Thursday, February 28, 2013

Sequestration and the Potential Impact on Childbirth in the US

You might think the two topics – sequestration and birth- don’t have anything in common.  Surprise!  They do.

If sequestration hits, and because we’ve succumbed to societal acceptance of the medicalization of childbirth, of course childbirth will be affected.

According to a White House announcement earlier this week, approximately 600,000 women and children would be dropped from the Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from March through September.  At least 1,600 state and local jobs and $600 million could be lost as a result.

In Ohio alone, 26,000 civilian Department of Defense (DOD) employees would be furloughed and funding for Army/Air Force operations would be cut by $4.9 million. Virtually no state is exempt from DOD cuts. In California, 64,000 civilian DOD employees will be furloughed. Many civilian employees make up the staff for maternity care in military hospitals.

According to the Maternity Care Coalition in Pennsylvania, advocacy groups across Pennsylvania describe $85 billion in federal budget cuts as potentially having dire consequences for social service programs in Pennsylvania, including education, housing, and nutrition assistance.

Disparities in maternal health care will continue.  From an article on the Center American Progress website, between two and three women die each day from complications of giving birth. Black women in the United States die in childbirth at three to four times the rate of other racial and ethnic groups. The infant mortality rate in the United States is twice as high as that of other wealthy nations, and rates are highest for low-income women of color, who often lack access to quality health care. Sequestration cuts $4 million from the Safe Motherhood Initiative, which helps prevent pregnancy-related deaths; $8 million from the Breast and Cervical Cancer Screening Program, which provides cancer screenings to low-income women; $24 million from Title X family planning and reproductive health services; and $50 million from the Title V Maternal and Child Health Services Block Grant. The cuts to the Maternal and Child Health Services Block grant alone would mean 5 million fewer low-income families would be provided with prenatal health care and other services that help eliminate disparities in infant mortality and maternal health.

Research and Innovation will be impacted - The National Institutes of Health (NIH) would be forced to delay or halt vital scientific projects and make hundreds of fewer research awards. Since each research award supports up to seven research positions, several thousand personnel could lose their jobs. Many projects would be difficult to pursue at reduced levels and would need to be cancelled, putting prior year investments at risk. These cuts would delay progress on the prevention of debilitating chronic conditions that are costly to society and delay development of more effective treatments for common and rare diseases affecting millions of Americans. The National Science Foundation (NSF) would issue nearly 1,000 fewer research grants and awards, impacting an estimated 12,000 scientists and students and curtailing critical scientific research. The FDA’s Center for Drug Evaluation and Research (CDER) would face delays in translating new science and technology into regulatory policy and decision-making, resulting in delays in new drug approvals. The FDA would likely also need to reduce operational support for meeting review performance goals, such as the recently negotiated user fee goals on new innovative prescription drugs and medical devices.

The Food and Drug Administration (FDA) could conduct 2,100 fewer inspections at domestic and foreign facilities that manufacture food products while USDA’s Food Safety and Inspection Service (FSIS) may have to furlough all employees for approximately two weeks. These reductions could increase the number and severity of safety incidents, and the public could suffer more foodborne illness, such as the recent salmonella in peanut butter outbreak and the E. coli illnesses linked to organic spinach, as well as cost the food and agriculture sector millions of dollars in lost production volume. Outbreaks of foodborne illness will put families (including expectant mothers) at risk and costing billions in lost food production.

According to the Harvard Law Blog, the Center for Disease Control (CDC) will be cut by $490 million and hospitals could encounter  a loss of almost 500,000 health care sector jobs in the first year of the sequester according to an American Medical Association and American Hospital Association study, including job losses for 40,000 practitioners such as physicians and dentists.

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