The other day, I received a press release titled “It’s Riskier to Have a Baby in the U.S. Than in Cuba or the Czech Republic.”
This, actually, I knew. The U.S. has one of the worst infant mortality rates in the industrialized world — and one of the worst maternal mortality rates as well. And the black infant mortality rate is twice that of the white infant mortality rate, with Native American infant mortality rates and some Latino mortality rates being significantly higher than the rates among whites as well.
Given the current climate, when this press release arrived in my inbox, I expected that it was going to be a call from a women’s organization in favor of universal health care, and a comparison against other countries that do in fact have such systems. (The fact that countries we tend to look down on are so regularly used as the point of comparison, and what that suggests, is a whole other can of worms I’m not going to get into today.) Indeed, quick google searches indicate that every country listed in the press release has some sort of public health care system in place. There’d seem to be a pretty strong correlation, especially with so many up-to-date facilities in the United States, that we’re always hearing these countries with universal health care don’t have.
The press release, though, was actually promoting a book about pregnancy. And it provided “tips” — tips which use the acronym SMART — for how pregnant American women can “improve their chances of having a healthy baby”:
S = Seek prenatal care early. Tests for potential chromosome problems, including mental retardation and spina bifida (a condition that causes paralysis) can be conducted only in the first and second trimesters. A first trimester ultrasound is also the most accurate in terms of determining a due date.
M = Mention all risk factors such as a family history of diabetes, high blood pressure, Rh negative blood, premature labor, bleeding problems or genetic conditions to your healthcare professional as soon as possible. Do not omit information such as smoking or using “recreational” drugs because such activities can affect your baby.
A = Ask to have your cervix measured during your ultrasound if you have a history of premature contractions or delivery. A cervical length of 2.5 centimeters or less is a risk factor for preterm labor. If you are at risk for delivering before 37 weeks, ask your healthcare provider about receiving steroids to help your baby’s lungs develop.
R = Research your hospital and prospective physician or midwife carefully. Is the physician or midwife skilled in managing high-risk conditions? Will your care continue if you lose your insurance? Has the newborn nursery had any recent outbreaks of antibiotic-resistant infections? Is the hospital a level-three facility?
T = Test for potential problems such as gestational diabetes, sickle cell trait and cystic fibrosis, and check for appropriate fetal growth with an ultrasound.
I imagine that this might pretty solid advice (though I don’t actually know one way or the other) — if you’re actually able to follow it.
But considering the email’s opening, and the highly relevant fact that tens of millions of Americans do not have health care access, I was basically blown away by the “advice” and the necessary level of privilege that it involves — even if this kind of thing is an incredibly and increasingly common sight. And its frequency is a big part of the reason why it’s worth discussing.
It’s easy to tell women to seek prenatal care early when you assume that your audience is middle class and with insurance. It’s easy to give women tips on choosing their doctor or midwife and birthing facility when you assume that all women reading the tips have such a choice available to them at all. It’s pretty easy to tell them to have specific and expensive tests done, again, when you assume that there’s means to pay for them. It genuinely sucks to worry about what is going to happen if you lose your insurance, and such worry is evidence of an abusive system — but it’s also quite a comparative privilege to have it in the first place. And it’s really easy to tell women to disclose smoking and/or recreational drug use, when the women you’re speaking to are the kind of women (white, middle-class, citizens) who will be offered advice and help, rather than end up in a prison cell with their babies snatched from their arms.
I’m really fucking sick and tired of pretending that health concerns are individual problems. I’m so incredibly exhausted by pretending that privileged women are the ones at primary risk and that serious health concerns can be alleviated by just being smart. (Hmm, what does that call the women who don’t do the things up above because they can’t?) I’m sick of pretending that health problems can be fixed by all of us just being responsible and taking better care of ourselves when many of us just plain can’t take better care of ourselves because we live in a country where health care access — not to mention healthy food, shelter, even water — is treated like a commodity that none of us have a right to, unless we’re good, and moral, and middle class enough to be able to pay a high premium for it.
And while I believe that better prenatal care — for a lot of women, any prenatal care at all — would indeed result in fewer deaths, of both women and infants, telling women to just get up and go to the damn doctor already sure as hell won’t. Rugged individualism, turning the conversation yet again on what women are supposed to do for themselves to be considered “smart” and worthy, rather than what we can all do together to make life better for all women, isn’t going to do shit.
Give advice to women who are lucky enough to be able to follow it, certainly. But don’t frame it as a solution to a structural and institutional problem. Don’t point out that infant mortality rates in the U.S. are abysmally high and then follow up by indicating that individual women can change it one ultrasound at a time, by implying that their actions and choices are the problem.
Because there is no solution to this problem until we acknowledge that there’s a reason why it exists, and it’s not the result of individual people’s poor choices. We won’t have an impact until we agree to spend our efforts fighting against racism, classism and other prejudices, and fighting for universal health care, a wide range of accessible birthing options, and all women’s rights. We won’t get anywhere until we admit that the only real and lasting solutions to the problem are national and community ones rather than personal ones.
Until then, we’re going to stay right where we are — rights and access for privileged Americans, and invisiblity and scorn for everyone else.