Comprehensive Insurance Protects Most Women – Post-Unification And Migration Status Elevate Maternal Mortality Rates
Since 1966 Germany has had a comprehensive healthcare system addressing maternal mortality issues1. Rates have consistently fallen since then, but have stalled in the last 15 years2. While rates are very low compared to worldwide statistics, tough Germany is only slightly average when compared to other developed countries. Unification with East Germany and migration issues may be the primary explanatory factors.
Germany was reunited in 1990. Differences in socioeconomic status, nutrition and the complexities of integration lead to an increase in the maternal mortality rates. Over the next decade these issues receded and rates have stabilized at 7 maternal deaths per 100,000 live births. Given the importance of early childhood nutrition on later health outcomes it is possible that young female children at the time of unification, who are now coming into their child bearing age, are slightly more susceptible to complicating health issues3.
Similarly, Germany receives a larger number of migrants for the developing world. Two issues impact maternal mortality rates. First, prior nutritional difference may also impact women coming to Germany. Most migration happens during high fertility years. As economic migration and family reunification migration takes places a large number of women raised in less affluent conditions are coming to Germany and subsequently have children. Second, women from this global migration do not have equal access to health care. Some of this inequality is due to policy, and some is due to cultural attitudes and knowledge of rights. The result is that non-German women have a slightly elevated risk for maternal mortalitiy and morbidity rates4.
Germany, has adjusted some of their immigration and health policies to address some of these issues. While the discussion is ongoing it appears some progress is being made.