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Reproductive Justice: Economics, Profit and Convenience

**NOTE**

Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth.  This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience.   Improperly used interventions have led to harm and death of women and babies and obstetrics  is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths. 

**NOTE**  This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research. 

**NOTE** Chronological order allows users to find new data.  It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

ECONOMICS AND CONVENIENCE OF MEDICALIZATION (WOMEN’S BODIES FOR PROFIT?)

We know that non-medically necessary interventions do not benefit women or their babies and, in fact, usually are harmful.  Why then do they occur? Some of the reasons identified include:

  • Displacement of independent midwives and doulas in the maternal healthcare system and move to hospital births
  • Convenience and scheduling for hospitals
  • Patient request
  • Profit

There are three common reasons other than profit that hospitals/physicians encourage non-medical c-sections. Doctors are often pressured into conforming.

  • 1.Convenience (allows scheduling of rooms and personnel, eliminates evening, night or weekend deliveries, shortens time of labor and delivery to manageable units of time, etc.
  • 2.Lack of supervision and training (medical schools train students to “treat” pregnancy and birth as medical issues that require intervention) and also teach “defensive medicine”.
  • 3.Absence or lack of observance of clinical guidelines (ignore best practices and/or research data re: pregnancy and birth.

Why would a mother request a c-section for non-medical reasons when most mothers would do everything possible to protect their unborn child

•Convenience and ability to select date in order to schedule work/home or other duties

  • •Fear of childbirth usually due to lack of education
  • •Encouragement of doctor
  • •Lack of informed consent (Oster & McClellan, 2019) or valid information about possible harm to child. Rarely are mothers given valid informed consent or full information about possible harm that is well documented in the literature. 

Profit has been identified in the literature as a reason for non-medical intervention.  “Indeed, studies have shown that the more physicians are paid for C-sections relative to vaginal births, the higher the C-section rates become. And when these differentials are reduced, C-section rates decrease. So let’s change the monetary incentives.” . (Oster, E. and McClelland, W., 2019) But how much money are we talking and how do we bring about change?   Four million babies are born in the U.S. every year, and one-third of them are now delivered by cesarean section instead of vaginal birth, a 50% increase in the last decade,” said Maureen Corry, Executive Director of Childbirth Connection. “Not only do unwarranted c-sections create greater health risks for women and babies, this study shows that they also dramatically increase costs for employers and, through Medicaid programs, state and federal budgets. For the commercially insured, the average cost of a birth by c-section in 2010 was $27,866, compared to $18,329 for a vaginal birth. Medicaid programs paid nearly $4,000 more for c-sections than vaginal births. If the rate of c-sections were reduced from 33% to 15% (the World Health Organization recommends a c-section rate of 15% or less), national spending on maternity care would decline by more than $5 billion.”  (Center for Healthcare Quality and Payment Reform, et al, 2013)

$5 billion in 2013 is the equivalent of $6,170,752,542.31 in 2022.  What if that amount would be redirected to providing medically necessary care or reducing cost of insurance/taxes?? 

Possible solutions:

  • 1.Require pre-approval by insurance for planned c-sections just as is required for other expensive treatments or tests such as MRIs, CTs and other.   If not medically required, insurance should not have to pay.
  • 2.Change payment schedules so that the price  paid is the same for vaginal or c-section birth in cases where insurance pays for elective c-sections. 
  • 3.Enforce laws that require fully informed consent so that mothers understand that selecting an elective C-section could result in harm to the baby.  A few lawsuits where informed consent is not given for an elective procedure and harm comes to the baby would discourage the practice in the future.

WHAT DOES THE LITERATURE SAY?

2023

Anderson, M. (2023). As more people give birth at home, hospitals lose out on cash. Access https://www.healthcare-brew.com/stories/2023/01/03/hospitals-lose-out-on-cash

  • Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, said that childbirth is a “cash cow” for hospitals because it is such a frequently performed procedure. “From a financial perspective, hospitals do not want to lose this service to at-home delivery,” Bai said.

2021

Bismark, R., Ross, M. and Estevez, D. (2021). Evaluation of Hospital Cesarean Delivery-Related Profits and Rates in the United States.  Accessed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777679

  • In this cross-sectional, nationally representative study using hospital discharge data between 2010 and 2014, women delivering at hospitals with higher profits per procedure were associated with an increased probability of undergoing cesarean delivery.  These findings suggest an association between financial incentives and the US cesarean delivery rate.

Jolivet, R. R., Gausman, J., Kapoor, N., Langer, A., Sharma, J., & Semrau, K. E. A. (2021). Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review. Reproductive Health, 18(1), 1–194. https://doi.org/10.1186/s12978-021-01241-5

  • Conclusion: About half of papers mentioned actions to protect privacy and to make sure every mother and newborn gets care when needed. Only 25% of papers mentioned actions to make sure all women and newborns receive equal care, and only 15% included actions to make sure women and newborns are physically free to leave facilities at will, and get care whether or not they can pay. This framework defining RMC behaviors for providers is based on data from many studies and can be useful to look at whether maternal newborn care in facilities meets these standards and to inform training and more research to improve RMC

Negrini, da Silva Ferreira, R. D., & Guimarães, D. Z. (2021). Value-based care in obstetrics: comparison between vaginal birth and caesarean section. BMC Pregnancy and Childbirth, 21(1), 333–333. https://doi.org/10.1186/s12884-021-03798-2

  • Conclusion “Cesarean deliveries in low-risk pregnancies were associated with a lower value delivery because, in addition to being more expensive, they had worse perinatal outcomes. Reviewing the financing model as well as the practice itself is essential to deliver more value-based healthcare in obstetrics”

New Perspectives: What is Wrong with Healthcare. (2021). University Wire.   “Accessed https://www-proquest-com.webdb.plattsburgh.edu:2443/docview/2577067498?pq-origsite=primo  Access https://www.thecollegianur.com/article/2021/09/new-perspectives-what-is-wrong-with-healthcare

  • CONCLUDED: “Overtreatment is the system of healthcare practices that are predatory in nature or do little to improve the health outcome of the person being treated, according to Makary. One of the reasons that he gives for the practice of overtreatment is because of asymmetric information between healthcare providers and patients, allowing healthcare providers to use their expertise to convince people to agree to medical interventions whether they are helpful or not.  Doctors are incentivized to over-treat patients because under the current health system,which is dominated by both private companies and the federal government, hospitals are reimbursed for every medical intervention they provide. This results in healthcare providers placing more emphasis on curative rather than preventative care, as this nets greater profits.”

Niethammer, C. (2020). Coronavirus exposes the business of safe birth. Accessed https://www.forbes.com/sites/carmenniethammer/2020/05/14/coronavirus-exposes-the-business-of-safe-birth/?sh=4cdaab5654da

  • From article ” Yet, over the past decades this group of “essential” professionals is said to have been squeezed out by market forces in many advanced economies where women think that cesarean sections performed at a hospital are safer. Moreover, there is the supply of surgeons and hospitals who make more money when they bring out the scalpel.  a ‘tummy-tuck special’ 

Sakai-Bizmark, Ross, M. G., Estevez, D., Bedel, L. E. M., Marr, E. H., & Tsugawa, Y. (2021). Evaluation of Hospital Cesarean Delivery-Related Profits and Rates in the United States. JAMA Network Open, 4(3), e212235–e212235. https://doi.org/10.1001/jamanetworkopen.2021.2235 

  • CONCLUDED: “This cross-sectional study of US national hospital discharge data found that delivering at hospitals with higher profits from cesarean procedures was associated with a higher likelihood of patients undergoing a cesarean delivery compared with patients who delivered at lower-profit hospitals. These findings suggest that financial incentives could be associated with variations in the rate of cesarean deliveries across the US. A greater understanding of the dynamics that contribute to the relationship between hospital profit and cesarean delivery rates may assist in future steps taken to reduce the rate of unnecessary cesarean procedures

2020

Center for Medicare and Medicaid Services (2020). Medicaid and CHIP beneficiary profile: Maternal and infant health. Accessed  https://www.medicaid.gov/medicaid/quality-of-care/downloads/mih-beneficiary-profile.pdf

  • Fast facts: In 2011–15, there were 17.2 pregnancy-related deaths per 100,000 live births in the U.S. For Black women, there were 42.8 pregnancy-related deaths per 100,000 live births. Nearly half of all deaths occur during pregnancy or on the day of delivery.

Institute for Medicaid Innovation (2020). Improving maternal health access, coverage and outcomes in Medicaid. Accessed

  • Under-utilization of high-value, evidence-based care, such as the midwifery-led model of care, and over-utilization of unnecessary care, such as cesarean deliveries without indication, are gaining attention in the U.S. as the nation attempts to address growing concerns about maternal health. These concerns include rising rates of maternal mortality and morbidity, increased costs of care, poor or even traumatic patient experiences, workforce shortages, and decreases in access to care in some regions of the country. The alarming trends of racial/ethnic, geographic, and socioeconomic disparities are necessitating local, state, and national conversations. These concerns are compounded by increased awareness of the role that unmet social needs, implicit bias, and structural racism have on maternal and infant outcomes. The factors contributing to poor maternal and infant outcomes in the U.S. are extensive and complex. There will not be only one intervention that will address all of these factors. As the nation considers the combination of potential interventions, it is important to fully consider opportunities to implement a high-value, evidence-based maternal model of care such as the midwifery-led model, both in hospitals and in freestanding birth centers. Midwifery-led care might be a means to improve health equity and ultimately, maternal and infant outcomes for pregnant individuals enrolled in Medicaid.

MACPAC (2020) Medicaid’s role in maternal health. Accessed https://www.macpac.gov/wp-content/uploads/2020/06/Chapter-5-Medicaid%E2%80%99s-Role-in-Maternal-Health.pdf

  • A blended payment consists of a single payment for a birth, regardless of mode of delivery. Payment rates for cesarean delivery are generally higher than those for vaginal delivery. By eliminating this discrepancy, a Chapter 5: Medicaid’s Role in Maternal Health Report to Congress on Medicaid and CHIP 111 blended payment may reduce the financial incentive to perform cesarean sections or minimize adoption of practices that lead to cesarean deliveries (such as limits on time in labor or management of fetal heart tracings) (MACPAC 2019b). Minnesota and Tennessee have adopted a blended-payment approach

COURTOT, B., HILL, I., CROSS‐BARNET, C., & MARKELL, J. (2020). Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High-Value Model of Care. The Milbank Quarterly, 98(4), 1091–1113. https://doi.org/10.1111/1468-0009.12473 Accessed https://www.milbank.org/quarterly/articles/midwifery-and-birth-centers-under-state-medicaid-programs-current-limits-to-beneficiary-access-to-a-high%E2%80%90value-model-of-care/Conclusions: Medicaid beneficiaries do not have the same access to maternity care providers and birth settings as their privately insured counterparts. Medicaid policy barriers prevent some birth centers from serving more Medicaid patients, or threaten the financial sustainability of centers. By addressing these barriers, more Medicaid beneficiaries could access care that is associated with positive birth outcomes for mothers and newborns, and the Medicaid program could reap significant savings. 2019Hoxha, Braha, M., Syrogiannouli, L., Goodman, D. C., & Jüni, P. (2019). Caesarean section in uninsured women in the USA: systematic review and meta-analysis. BMJ Open, 9(3), e025356–e025356. https://doi.org/10.1136/bmjopen-2018-025356Conclusions CSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuseOster, E. and McClellan, W. (2019)Why the C-section Rate is So High.  The Atlantic. Accessed https://www.theatlantic.com/ideas/archive/2019/10/c-section-rate-high/600172/CONCLUDED:  “A doctor and an economist note that doctors are generally paid quite a bit more for a C-section than for a vaginal birth.  This financial nudge might just have something to do with the rate of non-indicated C-sections in the U.S.  Evidence and expert consensus are consistent on the message that C-sections, on average, come with greater risks than vaginal births: more blood loss, more chance of infection or blood clots, more complications in future pregnancies, a higher risk of death. Even if serious complications don’t occur, C-section recovery tends to be longer and harder.”

University of Minnesota School of Public Health (2019)  Policy Brief: More midwife-led care could generate cost savings and health improvements  Accessed   https://www.sph.umn.edu/sph-2018/wp-content/uploads/docs/policy-brief-midwife-led-care-nov-2019.pdf

  • As shown in Figure 1, increasing the percentage of pregnancies with midwife-led care from 8.9% to 15% would result in over $1 billion in cost savings by 2023. By 2027, if midwives were leading care for 20% of births, savings would reach $4 billion. About three-quarters of these cost savings are attributable to lower costs for births covered by private insurance, while one-quarter of the cost savings would be from Medicaid-covered births. Specifically, by 2027, cost savings associated with this modest shift toward midwife-led care would reach $2.82 billion for private health plans and $1.13 billion for state Medicaid programs.

2018

Lesieur, Blanc, J., Loundou, A., Claquin, A., Marcot, M., Heckenroth, H., & Bretelle, F. (2018). Teaching and performing audits on caesarean delivery reduce the caesarean delivery rate. PloS One, 13(8), e0202475–e0202475. https://doi.org/10.1371/journal.pone.0202475

  • CONCLUDED: “In our study, the caesarean delivery rate was higher in private facilities and in level 3 maternity facilities. Perform audits on caesarean delivery could reduce the caesarean delivery rate. Teaching to trainees doctors could be an indicator of quality of caesarean practices. Indeed, doctors organize teaching and therefore, need to actualize their knowledge and practice recommendations. It would be a good thing that a maximum of maternities has an agreement to receive trainees doctors in a process of reducing caesarean section rate. Authors concur that relevant and accurate tools are now needed to reduce the caesarean delivery rate. An interventional approach in an extensive prospective trial would be very appropriate, recalling and encouraging compliance with good practices.

2017

Hoxha, I., Syrogiannouli, L., Luta, X., Tal, K., Goodman, D. C., da Costa, B. R., & Jüni, P. (2017). Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ Open, 7(2), e013670–e013670. https://doi.org/10.1136/bmjopen-2016-013670 

  • CONCLUDED:  “CS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women’s risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS.”

Morris, T., McNamara, K., & Morton, C. H. (2017). Hospital‐ownership status and cesareans in the United States: The effect of for‐profit hospitals. Birth (Berkeley, Calif.), 44(4), 325–330. https://doi.org/10.1111/birt.12299

  • CONCLUDED: “or patient-level characteristics, we found that the odds of a woman’s having a cesarean were two times higher in for-profit hospitals than in not-for-profit hospitals. We also found for-profit hospitals were significantly more likely to be members of multihospital systems and to have fewer full-time registered nurses and staff members per hospital bed.” 

Rossiter, K. (2017). Pushing ecstacy: Neoliberalism, childbirth and the making of mama economicus.  Women’s Studies, vol 46. no 1. Accessed https://www.tandfonline.com/doi/abs/10.1080/00497878.2017.1252568?journalCode=gwst20

  • From intro: This article considers the seemingly paradoxical, minority world response to birthing experiences in which both mother and baby emerge healthy and whole, but where mothers are left with a keen sense of disappointment.

2016

Johnson, E., & Rehavi, M. (2016). Physicians treating physicians: Information and incentives in childbirth. American Economic Journal: Economic Policy, 8(1), 115-141.  Accessed https://www.nber.org/system/files/working_papers/w19242/w19242.pdf

  • CONCLUDED: (from abstract): “This paper provides new evidence on the interaction between patient information and financial incentives in physician induced demand (PID). Using rich microdata on childbirth, we compare the treatment of physicians when they are patients with that of comparable non-physicians. We exploit a unique institutional feature of California to determine how inducement varies with obstetricians’ financial incentives. Consistent with PID, physicians are almost 10 percent less likely to receive a C-section, with only a quarter of this effect attributable to differential sorting of patients to hospitals or obstetricians. Financial incentives have a large effect on C-section probabilities for non-physicians, but physicianpatients are relatively unaffected. Physicians also have better health outcomes, suggesting overuse of C-sections adversely impacts patient health.”

2015

Arrieta, A. (2015). Over-utilization of cesarean sections and misclassification error. Health Services and Outcomes Research Methodology, 15(1), 54–67. https://doi.org/10.1007/s10742-014-0132-y

  • This paper develops a model for defining Cesarean sections’ over- and under-utilization as deviations from clinically appropriate treatment due to non-clinical factors. Physician decisions can be affected by both monetary and non-monetary incentives, and the perception of the patient’s medical information and preferences. 

Xu, Gariepy, A., Lundsberg, L. S., Sheth, S. S., Pettker, C. M., Krumholz, H. M., & Illuzzi, J. L. (2015). Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth. Health Affairs, 34(7), 1212–1219. https://doi.org/10.1377/hlthaff.2014.1088   Accessed https://www.healthaffairs.org/doi/10.1377/hlthaff.2014.1088

  • CONCLUDED: “Estimated facility costs were higher at hospitals with higher rates of cesarean delivery or serious maternal morbidity. Hospitals having government or nonprofit ownership; being a rural hospital; and having relatively low volumes of childbirths, low proportions of childbirths covered by Medicaid, and long stays also had significantly higher costs. The large variation in estimated facility cost for low-risk childbirths among hospitals suggests that hospital practices might be an important contributor to variation in cost and that there may be opportunities for cost reduction. The safe reduction of cesarean deliveries, increasing the coordination of care, and emphasizing value of care through new payment and delivery systems reforms may help reduce hospital costs and cost variation associated with childbirth in the United States.”

2014

Henke, Wier, L. M., Marder, W. D., Friedman, B. S., & Wong, H. S. (2014). Geographic variation in cesarean delivery in the United States by payer. BMC Pregnancy and Childbirth, 14(1), 387–387. https://doi.org/10.1186/s12884-014-0387-x

  • CONCLUDED: “In this study, we found significant variation in the rate of cesarean section at the CBSA level even after adjusting for patient mix. When medically appropriate, cesarean delivery represents an important intervention for improving maternal and neonatal outcomes. However, cesarean deliveries are a costly intervention and are associated with myriad complications, including higher risk of maternal readmission for surgical site and uterine infection [37]. Mothers who undergo cesarean sections often deliver via repeat cesarean for future births which, in turn, further drives increases in cesarean rates. Importantly, this potentially unwarranted geographic variation in medical care may be an indicator of poor quality of care. “

2013

Center for Healthcare Quality and Payment Reford, et al (2013).  Better maternity care could save $5 billion annually.  Accessed: https://www.catalyze.org/wp-content/uploads/2017/04/Maternity_1.07.2013.pdf  

  • CONCLUSION: “Better Maternity Care Could Save $5 Billion Annually New study shows unnecessary cesarean sections drive up healthcare costs for employers and government, increase health complications for mothers and newborns”

O’Malley, A. (2013). Preventing a return to twilight and straitjackets; using the patient protection and affordable care act as a starting point for evidence-based obstetric reform in the United States.  Northwestern Journal of Law & Social Policy, Vol. 8(2).  Accessed https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=1106&context=njlsp

  • CONCLUDED: “For the sake of women and babies in the United States and the future of our society, the maternal experience could significantly improve through obstetric healthcare reform. Financial motivations should not take precedence over quality healthcare. Quality healthcare is a basic human right that all women in the United States should have access to and such care should be supported through fundamentally sound, evidence-based standards of care.”  

Vedantim, S. (2013) Money may be motivating doctors to do more c-sections.  Accessed https://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections

  • From article: Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth.

2012

Dahlen, H. G., Tracy, S., Tracy, M., Bisits, A., Brown, C., & Thornton, C. (2012). Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open, 2(5), e001723–. https://doi.org/10.1136/bmjopen-2012-001723

  • CONCLUDED:  “he continual rise in obstetric intervention for low-risk women in Australia is concerning in terms of morbidity for women and cost to the public purse. The fact that these procedures which were initially life-saving are now so commonplace and do not appear to be associated with improved perinatal death rates demands close review. Low-risk primiparous women giving birth in private hospitals have more chance of a surgical birth than a normal vaginal birth and this phenomenon has increased markedly in the past decade with the gap between the public and private sector growing wider. Australia strives to provide a health system which offers equal access and equity to its population. The findings of this study suggest that a two-tier system exists in Australia without any obvious benefit for women and babies and a level of medical over servicing which is difficult to defend within a system that is bound by a finite health dollar.”

Hazarika, S. and Dutta, A. (2012). Profit from sickness; The case of technology-driven healthcare. Advances in Applied Sociology Vol.2, No.4, 237-244  Accessed https://www.researchgate.net/publication/276525088_Profit_from_Sickness_The_Case_of_Technology-Driven_Healthcare

  • CONCLUDED: “The explicit trend of profiteering over sickness at the behest of the corporate health and pharmaceutical industries is a huge challenge to human civilization and its long cherished goals like universal rights, freedom, and justice. It is now a syndrome of a systemic crisis—a crisis in which largely unregulated healthcare system can produce sickness by a technologically driven culture of diagnosis of diseases. In such a system, the noble efforts of agencies such as World Health Organization, United Nations Development Program or UN Millennium Declaration get completely undermined and marginalized.”  (Material omitted)

McKee, M., & Stuckler, D. (2012). The crisis of capitalism and the marketization of health care: the implications for public health professionals. Journal of Public Health Research, 1(3), 37–e37. https://doi.org/10.4081/jphr.2012.e37

  • CONCLUDED: “But it is now the medical industrial complex that is setting the rules of the game, by redefining the goals of health care away from those in most need, such as those with tropical diseases or ageing populations with chronic disorders and towards those who are essentially well. If the general practitioner is unwilling to respond to these pressures and incentives, many others will. In particular, those who do respond are the many private providers who offer so-called screening services using ever more complex imaging technology to visualise every part of one’s body to find entirely harmless anomalies for which they can extract money for giving what they call ‘treatment’.”

2011

Mohammed, & Panazzolo, M. (2011). Birthing Trends in American Society and Women’s Choices. Race, Gender & Class (Towson, Md.), 18(3/4), 268–283. Accessed https://www.proquest.com/docview/1348583698?accountid=13215&parentSessionId=0%2BU4UviBcakFzS4yeSawOzEV%2BRUDbGdKNWLNodHLa0s%3D&pq-origsite=primo

  • CONCLUDED: (abstract) “In America, childbirth has been an essential part of many women’s lives. Throughout the history of this country, there have been numerous birth practices that have revolutionized and deteriorated this unbelievable life process. At the turn of the 20th century, while the Industrial Revolution was taking place, birth in the United States transformed into a medical business. Since midwives and home births were associated with the old country, they were viewed as dirty and outdated. The original conventions were replaced by revolutionary, but detrimental, practices performed by Gynecologists and Obstetricians. Today, the most popular birthing practices in the United States reflect our capitalistic society, having the main focus not on the health of women and their offspring, but instead on monetary profits and efficiency. The notorious birthing techniques currently utilized allocate almost total power to doctors, leaving women in the dark. The false notion that America is filled with high-risk women that are unable to achieve childbirth naturally is used to justify the numerous medical and surgical interventions that occur in American childbirth. The media’s portrayal of “designer birth” has glamorized medical interventions and surgical births, while at the same time desecrating the natural birthing abilities of American women. Although there are a variety of birthing options available to American women, most women are not educated on these opportunities and allow physicians to make major decisions for them. In the era of the Obama presidency with the prospective changes in the American health care system, we have to ask the question whether birthing practices in American society will change.

2010

Brennan, R., Eagle, L. and Rice, D. (2010). Medicalization and marketing. Journal of Marketing (30)1, 8-22.  Accessed: https://doi.org/10.1177%2F0276146709352221

  • From abstract: Medicalization is the process by which aspects of the human condition, formerly considered nonmedical, are brought within the medical realm. Medical sociologists have asserted that medicalization is a prevalent contemporary sociocultural phenomenon that is actively promoted by pharmaceutical company marketing strategies and that has widespread negative societal effects. Medicalization has not been investigated from a business, marketing management, or macromarketing perspective. One of the principal implications of the medicalization thesis is that pharmaceutical marketing frequently acts to reduce human welfare. The central purposes of this article are to explain what evidence and argumentation has been deployed in medical sociology to implicate marketing practices in medicalization and to argue for the relevance of medicalization to the field of macromarketing.

ICAN (2010).  Cesareans 17% more likely at for-profit hospitals Accessed https://www.ican-online.org/blog/2010/09/cesareans-17-more-likely-at-for-profit-hospitals/

  • California Watch, a nonpartisan investigative reporting initiative, has released a study showing that for-profit hospitals in California are performing cesareans at higher rates than non-profits, even in low-risk pregnancies.

2009

Poitras, G., & Meredith, L. (2009). Ethical Transparency and Economic Medicalization. Journal of Business Ethics, 86(3), 313–325. https://doi.org/10.1007/s10551-008-9849-2

  • CONCLUDES: . (From abstract) “This article introduces the concept of economic medicalization where non-medical problems are transformed into medical problems in order to achieve the objective of corporate shareholder wealth maximization. Following an overview of the differences in ethical norms applicable to medical ethics and business ethics, the economic medicalization of medical research practice and publication is examined in some detail. This motivates a general discussion of the problems involved in the ethical approval process for medical research that balances the interests of both business and government in the market for medical products and services.”

2008

Poitras, G. and Meredith, L. (2008). Ethical Transparency and economic medicalization. (Journal of Business Ethics) Accessed https://www.sfu.ca/~poitras/jbe_08.pdf  Also https://www.sfu.ca/~poitras/jbe_08.pdf

  • ABSTRACT. This article introduces the concept of economic medicalization where non-medical problems are transformed into medical problems in order to achieve the objective of corporate shareholder wealth maximization. Following an overview of the differences in ethical norms applicable to medical ethics and business ethics, the economic medicalization of medical research practice and publication is examined in some detail. This motivates a general discussion of the problems involved in the ethical approval process for medical research that balances the interests of both business and government in the market for medical products and services

2002

Béhague, D. P. (2002). Beyond the Simple Economics of Cesarean Section Birthing: Women’s Resistance to Social Inequality. Culture, Medicine and Psychiatry, 26(4), 473–507. https://doi.org/10.1023/A:1021730318217   Accessed:   https://www.researchgate.net/publication/10912484_Beyond_the_Simple_Economics_of_Cesarean_Section_Birthing_Women’s_Resistance_to_Social_Inequality

  • CONCLUDED: (from abstract) “This research explored the reasons for women’s preferences for cesarean section births in Pelotas, Brazil. It is argued that women strategize and appropriate both medical knowledge and the technology of cesarean sections as a creative form of responding to larger public debates (and the practices that produced them) on the need for and causes of (de)medicalization. Questioning the reasons why some women engage more actively in this process than others elucidates the ways local forms of power engage gender, economic and medical ideologies. The current debate on why some women prefer c-section deliveries, or indeed if they really do at all, has diverted attention from the utility of the technology itself. This paper argues that for some women, the effort to medicalize the birth process represents a practical solution to problems found within the medical system itself. I end by exploring the socio-biological conditions that have produced a need for the technology.”

1993

Suarez. (1993). Midwifery is not the practice of medicine. The Birth Gazette, 9(2), 4–4.   Accessed https://openyls.law.yale.edu/bitstream/handle/20.500.13051/7178/16_5YaleJL_Feminism315_1992_1993_.pdf?sequence=2  

  • CONCLUDED: “Although obstetricians worldwide use the same sophisticated technology and drugs in pregnancy and childbirth as American physicians, doctors in other countries use them differently.4 Doctors in the country with the lowest infant mortality rate, Japan, use little or no drugs and are much slower to interfere with the natural process of birth. 5 In the United States, the economic alliance between doctors and the producers of technological equipment has obstructed preventive maternity care. “Medical priorities are set by the medical industrial complex, which focuses on providing health care at a profit”