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The Health 202: Meghan, Duchess of Sussex, delivered her son in a country with better maternal mortality rates than the United States

with Paulina Firozi

THE PROGNOSIS

Meghan, Duchess of Sussex, delivered her son yesterday in England, one of many developed countries where childbirth-related deaths have steadily fallen for decades.

But the opposite is true in the United States. The country’s maternal mortality rate more than doubled over the past 30 years, especially increasing among African American women — and the troubling trends are capturing increasing attention from policymakers and lawmakers.

President Trump signed a law in December directing the Department of Health and Human Services to provide state grants aimed at better scrutinizing maternal deaths. At least four of the Democrats running for president in 2020 have put forward measures aimed at improving maternal health. Last week, the American College of Obstetrics and Gynecologists released new guidelines on caring for pregnant women with heart disease, which causes about 1 in 4 pregnancy-related deaths.

And this Saturday, the group March for Moms — founded by an assistant professor of obstetrics at Harvard — will hold its third annual rally on the Mall in Washington to raise awareness of ways in which maternal health has backslid in this country in recent decades.

Deaths stemming from childbirth or pregnancy are still rare in the United States, at about 18 deaths per 100,000 births. But even that rate is striking when you consider that other countries have seen their maternal mortality rates decline into the single digits. In Sweden, the death rates is just 4 per 100,000 births. In England, it’s 9 deaths per 100,000.

Meghan's healthy delivery was the focus on social media yesterday, as royalty-obsessed Americans (a group which may, at times, include your Health 202 writer) celebrated the birth of a son, who is apparently seventh in line for the throne.

A beaming Prince Harry told the media that Meghan and the baby were doing “extremely well,” although Buckingham Palace didn’t release a name or any photos. As my Post colleagues William Booth and Carla Adam write, Harry endeared himself to moms everywhere when he gushed, “It’s been the most amazing experience I could ever have possibly imagined. How any woman does what they do is beyond comprehension.”

Former First Lady Michelle Obama:

Comedian and talk show host Ellen DeGeneres:

The Duchess of Sussex undoubtedly received top-notch medical care. Yet Meghan — whose father is white and whose mother is African American -- belongs to a group even more likely to die because of pregnancy.

Black women in both England and the United States have maternal mortality rates several times as high as those of white women. According to the Centers for Disease Control and Prevention, among black women in the United States, there are 40 pregnancy-related deaths for every 100,000 births — a rate comparable to those of women delivering in developing countries. To put it another way: Black women are more than three times as likely as white women to die of pregnancy-related conditions.

“We are facing a maternal mortality crisis in America,” Sen. Elizabeth Warren (D-Mass.) wrote in an op-ed published last week in the magazine Essence. “And for Black moms, particularly those living in rural areas, it’s an epidemic.”

Warren, who is seeking the 2020 presidential nomination, suggested giving hospitals a financial bonus if they succeed in improving health outcomes for new black mothers. Hospitals could lose money if they fail to do so, under a plan she outlined in the article.

Sen. Kamala Harris (D-Calif.), another presidential contender, has introduced legislation providing $30 million in annual grants to train medical providers on how to avoid racial bias and incentivize them to address racial disparities in prenatal care. Harris and 16 other Senate Democrats introduced a resolution last month designating the week of April 11 as "Black Maternal Health Week." Two other presidential candidates — Sens. Kirsten Gillibrand (D-N.Y.) and Cory Booker (D-N.J.) — have introduced similarly themed legislation.

Harris insists the disparities between black and white mothers are due to racial bias in health-care delivery systems. “Those women are not taken as seriously when they show up at the clinic or the doctor’s office or hospitals,” Harris said at a CNN town hall.

Harris:

Warren:

Former congressman Beto O’Rourke (D-Tex.), also running for president, via the Center for American Progress:

AHH, OOF and OUCH

AHH: President Trump has asked Health and Human Services Secretary Alex Azar to work with Florida on its plan to allow the state to import cheaper drugs to bring down costs for consumers, Politico's Alexandra Glorioso reports.

Trump and Azar met at the White House on the issue yesterday, Rep. Matt Gaetz (R-Fla.) told Alexandra. Florida Gov. Ron DeSantis (R) was also at the meeting. Florida’s legislature has approved a bill that gives the state until 2020 to send a plan for drug importation to the administration to review.

Allowing Americans to buy drugs approved and manufactered in other countries, such as Canada, is an idea the drug industry -- and many Republicans -- have opposed. Gaetz said Azar had several concerns about Florida's program, Alexandra writes. But Gaetz also said the meeting "set the stage for Azar’s department to review Florida’s plan and ultimately approve it." "Gaetz said the president called on DeSantis “to be prompt in production of the plan, and for the secretary to be prompt in review of the plan," she adds.

OOF: The Trump administration hasn't been reuniting separated migrant children with their legal guardians in all cases because they have been treating legal guardians as different from parents. The federal court case that forced the reunification of families who were separated under the administration's "zero tolerance" policy only included adoptive or biological parents, not legal guardians, Reveal News’s Laura C. Morel reports.

It’s not clear how many legal guardians have been affected by this exclusion.

“Some lawyers say these families should get the same court protections afforded to parents and their children. Legal guardians have to find attorneys to file their own legal claims, which means they have to wait much longer to see their children again,” Laura writes.

She details the story of one such legal guardian, Marta Alicia Mejia from Honduras, who was separated from her great grandson for seven months after they arrived at the border looking for asylum. She has been raising her great-grandson Esdras since he was born, but still Esdras was placed in a foster family because Mejia did not have documents confirming custody. When she was finally reunited with Esdras, she said: “When I entered this house, the first question he asked me was, ‘Why did you leave me behind?’ ”

OUCH: CDC officials reported 60 new measles cases in what is the most widespread outbreak of the disease in the United States in about 25 years.

There are now 764 confirmed cases of measles across 23 states. Pennsylvania is the latest state to have been impacted by the outbreak, Reuters’s Gabriella Borter and Manas Mishra report. “Federal health officials say a vocal fringe of U.S. parents who refuse to vaccinate their children have propelled the outbreak, which has mostly affected children who have not received the measles-mumps-rubella vaccine, which confers immunity to the disease,” they write. “These parents believe, contrary to scientific evidence, that ingredients in the vaccine can cause autism.”

In a piece mapping exactly who has been impacted by the measles outbreak, our Post colleagues Dan Keating, Brittany Renee Mayes and Tim Meko write that two groups have been affected the most this year: children under 4 and people who haven’t been unvaccinated.

Here is one of the key graphics from our colleagues:

HEALTH ON THE HILL

— Sen. Michael Bennet (D-Colo.) challenged members of his party who have backed Medicare-for-all to “be honest” with American voters about the realities of the health-care proposal.

The 2020 Democratic presidential contender said in a CNN interview that he supports universal coverage for all Americans and said it is critical to “dramatically reduce health-care costs for families and for this country.”

CNN host John Berman pointed to a poll that found 75 percent of Democratic voters say Medicare-for-all is a key issue.

“When you tell people the first thing about Medicare for All — either that it takes insurance away from 180 million Americans that have it through their employer or the taxes we would have to pay to afford that $30 trillion program — that 70 percent support falls to the mid-30s,” Bennet said. “I think we need to level with the American people. Be honest with them. As long as what we’re talking about is universal coverage, the question becomes: How do we get there?”

— Booker unveiled a 14-part plan to address gun violence that includes a proposed gun licensing program that would establish minimum gun ownership standards nationwide.

The plan also includes a ban on bump stocks, a limitation on bulk gun purchases, and a move to close loopholes that let domestic abusers and individuals on terrorist watch lists buy guns, the New York Times’s Matt Stevens reports, adding it’s “among the most progressive gun-control measures suggested by a candidate seeking the Democratic nomination for president.”

“My plan to address gun violence is simple — we will make it harder for people who should not have a gun to get one,” Booker said in a statement. “I am sick and tired of hearing thoughts and prayers for the communities that have been shattered by gun violence.”

INDUSTRY RX

— A new study from the American Medical Association has found there were more employed physcians than self-employed physicians for the first time in the United States.

The findings in part underscore a broader trend of physicians moving away from owning small private practices and toward large practices or practices owned by large health-systems.

In 2018, employed physicians made up 47.4 percent of all patient-care physicians, compared with 45.9 percent with an ownership stake in their practice. The percentage of physician employees was up six percentage points last year compared with 2012, and the percentage of physician owners was down seven percentage points in that time. The study also found there was a growth in the number of physicians who worked directly for hospitals or who worked for a practice that was at least in part owned by a hospital — that number went up from 5.6 percent in 2012 to 8 percent of all patient-care physicians last year.

— And here are a few more good reads: 

A $2 Million Drug Is About to Hit the Market (Wall Street Journal )

Republicans troll Democrats with proposals to rename upcoming health care bill (The Hill )

TRUMP TEMPERATURE

Trump May Redefine Poverty, Cutting Americans From Welfare Rolls (Bloomberg)

MEDICAL MISSIVES

1 in 15 borrowers has considered suicide because of student debt, survey says (Alex Tanzi)

STATE SCAN

Minnesota's rural hospitals are hanging on — for now (Star Tribune)

OPIOID OPTICS

W.Va. opioid addiction centers to pay $17 million fraud settlement (Modern Healthcare)

DAYBOOK

Today

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 21st Century Cures Act.
  • The House Rules Committee holds a hearing on the Supplemental Appropriations Act and the Protecting Americans with Preexisting Conditions Act.

Coming Up

  • The Senate Finance Committee holds a hearing on Medicare physician payment reform on Wednesday.
  • The Washington Post Live will host actress and mental health advocate Glenn Close and Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) for an event on mental health and addiction on May 16.
SUGAR RUSH

Britain's newest royal baby is breaking new ground

Prince Harry and Meghan, duke and duchess of Sussex, are doing things a bit differently than Prince William and Catherine, duke and duchess of Cambridge. (Video: Sarah Parnass/The Washington Post)
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