The United States is the only industrialized nation in which the maternal death rate has been high picking up. Each year, about 700 deaths are due to pregnancy, childbirth or subsequent complications, according to the Centers for Disease Control and Prevention.
When someone dies while pregnant or in a year from the party in Illinois, it is considered a maternal death. Karen Tabb Dina is a maternal health researcher at the University of Illinois at Urbana-Champaign who serves in a state-level committee who tries to understand what kills these mothers.
The group most recent analyzes found that about 75 women in Illinois die from pregnancy-related causes each year. In line with national trends, black women are at higher risk than white women, and most deaths were preventable.
“It’s the cause of the alarm,” Tabb Dina said. “Our country is in crisis in terms of unnecessary maternal deaths.”
In recent years, the Illinois Maternal Mortality Review Committee has ordered policy changes that will eliminate barriers to health care for pregnant and postpartum women. Top of the list: Make sure low-income moms don’t lose Medicaid coverage after the birth of a baby. Some women lose coverage just two months after birth.
In April, Illinois became the first state to be approved by the U.S. Department of Health and Human Services to extend Medicaid for up to a full year after a pregnancy.
“This is tremendous,” Tabb Dina said. “One of the biggest risk factors for maternal deaths is the lack of access to care: not being able to access the right suppliers and be seen in a timely manner ”.
Medicaid, the state and federal program primarily for low-income Americans, covers people with higher incomes. returned during pregnancy – but most states remove these women from the rolls 60 days after giving birth. As a result, hundreds of thousands of women who have had a child recently end up uninsured every year.
“Interruptions in Medicaid coverage result in higher costs and worse health outcomes,” HHS Secretary Xavier Becerra told a news conference in April., citing a federal report on the consequences of Medicaid beating. “More than half of pregnant women on Medicaid have experienced a coverage gap in the first six months of postpartum care.”
With the extension of Medicaid under the Affordable Care Act, mothers in Illinois with incomes up to twice the federal poverty level can keep their coverage for one year postpartum. Many other states – including New Jersey, Georgia and Virginia – are take similar steps.
Although the $ 1.9 trillion U.S. Rescue Plan has been passed to boost the economy amid the covid-19 pandemic, it still has a less noticeable benefit facing postpartum coverage. For the 12 states that have never expanded Medicaid under the ACA, the law provides new financial incentives for them to make Medicaid available to adults with incomes up to 138% of the federal poverty level ($ 12,880 for an individual, $ 21,960 for a family of three).
In addition, the stimulus package offers all states an easier option to extend postpartum Medicaid coverage beyond the 138% income limit. Starting in April 2022, states can submit a modification of the state plan to their Medicaid program – a process that has roadblocks menu to federal approval of the traditional way of applying for a federal waiver.
Maternal health experts say extending Medicaid coverage to a full year postpartum makes sense because pregnancy-related complications – both physical and mental – are not limited to the first few months.
“Many.” [postpartum] health problems and health problems extend beyond the 60-day period that Medicaid currently covers, ”said Dr. Rachel Bervell, a midwife in Seattle and co-founder of the Project OBGYN Black, which aims to raise awareness about racial injustices in maternal health care.
A report based on data from nine states found nearly 20% of deaths associated with pregnancy occur between 43 days and one year after delivery.
Bervell clearly remembers learning about this statistic. “She was so despised,” he said. “It makes you worried about the 1 in 5 individuals we might be missing.”
Medicaid is the the largest payer for maternity care in the United States. Black women are overrepresented in the Medicaid population and are also overrepresented among those who are removed from their plan after 60 days.
Chronic diseases – such as diabetes and hypertension – are more prevalent and less well controlled among black women, putting them at higher risk of pregnancy-related complications.
There are also structural barriers to health care, such as inadequate housing, transportation, and child care. Many of these barriers arise from racist and discriminatory policies, such as redlining, linked to poor health outcomes. Black moms are even more likely to be denied medication for postpartum pain.
Racial disparities in maternal health outcomes are caused by racism, not by race. So the problem cannot be solved, Bervell said, without addressing systemic racism in medicine and wider society.
U.S. Representative Robin Kelly (D-Ill.) Said racial disparities are unacceptable. He advocated for Medicaid change in the state and work other policies to improve the collection of maternal health data and establish national obstetric emergency protocols.
“When you look at educated black women with money, they always die more than less educated, less wealthy white women,” she said.
Kelly said she first became aware of the issue several years ago, when she met her family Kira Johnson, a black mother who died after the birth of her second child from obstetric bleeding – one of the most common causes of maternal death in the United States
“I will never forget her.” [older] the son came in and saw a picture of his mother on the screen. And she said, “There’s mom.” And that’s just me, “Kelly said.” What a pity. “
As the maternal mortality rate in the United States has increased, so has the incidence of “severe maternal morbidity,” according to the CDC. Every year, an estimate 50,000 women experience dangerous, even life-threatening health complications.
Jessica Davenport-Williams, a mother in Chicago, said she, after giving birth for the first time, had severe hemorrhage and would receive blood transfusions. She was pregnant with her second daughter around when Serena Williams and Beyoncé were in the news due to its serious complications of childbirth.
So she promoted herself before her next delivery.
“I wanted to make sure every doctor was well aware of my history, that they documented information in my file that would be transferred to the hospital. And I had a resistance,” he said. “They didn’t feel it was necessary. I had to push for multiple appointments for that to happen. ”
After her second daughter was born by cesarean section, Davenport-Williams bled again.
“It has become an emergency situation,” he said. “I just remembered that it could have been one of those cases … that I did [almost] I didn’t do it. “
Davenport-Williams said his experience forced him to become one defends maternal health.
“I don’t know if I will see the change for myself, in my life,” he said. “But I definitely don’t want my daughters to have the same story or experiences that many before they had.”
While extending Medicaid coverage is an important first step, efforts to prevent maternal death cannot stop there, Tabb Dina said.
Health care providers should be educated on racial inequities in medicine, he said. Screening all pregnant and postpartum women for mental illness and ensuring they receive treatment will also help save lives.
More experienced patients need a place at the table in policy discussions, he said.
“We need to understand the true stories of our ‘neighboring missions,'” said Tabb Dina. “What were their barriers? What were their complications?”
And then you ask: What more needs to change so that no child would grow up without a mother whose death could have been prevented?
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Survey, KHN is one of the top three operational programs in KFF (Kaiser Family Foundation). KFF is a gifted nonprofit organization that provides information on health issues to the nation.