US maternal mortality rate the highest among high-income countries

Benjamin Mateus

The release of a critical report by The Commonwealth Funds this week only further underscores the decrepit state of healthcare in the United States, the center of world capitalism. The study, titled “Insight into the US Maternal Mortality Crisis: An International Comparison,” found that in 2022 maternal mortality for the US at 22.3 maternal deaths for every 100,000 live births continues to be the highest among high-income nations. And as the Centers of Disease Control and Prevention (CDC) has previously noted, more than four in five of these deaths could have been prevented. 

The US has by far the highest maternal mortality rate among high-income countries. [Photo: Commonwealth Fund]

By comparison, Chile and New Zealand, the next closest countries in this category, are substantially lower at 14.3 and 13.6 deaths per 100,000, respectively. For many European Union nations, the rates are three-fold lower. In Norway, the maternal mortality rate in 2022 reached zero deaths per 100,000. 

Although the US figures are down considerably from their 2021 highs at 32.9 deaths per 100,000 (a 33 percent decline), this has more to do with the decline in rates of COVID deaths among pregnant women. Numerous studies indicated that COVID significantly contributed to preeclampsia, preterm births, stillbirths and other adverse outcomes. Still, when compared to 2020, when the rate was 23.8 maternal deaths, the figures have remained essentially unchanged since the pre-pandemic period.

Perhaps what is most remarkable is that 65 percent of these deaths occur after delivery. Twelve percent occur in the first week after birth. Contributing factors during this early period include severe bleeding, elevated blood pressures and infections. Another 23 percent of deaths take place between days seven and 42, while 30 percent are in the late postpartum period, between days 43 and 365. Causes for these deaths are usually attributable to a condition called cardiomyopathy, when the heart muscles grow weak.

The bulk of maternal deaths occur after delivery of the baby. [Photo: Commonwealth Fund]

Researchers have been scratching their heads to identify the causes for these alarming outcomes. Certainly, conditions like obesity and other chronic diseases compounded by increasing cesarean sections have contributed to severe maternal comorbidities. However, as Dr. Lindsay Admon, an obstetrician-gynecologist at the University of Michigan Medical School, told Scientific American, “Focusing too narrowly on demographics, labor and delivery paints an incomplete picture of maternal health.”

As the report observed, “[Over] the past decade, maternal mortality during labor and delivery has decreased in US hospitals across people of all ages, races and ethnicities, which researchers say is a result of improved birthing protocols. This reduction in deaths during childbirth itself implies that other factors are driving the overall rising rates of maternal mortality.”

Indeed, while efforts have been placed on ensuring safer deliveries, little has been done to improve outcomes before and after deliveries.

When one reviews maternal mortality by state, there is an obvious correlation between states like Arkansas (43.5 maternal deaths per 100,000), Mississippi (43.0), Tennessee (41.7), Alabama (41.4), and Louisiana (39.0) and high rates of poverty. An eye-opening report from last month published by Lending Tree, an online lending marketplace, found that six of 10 states that offered the worst access to prenatal and maternal care were in the South. Among these were Alabama, Texas, Florida, Georgia, Arkansas and Tennessee. In particular, Alabama ranked lowest in the number of maternal care providers per capita. Mississippi also has the highest infant mortality rate in the country. 

In another concerning difference in the international comparison study, Commonwealth Funds found that the number of providers per 1,000 live births in the US was one of the lowest among the high-income countries. Although the number of obstetricians per capita was the same for the US and Sweden, which has almost ten-fold lower maternal mortality, Sweden has 69 midwives per 1,000 live births, compared to the US with only four midwives per 1,000 live births.

The US supply of midwives is among the lowest of the advanced countries. [Photo: Commonwealth Fund]

These differences have a historical context. Although, as an institution, midwifery survived in Europe, in the US it was displaced in the early 20th century when pregnancies were “medicalized” and births began to take place more and more in hospital settings. A 2014 State of the World’s Midwifery Report demonstrated that well-educated midwives operating under international standards could provide more than 80 percent of the essential care for women and their newborns.

In a Lancet Global Health report from 2021, the authors noted that “[in] high-income settings, midwife-led continuity of care has been associated with positive outcomes, including fewer preterm births, fewer fetal losses at any gestation, and high rates of positive experiences reported by women.”

The authors of the Commonwealth Fund study said, “Midwives are clinicians trained to provide a wide range of services—helping to manage normal pregnancies, assisting with childbirth, and providing care during the postpartum period, among others.” 

Such services over the months that pass after delivery can greatly facilitate long-term health assessments such as symptoms of heart overload that may manifest with swelling and fatigue, early signs of thromboembolic events, or even assessment of postpartum depression or domestic violence that could herald tragic consequences. Optimally utilizing midwives could avert 41 percent of maternal deaths, 39 percent of neonatal deaths, and 26 percent of stillbirths. 

Furthermore, the Commonwealth study added, “By placing a priority on natural reproduction processes and relationship-building, midwives also can help address the social needs of mother, baby, and family.”

Yet, in the US, the trends are diametrically opposed to these conceptions. The cost of delivery continues to climb, and access to obstetric services continues to dwindle. A 2022 March of Dimes report indicated that 5 percent of counties across the country had less access to obstetric services than two years before. “These areas of combined low or no access,” they wrote, “affect up to 6.9 million women and almost 500,000 births in the US,” or one in eight children born per year.

Another issue that exacerbates maternal mortality rates is the lack of any federally mandated paid leave policy that could help women adjust to the physical and mental demands placed on new mothers while being guaranteed their income and job security. The Bureau of Labor Statistics indicated that in 2023, only 27 percent of civilian workers had access to paid family leave. Even these statistics conceal the fact that access to paid leave is lowest among workers with the greatest needs.

Paid leave has many positive correlations: a decline in infant mortality, decreased risk of preterm birth and low birth weight, lower rates of rehospitalizations, higher rates of attending pediatric and postpartum visits, improved vaccination rates, higher rates of breast feeding, improved parent and child health and interrelationships. There are long-term benefits for the entire family unit, with lowered rates of depression among mothers and better cognitive and coping skills for children. 

The study also highlights that while maternal mortality is higher in the US than other high-income countries, it is highest among black women. One can also say that it is highest among all racial categories in the US, or, in other words, no one is spared. Clearly, the disproportion among black women is considerable at 49.5 per 100,000 while among whites it is 19.0 per 100,000 live births—also higher than any other high-income country. 

The socioeconomic factors that contribute to these outcomes are multifactorial and regional. The Southern states where access to obstetric care is worst also have a higher proportion of African Americans. Nearly all of the health conditions discussed above are worse in that region of the country. But fundamentally, the issue of maternal mortality is a class issue, and the class differences are pervasive across countries whatever the race or racial divisions in the populations.

A 2021 report by Gopal K. Singh from the US Department of Health and Human Service, published in the International Journal of Maternal and Child Health and Aids, looked at trends and social inequalities that contributed to maternal mortality in the  US over five decades. Although there had been a notable decline in mortality from 1970s into the 1990s, that trend has ended, along with the broader decline in the global economic standing of the US.

The trends among racial groups have also persisted over the last two decades. The authors found that increasing maternal age increased maternal mortality for all racial groups but was most marked for black women 40 years old and older. Also, higher maternal education was protective of health, while unmarried status increased risk of death. Additionally, those living in small towns and large rural areas had higher mortality rates. But the overriding factor, among women of all races, was poverty.

Singh found that “between 2002 and 2018, both absolute and relative disparities in maternal mortality by deprivation level widened. Higher deprivation levels were generally associated with higher maternal mortality risks among both white and black women in each period. For example, in 2014-2018, black women in the most-deprived area group had a 70 percent higher maternal mortality risk than black women in the most affluent area group. For white women, the corresponding relative risk of mortality was 104 percent higher in the most-deprived group compared to the most-affluent group.” Although Singh notes that within each deprivation group racial disparities in maternal mortality existed, these factors are best understood through the perspective of class and the historical development of social life in the United States.

Australian Rich List shows acceleration of wealth accumulation over 40 years

Mark Wilson

The 2024 edition of the annual Rich List published by the Australian Financial Review (AFR) reports that the 200 wealthiest Australians now control $625 billion, up by 11 percent from last year’s figure of $563 billion. This astounding amount of wealth represents approximately a quarter of the Australian annual gross domestic product as of 2023.

An astronomical rise in personal fortunes over the past four decades is accelerating again after a slight slowdown last year. The first Rich List, published in 1983, contained total fortunes of $4.6 billion, or less than $20 billion in today’s dollars, adjusted for inflation.

This year’s list boasts of 150 billionaires. In 1983 only one group, the Murdoch family, was worth more than $200 million and only eight had more than $100 million.

Increasingly, Australia’s billionaires primarily derive their fortunes from some of the most parasitic activities, either based on extracting minerals and fossil fuels or on property and financial speculation. First and foremost were mining and property, followed by finance market-backed technology start-ups.

Among the fresh entrants to this year’s list are “three newly-discovered billionaires in the form of Estonian-based online gaming mogul Tim Heath, the brain behind the CoinSpot cryptocurrency exchange Russell Wilson and the flashy Lamborghini-loving founder of the LMCT+ online promotions business Adrian Portelli.”

Another crypto gambling billionaire, Ed Craven, and “fintech entrepreneur” Jack Zhang also joined the list. Zhang’s Airwallex, which offers big businesses faster payment transfers than banks, is headquartered in Singapore, a low-tax location, and its holding company is registered in the Cayman Islands, a tax haven.

Topping the list for the fifth year in a row was iron ore magnate Gina Rinehart, who now has a net worth of over $40 billion for the first time. Her 8.5 percent increase in wealth came despite an $800 million decrease in net profits for Hancock Prospecting, the private mining company founded by her father in 1955. Her expanded worth was instead driven by “higher valuations across the mining industry” on share markets.

Gina Rinehart and Harry Triguboff [Photo: Department of Foreign Affairs and Trade / Meriton]

Others in the top 10 whose fortunes are based on extraction include former Glencore CEO Ivan Glasenberg (No. 9) and Clive Palmer (No. 6), who reaped almost $447 million in mining royalties last financial year from his private company Mineralogy.

These outcomes underscore the continuing reliance of mining, Australian capitalism’s biggest single revenue source, on exports to China, even as the US and its allies, including the Albanese Labor government, step up their economic and military confrontation with China.

Rinehart was far from the only one on the list who obtained an increase in personal wealth despite falling profits in their companies. Property tycoon Harry Triguboff secured an 11 percent increase in his wealth up to $26.5 billion, moving him to a distant second place on the list.

Despite “higher property management and building costs” causing a $30 million decrease in net profits for his property empire Meriton, his personal revenue still rose by over $130 million. According to the AFR, that was because his “extensive build-to-rent portfolio allows him to arbitrage between selling completed apartments and keeping them.”

As a result of such profiteering throughout the property market, around 2 million rental households in Australia are experiencing negative cash flow, where their soaring rents and outgoing costs are higher than their income, fueling a worsening housing affordability crisis.

The tech sector grew in prominence on the list, up from 13 percent to 17 percent of the total wealth, the third highest source behind mining and property. Mike Cannon-Brookes, the co-founder of software company Atlassian, appears on the list with his separated wife Annie. Their combined wealth has increased by over $5 billion in the past 12 months and now stands at over $24 billion.

Eleven individuals made the list for the first time. Astonishingly, six are already billionaires, highlighting the extraordinary speed at which the wealth of the ultra-rich can increase.

Also making the list for the first time was the Murphy family (No. 193), who are behind the company Canstruct, which earned $1.82 billion over five years from the refugee detention camp on the Pacific island of Nauru, a barbaric facility that the Labor government has reopened.

This pattern points to the separation of vast wealth accumulation from the process of production and fulfilling genuine social need. Instead, the rich are relying evermore on speculative investment and property ownership. This trend represents an intrinsic response of the capitalist system to falling rates of profit, a response that leads to instability and breakdowns like the 2008 financial crisis.

The AFR lauds the wealth of those on the Rich List as exemplifying “risk-taking” and “hard work.” It smugly dismisses criticism of the list as “envy.” In reality, the hundreds of billions of dollars collectively controlled by those on the list have been extracted from the labour power of the working class, the true source of wealth in society.

At the same time that a tiny fraction of the richest people continue to pile on extraordinary amounts of wealth, Australian workers have seen cuts to their living standards larger than at any other time in the last 50 years.

The Australian Council of Social Services (ACOSS) recently reported that of the approximately 5 million Australians receiving income support payments, almost three quarters of them are “eating less or skipping meals due to the low rate of payments and rising cost of living.”

By the standards of poverty set by ACOSS, which is just $489 per week for a single adult or $1,027 per week for a couple with children, 13.4 percent of Australians live in poverty, that is, over 3 million people.

It seems that the AFR, nervous about the hostility to the ever-growing cost-of-living crisis for working-class households, decided this year to portray the ultra-rich in a more mundane light, playing down the celebratory tone of recent lists.

In one jarring comment, a rich lister valued at almost $800 million commented that he valued his wealth because it allowed his family to be provided with “the bare essentials in life.”

The class divide is the fundamental one in Australia and every other capitalist country. The interests of the working class are irreconcilably at odds with those of the capitalists and the uber-wealthy.

The $625 billion controlled by the 200 richest Australians could fund essential social services. Federal spending on health in 2022‒23 was around $105 billion, just one-sixth of the worth of the Rich List.

The Labor government is continuing to cut social spending in real terms, while giving the wealthy the vast majority of the more than $200 billion in income tax cuts legislated for the next decade, and expanding military outlays, including $368 billion for nuclear-powered submarines as part of the AUKUS military pact to prepare for war against China.

Boeing in “panic mode” as airline company’s crisis continues

Bryan Dyne

A recent report in the Guardian reveals that managers and executives at Boeing responsible for operating the company’s plant in Everett, Washington, are in “panic mode” as quality and safety concerns continue to emerge about the planes produced by the aerospace giant.

One of the main issues revealed is that the facility is “full” of 787 Dreamliner aircraft that are faulty, according to a mechanic with more than 30 years at Boeing. The jetliner’s fuselage is produced by Boeing supplier Spirit AeroSystems and assembled at Boeing’s factory in South Carolina.

“There is no way in God’s green earth I would want to be a pilot in South Carolina flying those from South Carolina to here,” continued the mechanic. “Because when they get in here, we’re stripping them apart.”

Boeing employees walk a Boeing 787-10 Dreamliner down towards the delivery ramp area at the company’s facility after conducting its first test flight at Charleston International Airport, Friday, March 31, 2017, in North Charleston, South Carolina. [AP Photo/Mic Smith]

The Guardian also reported that managers “will hound mechanics” not to report safety and quality concerns, demanding that planes are put into service to ensure corporate profits rise.

Once considered among the safest aircraft manufacturers, Boeing is now facing an essentially continuous deluge of whistleblowers and leaks making clear that the primary concern of the company’s managers and corporate heads is not the safety of the flying public but the bottom line for their shareholders and themselves.

The dangers of such an attitude were dramatically exposed this past January, when a door plug blew out of a 737 MAX 9 jetliner shortly after takeoff, injuring dozens on the flight. It was only luck that the incident occurred at a relatively low altitude, that no passengers were killed by being sucked out of the plane.

Since then, dozens of incidents have been reported on Boeing planes, from panels coming off, landing gear not deploying correctly and fires on board aircraft. Even the company’s new manned spaceship, the Starliner, had been delayed for months for various critical problems discovered by NASA before it finally launched on Wednesday.

The January door blowout also brings to mind the two 737 MAX 8 crashes in October 2018 and March 2019, when 346 passengers and crew were killed. Subsequent reports found that Boeing deliberately hid internal software issues from pilots, regulators and all those on board their planes, problems that Boeing knew were incredibly dangerous.

None of Boeing’s senior executives were ever tried for murder for knowingly encouraging the deadly planes to be developed and produced. The most Boeing suffered was a $2.5 billion plea deal to avoid criminal liability for fraud and for the 346 deaths.

The ongoing issues with the 787 Dreamliner are especially significant because of the fate of Boeing whistleblower John “Mitch” Barnett. On March 9, Barnett was about to give a third day of a deposition about his time as a quality manager for Boeing and his criticisms of the company’s attitude toward safety on the 787 project and the factory in South Carolina, when he was found dead by a “self-inflicted gunshot wound” to his head in his rental car in his hotel parking lot.

Barnett had been let go by Boeing in 2017, which he alleged was retaliation for concerns he had raised internally about quality problems of the production of the Dreamliner aircraft. Since then, he had been interviewed many times about the dangers he saw for anyone flying on a 787 jet.

A family friend quoted Barnett as telling her, “If anything happens to me, it’s not suicide.”

Among the many problems Boeing currently faces is the fallout of an audit done in March by the Federal Aviation Administration (FAA), which found numerous instances where manufacturing and quality control were well below federally mandated requirements.

One of the FAA’s auditors, Najmedin Meshkati, especially called out the 1997 merger of Boeing and McDonnell Douglas, which “under the direct watch of its leaders and board of directors,” are “complicit in and ultimately responsible for its present problems.”

McDonnell Douglas gained infamy in the 1970s for the production of the DC-10, which remains to this day one of the deadliest aircraft ever produced. In its original design, the rear cargo door did not always lock properly, inducing explosive decompression that collapsed the floor of the plane’s main cabin. The DC-10 suffered 55 accidents over its lifetime, which have caused a total of 1,261 fatalities.

Boeing’s contempt for safety is also highlighted the ongoing contract talks with 32,000 machinists, part of the International Association of Machinists and Aerospace Workers (IAM), at the Everett plant. One of the main demands of the workers is the restoration of the many hundreds of positions dedicated to maintaining safety and quality that Boeing has eliminated over the past decade. Boeing has so far refused this demand.

The contract for the machinists expires on September 12, and a strike authorization vote is scheduled for July 17.

The elimination of so many safety and quality positions speaks to the underlying class nature of Boeing’s position. While the merger with McDonnell Douglas certainly accelerated the process, the decline of American capitalism ultimately underscores the degeneration of Boeing. The drive by every corporation is for profits—in Boeing’s case, market share against European rival Airbus—and human lives are just the cost of doing business.

Modi and his Hindu supremacist BJP cling to power after major Indian election losses

Keith Jones

Prime Minister Narendra Modi and his Hindu supremacist Bharatiya Janata Party (BJP) are clinging to power after suffering a major reversal in India’s general election.

Results of the seven-phase election, which began April 19 and concluded Tuesday with the tabulation of votes, are yet to be finalized. However, it is certain that the BJP, which won back-to-back majorities in 2014 and 2019, will fall 30 or more seats short of the 273-seat threshold needed to give it a majority in the 543-seat Lok Sabha (People’s Assembly).

Its continued rule is now dependent on its National Democratic Alliance (NDA) partners. The final tally for the BJP-NDA will be in the 290 to 296-seat range. This is a far cry from the 353 seats they captured in 2019 and from the 400 seats that Modi and his chief henchman, Home Secretary Amit Shah, boasted the BJP-led NDA would win at the campaign’s outset.

Prime Minister Narendra Modi is greeted by supporters as he arrives at Bharatiya Janata Party (BJP) headquarters in New Delhi, India, Tuesday, June 4, 2024. [AP Photo/Manish Swarup]

Significantly, the NDA’s losses were heavily concentrated in the BJP column. The dominant partner in the NDA captured some 60 fewer seats in 2024 than in 2019. Meanwhile, gains and losses among the BJP’s NDA partners effectively cancelled each other out.

The Congress Party-led opposition electoral bloc—the Indian National Developmental Inclusive Alliance or INDIA—appears to have won more than 230 seats.

It made a calibrated and thoroughly demagogic appeal to popular anger over mass joblessness, chronic hunger, ever widening wealth and income inequality, the BJP’s victimization of Muslims and other minorities and its repression of political opponents.

Congress Party leader Rahul Gandhi, himself the son, grandson and great grandson of Indian prime ministers, repeatedly attacked Modi for his “crony capitalist” ties with Mukesh Ambani and Gautam Adani, respectively India’s and Asia’s richest and second richest billionaires.

A rag-tag coalition of more than 30 parties, INDIA aims to provide the bourgeoisie with a right-wing governmental alternative to Modi and the far-right BJP. It would be no less beholden than the Modi regime to big business and, like it, committed to increasing worker exploitation through pro-investor “reform” and to the anti-China Indo-US Global Strategic Partnership that is the cornerstone of India’s foreign policy.

Led by the Congress, till recently the bourgeoisie’s preferred party of national government, the INDIA alliance is comprised of more than two-dozen ethno-regional and caste-ist parties—many of them erstwhile BJP allies, like the Uddhav Thackeray wing of the fascistic, Maharashtra-based Shiv Sena. It also includes the two Stalinist parliamentary parties, their Left Front allies and the Maoist CPI (M-L).

Given the right-wing record of its constituents, INDIA’s claims to offer a “progressive,” secular and “pro-people” alternative to the BJP were, to say the least, not credible and no doubt were viewed as such by many. Nevertheless, large swaths of India’s workers and toilers appear to have seized on it as a means to voice their opposition to the Modi government, and they have done so in the face of an immense campaign, trumpeted by the corporate media, to intimidate the population with claims that Modi and the BJP were being propelled to a historic triumph on a tidal wave of popular support.

The Congress’s share of the vote increased by 1.7 percent to 21.2 percent from its historic 2019 low of 19.5 percent, even though, in deference to its INDIA allies, it contested some 80 less seats. According to the latest projections, it will capture 99 seats, more than double its score from 2014 (44) and almost double that from 2019 (52).

Speaking Tuesday afternoon, Congress Party leader Rahul Gandhi claimed the country had voted to “save the Constitution” in the face of the BJP government’s efforts to rig the elections by using the intelligence and police agencies and judiciary to harass, smear and jail opponents. “The country,” he declared, “has said that we don’t want Mr. Narendra Modi and Mr. Amit Shah.” Gandhi went on to announce that the INDIA leaders would convene in the capital, New Delhi, on Wednesday to discuss whether to make a bid to form the government when parliament reconvenes.

The latter statement is likely to prove to have been nothing more than post-election hyperbole. The BJP has emerged from the polls bloodied. The cult it has constructed around Modi as a beloved “Hindu strongman” and “holy man” has taken a hit. Nevertheless, Modi and his BJP continue to be seen by the dominant sections of the Indian ruling class as the most ruthless, and hence, best instrument for pushing through further austerity, privatization, deregulation and other “pro-investor” reforms in the face of mass opposition, and to pursue their great-power ambitions on the world stage.

Some among them, may wring their hands over the BJP’s “excesses” and worry that its Hindu supremacism incites opposition and could destabilize the institutions of the Indian state. But the Indian bourgeoisie, terrified of the threat from below, has long deployed communalist and caste-ist appeals as a means of channeling social anger and frustration at chronic poverty and social inequality along reactionary and divisive lines.

The Indo-US anti-China strategic partnership

A striking feature of the election campaign was the absence of any discussion of the global war initiated by US imperialism of which the NATO-instigated war with Russia over Ukraine, the imperialist-backed Israeli genocide against the Palestinians in Gaza and Washington’s military-strategic offensive against China are the three main fronts.

India is providing critical support for Washington in this war, especially in regards to its drive to strategically encircle China and economically thwart its rise. Under Modi, India has been transformed into a US frontline state, evermore tightly bound to Washington through an expanding web of bilateral, trilateral and quadrilateral military-strategic ties with the US and its principal Asia-Pacific allies, Japan and Australia. Indian ports are now open for routine use for repair and resupply by US, British, French and Japanese ships.

India is also deeply implicated in the US scheme to reorder the Middle East. It is part of the I2U2 (India, Israel, US, UAE) grouping which Washington wants to transform through war, diplomatic intrigue and infrastructure development into a “Mideast economic corridor,” so as to weaken and subjugate Iran and counter Russian and Chinese influence in the region.

While New Delhi has not submitted to US demands to break its strategic ties with Russia, it is working with Washington to lessen its dependence on Russia armaments and otherwise intensify its collaboration with Washington globally. More fundamentally, the support New Delhi is providing US imperialism in the Indo-Pacific arena is emboldening the US to pursue its drive for global hegemony everywhere. Last summer the Indian military announced it was answering an urgent Pentagon request as to what support it would provide in the event of a US-China war over Taiwan.

Yet none of this was the subject of any debate in what was trumpeted as the world’s largest exercise in democracy.

Insofar as there was any discussion of India’s foreign policy, it largely revolved around the Congress Party’s attacks on Modi for being “too soft” on China. This under conditions where for the past four years, India and China have been locked in a military stand-off along their disputed Himalayan border, with the Modi government forward deploying tens of thousands of troops, tanks and war planes.

There are two reasons for the conspiracy of silence over the Indo-US strategic partnership and India’s role in the developing global war. First, the Indian ruling class and its political parties all stand four-square behind the reckless strategy of transforming India into a great power by clutching at the bedraggled coattails of US imperialism as it desperately seeks to offset its economic decline through aggression and global war.

Second, they are keenly aware that among the Indian masses there is enormous latent anti-imperialist sentiment and fear that it would be galvanized were the working class and oppressed toilers to gain any insight into the extent to which India has been transformed into a satrap for US imperialism and the threat this poses to the people of the region and world.

A particularly pernicious role in all this is played by the twin Stalinist parties—the Communist Party of India (Marxist) or CPM and the smaller, but older Communist Party of India (CPI)—and the Maoist CPI (M-L). They profess to be opposed to the Indo-US strategic alliance. But so as not to embarrass their INDIA partners and even more importantly arouse working class opposition to their partnership with the enablers of US imperialism, they confine their “opposition” to the occasional press release. For like reasons, the Stalinists called off the protests they belatedly organized last November against the Israeli assault on the Palestinians of Gaza.

Another critical question that was excluded from the election campaign was India’s ruinous “profits-before-lives” response to the ongoing COVID-19 pandemic. Officially India acknowledges some 533,000 COVID-19 deaths, but the real figure, as indicated by excess deaths, is in the order of 10 times that. The pandemic laid bare the Modi government’s utter indifference to the well-being of working people and the deplorable state of the public healthcare system. But the opposition parties said next to nothing about this as they were entirely complicit in India’s pandemic policy. In the states where they formed the government, they press-ganged people to return to work even as the virus spread like wildfire.

The Modi government: A regime of extreme crisis

As the WSWS previously noted, there were indications that as the seven-phase election unfolded, the BJP became apprehensive as to its outcome. After the first phase in the voting, the BJP largely ditched its promises of economic development and celebratory proclamations of India’s “world-beating” economic growth and increasing influence on the world stage. Instead, Modi, Shah and Uttar Pradesh Chief Minister Yogi Adityanath, its chief campaigners, doubled down on the most reactionary and vile communal appeals. This included claims the opposition parties wanted to steal the wealth of India’s “mothers and daughters” so as to give it as to “infiltrators,” “jihadis,” and those who have “large numbers of children”—all code words for Muslims.

This appears to have backfired. In several states in the north Indian Hindi belt, the BJP’s traditional heartland, it suffered significant losses. This was especially true in Uttar Pradesh, India’s most populous state, and where Modi’s protégé the Hindu priest and criminally-indicted instigator of anti-Muslim violence Yogi Adityanath has ruled with an iron fist. In UP, the BJP-NDA lost 26 seats and saw its vote share fall by almost 10 percentage points.

Among the BJP MPs to go down to defeat was the representative for Faizabad (Ayodhya), where the temple to the mythical Hindu god Lord Ram has been constructed on the site of the razed Babri Masjid, a 16th century mosque illegally demolished 30 years ago by fundamentalist fanatics mobilized by the BJP and its RSS allies. In January, Modi inaugurated the temple as part of a nationally televised spectacle that was meant to both launch the BJP re-election campaign and signal India’s “rebirth” as a “Hindu nation.”

Given the right-wing character of the forces involved, including the so-called Left parties, the Indian elections could give only a pale and highly distorted indication of the mass but as yet inchoate anger, against the BJP and indeed the entire rotten Indian capitalist social order. Recent years have seen myriad bitter working class struggles, including by autoworkers, Maharashtra State Road Transport Commission (MSRTC) workers, teachers and healthcare workers, as well as major peasant-farmer agitations, and repeated massive one- and two-day protest general strikes. But these struggles have been systematically isolated by the trade unions and politically bound by them and the Stalinist CPM and CPI to the right-wing anti-BJP bourgeois opposition.

The elections have underlined that far from being an unstoppable force, the Modi government is a regime of extreme crisis that sits atop a political and social volcano.

UK parliamentary report reveals shortage of midwives is causing preventable maternal deaths

Margot Miller & Jean Gibney

The abysmal state of maternity care in the UK, among the worst in Europe that is putting mothers’ and babies’ lives at risk, was spelled out in a parliamentary report following a recent inquiry into birth trauma.

“Listen to Mums: Ending the Postcode Lottery on Perinatal Care. A report by The All-Party Parliamentary Group on Birth Trauma” was published in May and paints a devastating picture of neglect after decades of underfunding to the National Health Service (NHS).

St Mary's maternity hospital in Manchester, England, June , 2024

The inquiry was set up by Conservative MP Theo Clarke and Labour MP Rosie Duffield after Clarke, giving birth in an NHS maternity unit, was left traumatised thinking she “was going to die.”

The inquiry’s findings are shocking. Sampling 1,300 women and maternity professionals, it found 4 to 5 percent of women develop post-traumatic stress disorder (PTSD) every year after giving birth—approximately 30,000 women in the UK. About a third experienced birth as traumatic.

One respondent to the inquiry spoke about postnatal bleeding, which is life-threatening: “About 6 hours after [my son] was born, I experienced a heavy bleed. I could see my white hospital bedsheets going red and I thought I was haemorrhaging again. I pressed my bell, nobody came. I pressed it again harder, and nobody came.”

Others told the inquiry they were denied pain relief, or left with life changing injuries, including severe tearing leading to bowel incontinence. Some babies were brain damaged through lack of oxygen, while others were stillborn through complications during labour.

Behind the litany of horror stories, including overworked maternity staff not having time to listen to patients, is a service depleted of funds.

One midwife told the inquiry she and her colleagues “are witness daily to the devastating impact of poor staffing, poor provision of resources, poor care and poor communication, which result in people lacking confidence in the service and the standard of care they will receive.”

Unable to do their jobs properly, suffering stress and burnout, the inquiry found that midwives have “the highest rate of absences for mental health reasons within the NHS.”

Donna Ockenden, who chaired an Independent Review of Maternity Services in Nottingham, told the inquiry that staff retention was a major problem: “If we are losing midwives with 20, 30, 35 years’ experience, if they are leaving the NHS in their fifties, early sixties because they can’t cope… then being replaced by a more junior workforce who are not being supported in those early days of their career… two going out doesn’t equal two coming in.”

A survey by the Royal College of Midwives (RCM) over a one-week period in March this year revealed 136,834 extra unpaid hours were worked. But this did not compensate for staff shortages as 76 percent surveyed said “their workplace was not safely staffed during those seven days in March.”

The BBC reported in January a shortage of 2,500 midwives, with many more leaving the job. Hannah, a midwife, told the BBC, “I walked away from it because I couldn’t live with myself if I provided unsafe care for someone because the staff numbers were unsafe.”

The consequences of staff shortages and underfunding are catastrophic. Birth Trauma cites the findings of a separate report, “”, produced by Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries Across the UK (MBRRACE-UK). It found the UK’s maternal death rate was the second highest in an eight-country European study in 2022.

MBRRACE-UK reported maternal death rates in pregnancy and up to 42 days after birth were 9.6 per 100,000 births, only less than the worst rate in Slovakia at 10.9. The lowest rate of 2.7 was in Norway. Heart disease, thrombosis and suicide were listed as the main cause, the latter pointing to traumatic experiences during birth and poor aftercare, when women are susceptible to postnatal depression. The lack of good quality pre/post-natal care plays a significant role in preventable deaths.

Led by Professor Marian Knight of the University of Oxford, the MBRRACE-UK study reported rising maternal mortality rates. In 2020-2022, 272 mothers or 13.41 per 100,000 died during pregnancy or up to six weeks after giving birth. Between 2017-2019 and 2020-2022, there was a statistically significant increase in maternal mortality, excluding deaths due to COVID-19. The rate in 2017-2019 was 8.79 in 100,000.

Commenting on the findings, Knight told the Guardian, “Maternal mortality rates are a barometer of health systems.”

MBRRACE-UK also found “Women living in the most deprived areas have a maternal mortality rate more than twice as high as women living in the least deprived areas.” Women from Black ethnic backgrounds are almost three times more likely to die around childbirth and Asian women twice more, than white women.

The Royal College of Obstetricians and Gynaecologists declared the work by MBRRACE-UK “adds to the weight of evidence showing lives are being lost to persistent inequalities.”

Birth Trauma is not the first official inquiry into maternity services involving deaths and injuries to mothers and babies. All were ignored by government.

The past 10 years alone saw three investigations into maternity care, at Morecambe Bay, Shrewsbury and Telford, and East Kent hospital trusts, which made recommendations to improve maternity care.

Current inspections by the Care Quality Commission (regulating health and social care), however, found nearly half of maternity units in England either “inadequate” or “requires improvement”. There are currently nearly 1,900 cases under investigation at the Nottingham Hospitals Trust alone concerning failings in maternity care.

The Birth Trauma report concludes with a list of recommendations, including “a new Maternity Commissioner who will report to the Prime Minister, which will outline ways to: 1. Recruit, train and retain more midwives, obstetricians and anaesthetists to ensure safe levels of staffing in maternity services and provide mandatory training on trauma-informed care.”

Women’s Health Minister Maria Caulfield responded to the findings of Birth Trauma with the lame statement: “maternity services are not what they should be” while remaining silent on decades of funding cuts overseen by Tory and Labour governments.

The deliberate collapsing and defunding of the NHS is being used as a battering ram to pave the way to a private health insurance model.

In 2021 and again in 2022, midwives and maternity support staff took to the streets to protest lack of funding and chronic understaffing. This rank-and-file action was not supported by the Royal College of Midwives (RCM).

Last year the RCM and other health unions sold out their members’ disputes over jobs, wages and cuts to the NHS, pushing through below-inflation pay deals. The health unions blocked calls for sector-wide action against the destruction of the NHS, working with the Labour Party to head-off a direct confrontation with the Tory government.

Labour Shadow Health Secretary Wes Streeting has rejected calls for extra spending on the NHS, decrying a “something for nothing culture.” His promise to shorten NHS waiting lists is based on exhausted doctors working weekends and a further extension of the private sector.

Streeting has pledged “unsentimental reform” of the NHS, saying a Starmer-led government “will go further than New Labour ever did. I want the NHS to form partnerships with the private sector that goes beyond just hospitals.”

Both Labour and the Tories are committed to NATO’s expanding wars and massive hikes in military spending. The Institute for Fiscal Studies has predicted the health budget will fall from £168.2 billion in 2023-24 to £166.2 billion in 2024-25. Institute for Fiscal Studies Senior Research Economist Ben Zaranko wrote last year that “Defence cuts effectively paid for UK welfare state for 60 years—but that looks impossible after Ukraine”.

Claudia Sheinbaum, AMLO’s protégé, elected president of Mexico

Andrea Lobo

The Morena party of Mexico’s President Andrés Manuel López Obrador, known as AMLO, won a resounding victory in Sunday’s general elections, with its results described as a “landslide” or “tsunami” in the corporate media.

Claudia Sheinbaum, Zocalo Plaza, Mexico City [Photo by EneasMX / CC BY 4.0]

Claudia Sheinbaum, a climate scientist who until recently governed Mexico City, was elected president with 58.8 percent of the vote. Once all votes are tallied, she is expected to surpass the 30.1 million votes received in 2018 by her mentor, López Obrador, who was limited to a single term in office by Mexico’s constitution.

According to the preliminary results, the ruling coalition led by Morena is also expected to increase its seats in Congress, reaching a two-thirds supermajority in the House of Deputies and close to one in the Senate. The ruling party is also expected to prevail in four additional state governments, extending its control to 25 out of Mexico’s 32 states, including the capital, Mexico City.

Despite receiving a distant 28.2 percent, Xóchitl Gálvez, the right-wing candidate supported by a coalition of the traditional oligarchic parties (PRI-PAN-PRD), initially declared herself the victor, raising the specter of an attempted coup and a social eruption in response. However, after the Business Coordinating Committee (CCE), the top employers’ association, congratulated Sheinbaum and called on the opposition to strive for “unity” nationally, Gálvez backpedaled and acknowledged her defeat. 

Jorge Álvarez Máynez of the Citizens’ Movement, which dubiously styles itself as “center-left,” reached 10.5 percent of the presidential vote. 

Predictably, the corporate media in Mexico and internationally has focused its commentary on Mexico’s election of its first female president, suggesting fraudulently that this milestone will somehow open the door to a more democratic and socially conscientious form of capitalist rule.

While Sheinbaum, an accomplished scientist, made a more appealing candidate than the at times shrill and cartoonish “tech entrepreneur” Gálvez, the vote mostly reflected the ongoing popularity of AMLO.

The results expressed a persistent popular hatred for the right-wing record of austerity, corruption, repression and subservience to US imperialism associated with AMLO’s predecessors. Masses of workers and youth seek a radical expansion of the limited social programs initiated under Morena, which consisted of cash transfers for pensioners, students and small farmers, and more than doubling of the minimum wage.  

López Obrador saw a major spike in his popularity in recent weeks, with a positive rating of up to 80 percent, according to pollster Gallup. This reflects in large measure short-term economic expectations, nationalist sentiments after the police invasion of the Mexican embassy in Ecuador, and support for a shift by the government toward open denunciations of the Israeli genocide in Gaza.

The election campaign was dominated by empty populist bluster. Gálvez even stood in front of a crowd and signed in blood her promise to maintain AMLO’s social assistance programs.

Sheinbaum’s acceptance speech Monday morning summed up her campaign. She stressed her gender, declaring: “I do not arrive alone, all women arrive with me.” She vowed to secure resources for establishing a “welfare state” and prevent increases in fuel and electricity costs. 

On the other hand, she promised to promote “national and foreign private investment,” to “consolidate the National Guard, intelligence and investigation for security,” and “a relationship of friendship, mutual respect and equality” with the US government. 

Throughout the election cycle, there was no significant or honest discussion in the debates or rallies about the explosive crisis of the entire global capitalist order, and how the next Mexican government will attempt to balance the growing demands and threats from US imperialism that Mexico align its policies with the drive to World War III. 

The US corporate media largely focused on demanding that Sheinbaum “turn her back on López Obrador once elected,” as expressed by the right-wing CNN and Miami Herald commentator Andrés Oppenheimer. 

In a sign that sections of the ruling class are concerned above all by the unprecedented political crisis and brinksmanship of their imperialist overlord north of the border, the major Mexican daily La Jornada dedicated its editorial on election day to denouncing the US war drive against China. It states:

The truth is that Washington’s determination to prolong its imperial control has a negative impact on its own society and on those of the entire planet. To mention just one example, one wonders what percentage of the inflation that has destabilized the world economy and impoverished millions of people can be explained by the illegal sanctions and tariffs imposed by the United States on Russia, China and other countries. The United States would do well to fix its own problems, such as the very deficient democratic institutionality that we have reported here. 

Morena’s own record and the numerous assurances made by Sheinbaum to Wall Street make clear that, amid the emerging escalation to global war and growing economic shocks, the next administration will put the defense of the massive fortunes of Mexican billionaires and the profits of global corporate and finance capital above the social programs, democratic rights and even the lives of the Mexican working class and poor. 

The main transformation of Mexico under AMLO has been its total integration into the North American economic platform that US and Canadian imperialism rely on to wage economic and military warfare against their rivals, above all Russia and China, both nuclear powers.

During the beginning of the COVID-19 pandemic in early 2020, as major companies in defense and other key US industries warned that they couldn’t operate without Mexican suppliers, López Obrador joined Trump in opening the factories and sacrificing hundreds of thousands of lives. Sheinbaum also dropped all major protections in 2020 and deliberately covered up the death toll in Mexico City—a clear exposure of the claim that, as a scientist, she will rule “following the data.”

In her government plan, titled “100 steps toward transformation,” Sheinbaum explicitly calls for Mexico to “to take advantage of the economic situation to replace imports mainly from Asia with regional production, with a high domestic content. The idea is to produce in North America what is consumed in North America.” This closely jibes with the “nearshoring” drive of US imperialism.

On security, she calls for the “establishment of bi-national working groups to deal with determined criminal phenomena” with the US government. She told The New York Times that she is “prepared to work with whichever candidate wins the next U.S. election,” at a time when one contender, Joe Biden, is moving headlong toward a war with Russia and the other is planning on establishing a fascistic dictatorship and conducting the mass deportation of migrants. 

While the US and Mexican ruling classes would have preferred Gálvez to win and carry out a swifter shift to the right, they have taken the measure of Sheinbaum. Bloomberg, for instance, writes: “Businesspeople see her as potentially more market-friendly than AMLO and open to change in policy areas such as energy and private investment.”

Sheinbaum has promised not to increase any taxes, including maintaining the major corporate incentives across the free trade zone on the US-Mexico border, and to maintain a strict “no deficit” policy for the government under the slogan of “Republican austerity.” This can only mean that social spending will be the first casualty of the imminent economic shocks and, above all, demands for even greater spending on the military. 

In fact, the shameless efforts by AMLO and Sheinbaum to give the military a facelift are the clearest demonstration of the real character of Morena, which has effectively allowed the traditional oligarchic parties represented by Gálvez to pose as defenders of democratic institutions. 

The AMLO administration retrieved Mexico’s former defense minister retired Gen. Salvador Cienfuegos after his arrest in the US on drug charges, has enshrined the domestic deployment of troops in the Constitution, increased the combined military budget by 150 percent, handed to the armed forces management of ports, customs and infrastructure projects, and has allowed them to continue to cover up their role in the 2014 disappearance of the 43 Ayotzinapa teaching students. 

Tens of thousands of troops are currently deployed in “migrant containment” operations and have detained record numbers of migrants at the behest of Washington. 

López Obrador has called the military “the pillar of the Mexican state,” which means that the ruling class is prepared to enforce its interests via the use of military force against opposition at home under conditions of an unprecedented level of social inequality and an explosive descent into war and barbarism globally. Absent the revolutionary intervention of the working class, the Tlatelolco massacre of hundreds of student protesters in 1968 and other deadly repressive experiences throughout Mexican history will pale in comparison to the state violence that is to come.