The especial province of the mother is the prevention of disease, not its cure. When disease attacks the child, the mother has then a part to perform, which it is especially important during the epochs of infancy and childhood should be done well. I refer to those duties which constitute the maternal part of the management of disease.

Medical treatment, for its successful issue, is greatly dependent upon a careful, pains-taking, and judicious maternal superintendence. No medical treatment can avail at any time, if directions be only partially carried out, or be negligently attended to; and will most assuredly fail altogether, if counteracted by the erroneous prejudices of ignorant attendants. But to the affections of infancy and childhood, this remark applies with great force; since, at this period, disease is generally so sudden in its assaults, and rapid in its progress, that unless the measures prescribed are rigidly and promptly administered, their exhibition is soon rendered altogether fruitless.

The amount of suffering, too, may be greatly lessened by the thoughtful and discerning attentions of the mother. The wants and necessities of the young child must be anticipated; the fretfulness produced by disease, soothed by kind and affectionate persuasion; and the possibility of the sick and sensitive child being exposed to harsh and ungentle conduct, carefully provided against.

Again, not only is a firm and strict compliance with medical directions in the administration of remedies, of regimen, and general measures, necessary, but an unbiased, faithful, and full report of symptoms to the physician, when he visits his little patient, is of the first importance. An ignorant servant or nurse, unless great caution be exercised by the medical attendant, may, by an unintentional but erroneous report of symptoms, produce a very wrong impression upon his mind, as to the actual state of the disease. His judgment may, as a consequence, be biased in a wrong direction, and the result prove seriously injurious to the welldoing of the patient. The medical man cannot sit hour after hour watching symptoms; hence the great importance of their being faithfully reported. This can alone be done by the mother, or some person equally competent.

There are other weighty considerations which might be adduced here, proving how much depends upon efficient maternal management in the time of sickness; but they will be severally dwelt upon, when the diseases with which they are more particularly connected are spoken of.

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Systemic Failures and Shocking Disparities in Maternal Health Care System

New York Is 47th Among All States in Maternal Mortality; 40 Percent of Women Live in a Medically Underserved Areas

In releasing a new report on maternal health nationwide, Amnesty International revealed that flaws and shocking disparities in maternal health care that the government is ignoring lead to two to three women dying daily in the United States from pregnancy-related complications, with half of these deaths believed preventable, according to the Centers for Disease Control. A state-by-state examination shows that New York is 47th on a maternal mortality ranking, with 16 deaths per 100,000 live births. National Women’s Law Center, National Report Card on Women’s Health, Maternal Mortality Rate Table; available at http://hrc.nwlc.org/Status-Indicators/Key-Conditions/Maternal-Mortality-Rate.aspx.

The new Amnesty International report, Deadly Delivery: The Maternal Health Care Crisis in the USA, also reveals that severe pregnancy-related complications that nearly cause death — known as “near misses” — are rising at an alarming rate, increasing by 25 percent since 1998; currently nearly 34,000 women annually experience a “near miss” during delivery. With a lifetime risk of maternal deaths that is greater than in 40 other countries, including virtually all of the industrialized countries, the United States has failed to reverse the two-decade upward trend in preventable maternal deaths, despite pledges to do so.

The report cited numerous causes for the crisis and offers lengthy recommendations on improving maternal health care.

Inadequate prenatal care is cited as a contributing factor in the crisis; women who do not get prenatal care are three to four times more likely to die than women who do. In New York, one in six women (15 percent) receive delayed or no prenatal care. The number rises to one in five women (19.1 percent) among women of color.

Obstacles to care are widespread: the most obvious being that across the United States nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. In New York, nearly 15.1 percent are uninsured; among women of color the number of uninsured climbs to 21.2 percent. The state’s Medicaid eligibility level for working parents is also low, $26,400. Lack of access to health care centers and providers is a problem nationwide, the report found; in New York 40 percent of women live in medically underserved areas.

“It is inexcusable that the United States is facing a crisis in maternal health care,” said Josh Rubenstein, Northeast Regional Director for Amnesty International USA. “Pregnancy and childbirth are not new or rare diseases; they are exceedingly common medical events that impact every family in the nation. The maternal health crisis should be addressed as a matter of national urgency and political unity to better the health and dignity of all Americans.”

Maternal health is a human right for every woman in the United States, regardless of race or income. Yet, the United States lacks a systematic, robust government response to this critical problem. Amnesty International is urging President Obama to work with Health and Human Services Secretary Kathleen Sebelius to establish, and seek Congressional funding, for a single office responsible for ensuring that all women receive quality maternal health care. An Office of Maternal Health would lead government action to reduce the soaring pregnancy-related complications and maternal deaths nationwide.

Additionally, Amnesty International calls for vigorous enforcement of federal non-discrimination laws and an increase in support for Federally Qualified Health Centers by 2011 to expand the number of women who can access affordable maternal health care.

“This country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful,” said Larry Cox, executive director of Amnesty International USA. “Mothers die not because the United States can’t provide good care, but because it lacks the political will to make sure good care is available to all women.”

Amnesty International’s analysis shows that health care reform before Congress does not address the crisis of maternal health care.

“Reform is primarily focused on health care coverage and reducing health care costs, and even optimistic estimates predict that any proposal on the table will still leave millions without access to affordable care,” said Rachel Ward, one of the authors of the Deadly Delivery report. “Furthermore, it does not address discrimination, systemic failures and government accountability documented in Amnesty International’s report.”

Rapid and comprehensive federal leadership is required, as the report found numerous systemic failures, including the following:

• Burdensome bureaucratic procedures in Medicaid enrollment substantially delay access to vital prenatal care for pregnant women seeking government-funded care. Twenty-one states do not offer “presumptive eligibility” which allows pregnant women to temporarily access medical care while their permanent application for Medicaid is pending. Women who do not receive any prenatal care are three to four times more likely to die than women who do.

• The number of deaths is significantly understated because there are no federal requirements to report maternal deaths or complications and data collection at the state level is insufficient.

• Oversight and accountability is lacking. 29 states and the District of Columbia have no maternal death review process at all.

For more information or to take action, visit: www.amnestyusa.org\deadlydelivery

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Raising kids is expensive, but the tax laws can ease that burden, according to CCH, a Wolters Kluwer business and a leading provider of tax, accounting and audit information, software and services (CCHGroup.com). From birth through college graduation, there are breaks that reduce taxes and help defray the costs of education. Here are ten ways:

1. Personal Exemption – A reduction of taxable income of $3,650 ($3,650 in 2010) for each dependent child under age 19 or, if a full-time student, under age 24. For divorced parents filing separately, generally the exemption goes to the parent who has custody for the greater part of
the year.

2. Child Credit – A reduction of tax of $1,000 per child, beginning to phase out when adjusted gross income (AGI) exceeds $75,000 for single filers and $110,000 for joint filers. May be partially refundable, depending on income.

3. Childcare Tax Credit - A credit based on childcare expenses for children up to age 13, or older children if they are physically or mentally incapable of caring for themselves. Credit taken against maximum qualifying expenses of $3,000 for one qualifying dependent and $6,000 for two or more. Credit equals 35 percent of qualifying expenses for taxpayers with AGI up to $15,000 and decreases with income to 20 percent of allowable expenses for AGI of $43,000 or more.

4. Adoption Credit - A maximum credit of $12,150 for a regular adoption, with credit amounts phased out at incomes between $182,180 and $222,180 for both single filers and joint filers. For a special-needs adoption, the credit is figured without regard to the actual expenses paid or incurred in the year the adoption becomes final.

5. Earned Income Tax Credit (EITC) – Amounts increase for eligible taxpayers with children. Size of increase depends on income level, number of children.

6. Coverdell Education Savings Accounts (ESAs) – Earnings in these accounts grow tax-free. Withdrawals also are tax-free if used to pay for qualified educational expenses. Can be used to pay for tuition, fees, books, supplies and equipment for both K-12 and post-secondary. For K-12, can also pay for uniforms, transportation, supplementary items and services such as extended day programs, room and board and purchase of computer technology and Internet access. Contributions limited to $2,000 per year.

7. Qualified Tuition Programs (529 Plans) - Investment earnings in these plans are not taxed if withdrawals are used for qualified expenses. Contributions to state-sponsored programs are partially or fully deductible on some state tax returns. Annual contribution limits for the plans are set by the state or educational institutions sponsoring the plan and may be in excess of $300,000, but a contribution in excess of $65,000 by any individual ($130,000 for joint filers) in one year could restrict those persons’ ability to make additional contributions in further years without being subject to gift tax.

8. Bond interest – For 2009, interest on proceeds of qualified savings bonds (specifically, Series I bonds or qualified Series EE bonds issued after 1989) cashed to pay education expenses is tax free for joint filers with less than $104,900 in AGI, partially tax free for AGI of $104,900-$134,900; comparable limits for single filers are $69,950-$84,950. For 2010 returns, phaseout ranges are $105,100-$135,100 for joint returns, $70,100-$85,100 for single filers.

9. Higher Education Tuition Deduction – An above the line deduction for qualifying educational expenses of up to $4,000 at an accredited
post-secondary institution. The deduction is reduced to $2,000 at AGI above $65,000 ($130,000 for joint filers) and is not available if AGI exceeds $80,000 ($160,000 for joint filers). This must be coordinated with other educational exclusions and cannot be used for anyone for whom the American Opportunity Tax Credit or Lifetime Learning Credit is claimed.

10. American Opportunity, Hope and Lifetime Learning Credits – For 2009 and 2010, the American Opportunity Credit virtually replaces the Hope and Lifetime Learning credits for undergraduate expenses, providing a credit of up to $2,500 per student per year for the first four years of post-secondary qualified tuition and expenses. Up to 40 percent of the credit is refundable, depending on income. Residents of Ark., Ill., Ind., Iowa, Kan., Mich., Minn., Miss., Neb. and Wis. who are in the “Midwestern Disaster Area” might do better choosing the Hope Credit for 2009 expenses.

Source: CCH, a Wolters Kluwer business

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