands, for instance.

But the latest outsourcing, which has contributed to the loss of hundreds of domestic health jobs, is done for financial reasons. And the outsourcing of nursing functions, in particular, may be the most novel - and possibly the most risky - of the jobs being shifted.

At the forefront of the trend is WellPoint Inc., one of the nation's largest health insurers and owner of Anthem Blue Cross, California's biggest for-profit medical insurer.

In 2010, WellPoint formed a separate business unit, Radiant Services, aimed at advancing outsourcing and other cost-saving strategies. WellPoint has eliminated hundreds of jobs in the U.S. over the last 18 months as it has moved jobs overseas, a company spokeswoman acknowledged.

The spokeswoman, Kristin Binns, said WellPoint's shifting of clinical jobs overseas was a small part of the outsourcing and being done through Radiant because it has the technical expertise and can ensure compliance with laws.

Nursing organizations, however, were cautious.

"It's obviously a very disturbing trend," said Chuck Idelson, a spokesman for the California Nurses Assn. "There are serious questions if you're talking about utilization reviews ... and making recommendations on procedures."

Nursing experts said there also may be licensing issues as states generally require certification for those practicing and dispensing health information.

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Worries grow as health care companies send jobs overseas

Health care and unemployment continue to top the list of issues Canadians deem worrisome but, according to a monthly poll, priorities vary widely when broken down by region.

Every month, the pollsters ask 1,000 people across the country via an online panel which three of the following topics do you find the most worrying about Canada? The options include health care, taxes, crime, poverty/inequality, immigration control, unemployment/jobs, corruption, education, environment and moral decline.

While most people, regardless of region, said health care and unemployment/jobs were their top concerns, further down the list, provincial differences become clear.

John Wright, senior vice-president of Ipsos Public Affairs, which has conducted the monthly survey in Canada since 1990, said this is a very diversified country . . . while there may be an underlying concern about the economy and health care which is constant the next number of issues are very regionalized and for very distinct reasons.

Wright said the issues can often be linked to current events in each province, demonstrating the effect news stories and government announcements have on public opinion.

In Eastern Canada, unemployment and poverty are top of mind, while the No. 1 concern for Quebecers is corruption. Further west, citizens in the Manitoba and Saskatchewan provinces cite crime as their greatest worry, above both unemployment and health care. Meanwhile, concern over inequality/poverty has risen consistently in the Prairies since January. In Alberta, health care dwarfs any other concern. Wright said thats fuelled largely by strains on the system brought by an increased population looking for jobs in the provinces booming oilsands. And, in British Columbia, much like Ontario, unemployment and health care top the list of concerns. However, while the environment is a growing concern in B.C., Ontarians have recently been more focused on crime.

The big three concerns in Ontario were unemployment/jobs (50 per cent), health care (45 per cent) and taxes (32 per cent). The environment was last in line of issues keeping Ontarians up at night, with just 12 per cent, beat only slightly by education, at 13 per cent.

In Quebec, corruption (47 per cent) trumped health care (46 per cent) and taxes (32 per cent) as the major concern for citizens.

Wright said the ongoing Charbonneau commission, which is looking into allegations of corruption involving construction firms, local and provincial governments, political parties and organized crime, has raised that issue from 25 per cent in December 2011 to top of mind today.

In Saskatchewan and Manitoba, crime (38 per cent) and unemployment/jobs (35 per cent) were top of mind. Health care and poverty/inequality were tied at 33 per cent. Crime, although on a decline from a recent high in September 2011, when 60 per cent of prairie dwellers cited it among their three top concerns, still beat out corruption (23 per cent) and the Environment and Education, which were tied on the bottom rung at 13 per cent.

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Health care, jobs top concerns for Canadians: poll