What Bubbe Hannah Knew: Lessons for Health Reform From A 19th Century Midwife

This article was originally distributed by American Forum, a nonprofit op-ed syndication service.

As a midwife in Pittsburgh’s Jewish community during the late 19th and
early 20th centuries, my great-great-grandmother Hannah Sandusky brought many healthy children into the world despite the high maternal and infant mortality rates of the time.

I can’t help but wonder what "Bubbe" Hannah – as she was known to all –
would make of the fact that today, some 100 years later, the U.S. ranks
42nd globally in maternal mortality rates, the highest among
industrialized countries. Maternal mortality is a key indicator of
health worldwide and reflects the ability of women to secure not only
pregnancy-related services but also other health care services.

What Bubbe Hannah no doubt knew in 1909 surely remains true in 2009:
healthy women have healthy babies.

The pending reform of the American health care system recognizes this
simple equation, creating — for the first time ever — a seamless,
lifelong continuum of care for women.

Women will be able to participate in a health care system in which they
won’t be charged up to 45 percent more than men for identical coverage,
and maternity and reproductive health will be part of a basic care

That’s good news for the more than 62 million American women now in
their reproductive years. The average woman wants two children, so she
will spend five years of her life trying to become pregnant, being
pregnant and recovering from pregnancy, and three decades trying to
avoid pregnancy.

That means pregnancy-related care alone is not enough. Health education, prenatal care, family planning and medical care should all be integrated to help women attain good health in their youth, maintain it through their reproductive years, and age well. These factors are so critical to the health of America that the deans of 39 of America’s 50 schools of public health have endorsed a scientific, data-driven report urging that women’s health needs be treated as a top priority.

According to the report, "The evidence shows that reproductive health
care is essential to women’s health. If national health reform is to
fulfill the goal of correcting our fragmented health system to improve
America’s health, it must address the specific health needs of women."

As these experts understand, taking care of women really means taking
care of everyone, because women have a major stake in decisions about
health care for their entire families, and they often play a significant
role in the health care that their children, spouses or parents receive.

In a recent speech at the White House, First Lady Michelle Obama
affirmed this fact, noting that eight in 10 mothers report they are the
ones responsible for choosing their children’s doctors, and more than 10
percent of women in this country are caring for a sick or elderly

"Being part of the sandwich generation, raising kids while caring for
sick or elderly parents, that’s just not a work-family balance issue
anymore… it is a health care issue," Mrs. Obama said. "If we want to
ensure women have opportunities that they deserve, if we want women to be able to care for their families and pursue things they could never
imagine, then we have to reform the system."

The First Lady is right. By ensuring coverage of prevention and basic
health services such as maternity benefits, the proposed reforms will
create a system that provides not just "sick care" but true health care
for women and ultimately for all citizens of our nation.

Bubbe Hannah may not be here to see it, but the many descendants of the children she brought into the world will certainly benefit from this
momentous change. And the many generations of children to come will grow up knowing that health care is a basic human right, not a privilege.

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  • cmarie

    I doubt Ann Coulter is a big favorite here but she wrote an excellent column on the subject of health reform and infant mortality please see http://anncoulter.com/cgi-local/article.cgi?article=332
    or if it doesn’t work Ann Coluter + A statistical regression analysis (9/30/09) the general point being that U.S doctors have to count any baby who shows a sign of live as “born alive” while Europeans count only those born at 26 weeks and up and Canada, Austria and Switzerland count only those weighing at least a pound at birth. Many of the babies contributing to “high infant mortality” in the U.S. would just be written off as miscarriages in countries we are frequently told have the lowest infant mortality rates.

  • colleen


    This article does not discuss infant mortality, it speaks to maternal mortality.

    The only difference between the American anti-abortion movement and the Taliban is about 8,000 miles.

    Dr Warren Hern, MD

  • crowepps

    It’s my understanding the UN using a model to adjust the statistics, although I can’t speak to how good it is. Certainly the “Linked Infant Birth and Death Data” would be helpful to them in doing so.


    If this is a serious problem and there is motivation to correct it, why doesn’t the Federal government mandate that all states have to conform to the National Vital Statistics System and use the standard forms and model procedures? Certainly in a age where global comparisons are ubiguitous and science can help address problems, using ‘we count differently’ is a lousy excuse.


  • cmarie

    You’re right. It is maternal death rates. I’m sorry I didn’t see that.