search
Sections List
American Journal News

Maternal mortality is a huge problem in the United States. COVID aid could help.

‘Accessing health services for 12 months postpartum is essential for maternal health,’ Nan Strauss of Every Mother Counts said.

By Donna Provencher - March 15, 2021
Share
Rep. Robin Kelly (D-IL)

The $1.9 trillion COVID relief bill signed into law by President Joe Biden Thursday contains legislation experts say could drastically improve outcomes in women’s health care: a Medicaid extension that could reduce maternal mortality.

A provision in the American Rescue Plan offers to states the option of extending Medicaid coverage for women giving birth up to a year after labor and delivery.

The Center for Children & Families at the Health Policy Institute at Georgetown University’s McCourt School of Public Policy explains:

The American Rescue Plan offers states a new “state plan” option to provide pregnancy-related Medicaid and CHIP coverage for one year after the end of pregnancy, extending coverage well beyond the current cutoff of 60 days. Previously, states could only receive federal matching funds to extend postpartum coverage beyond 60 days …

 

The American Rescue Plan includes a number of provisions expanding and strengthening the Medicaid and CHIP programs. Some of these provisions are dependent on state action to fulfill their promise. These include financial incentives to spur more states to adopt the Medicaid expansion; a new state option to provide extended postpartum coverage to help address the maternal mortality crisis; extend through Medicaid coverage of COVID-19 vaccines and treatments for uninsured people; and provide enhanced federal financial support for home and community-based services for those with long-term service and support needs.

Medicaid covers 40% of American hospital births.

“Accessing health services for 12 months postpartum is essential for maternal health,” Nan Strauss, managing director of policy, advocacy, and grant-making for Every Mother Counts, told the American Independent Foundation. “With nearly one in four maternal deaths occurring between six weeks and one year after birth, the current pregnancy-related Medicaid coverage for only two months after childbirth is simply not enough.”

Certain preexisting pregnancy-related complications can develop into life-threatening conditions down the line after delivery, Strauss said, and some complications that occur during childbirth — such as organ failure or severe blood loss — can endanger the mother’s health long after the 60 days previously covered by Medicaid.

Moreover, some conditions, such as cardiomyopathy, don’t arise until after childbirth, while symptoms of mental health conditions such as postpartum depression that require psychiatric treatment may take months to appear.

“[All of these conditions] need to be treated after that [60-day] period, during which people have historically been unable to maintain their Medicaid coverage,” Strauss said. “It’s just not a time when people should be without care.”

The new provision is timely: Maternal mortality is up in the United States. Though internationally the death rate is down, in 2018, the most recent year for which National Center for Health Statistics data is available, the U.S. maternal mortality rate was 17.4 per 100,000 live births.

In 2007, the agency’s data indicated a mortality rate of 12.7 per 100,000 live births.

And, Strauss noted, much of the data available only reflects deaths that occur within 42 days of delivery and does not paint a full picture.

In 1985, the maternal mortality rate was 11.3, dropping to 11 by 1997 and then climbing again. In 2019, Harvard Medical School obstetrician Dr. Neel Shah told the Associated Press, “An American mom today is 50% more likely to die in childbirth than her own mother was.”

This increase is due to a number of factors, said Strauss, noting that the United States is one of only two countries in the world where the World Health Organization reports an increasing number of maternal deaths. While some of the increase can be attributed to better data collection, many other factors are at play.

One of these is the higher number of non-medically indicated cesarean sections performed in the United States than in other countries.

The risks of childbirth are particularly high for non-Hispanic Black women, who are three to four times as likely to die of delivery complications as non-Hispanic white women, and Native American and Alaskan Native women, who are 2.3 times more likely to die. These disparities are “not only extreme, but they have been consistent over the last 60 years” and appear across all age brackets and socioeconomic groups, Strauss said.

They are “unquestionably related to system and interpersonal bias and racism,” both in the health care system and in society as a whole, Strauss said, noting that poor outcomes for women of color are caused by preexisting social determinants, exposure to interpersonal racism, and implicit and explicit bias present when people are seeking and obtaining health care.

In 2016, Strauss helped develop a participatory research process alongside other clinicians, researchers, and community health service leaders on maternity care experiences. It found that 1 in 3 Black women reported “one or more instances of mistreatment and disrespectful care during labor and delivery” compared to 1 in 4 white women.

The types of disrespectful care most frequently reported were not being listened to, not being responded to in a timely manner, and being shouted at or treated disparagingly, all of which have been found to be contributing factors to maternal risk.

Strauss said maternal mortality rates cannot be improved without first focusing on racial discrepancies in maternity health care through implicit bias training and anti-racism training for health care providers, as well as advocacy for person-centered care.

The new Medicaid extension is a “triumph for maternal health” and a positive step toward ensuring families have access to health care during the first year postpartum, Strauss said, but there is still more to be done.

“While the current option for states to extend Medicaid coverage is a critical first step, a more robust extension would have a much bigger impact,” Strauss said, noting that she would like to see the extension mandated in all 50 states and Washington, D.C., instead of adopted on an opt-in basis. Right now, the extension is also temporary, and legislation to permanently codify it would further improve women’s health outcomes.

“[The new legislation] should be accompanied by enhanced federal matching funds that would make this shift more feasible for states, particularly during this time where their budgets are decimated by the effects of COVID-19,” she said.

Providing reimbursement through Medicaid and private insurance for doula support, as well as making sure that the midwifery model of care is integrated into the health care system, could also improve outcomes, Strauss said.

Published with permission of The American Independent Foundation.


Read More
Biden calls for expanded child tax credit, taxes on wealthy in $7.2 trillion budget plan

Biden calls for expanded child tax credit, taxes on wealthy in $7.2 trillion budget plan

By Jennifer Shutt, States Newsroom - March 11, 2024
December jobs report: Wages up, hiring steady as job market ends year strong

December jobs report: Wages up, hiring steady as job market ends year strong

By Casey Quinlan - January 05, 2024
Biden’s infrastructure law is boosting Nevada’s economy. Sam Brown opposed it.

Biden’s infrastructure law is boosting Nevada’s economy. Sam Brown opposed it.

By Jesse Valentine - November 15, 2023
Biden infrastructure law helps Pennsylvania’s small manufacturers

Biden infrastructure law helps Pennsylvania’s small manufacturers

By Oliver Willis - October 20, 2023
GOP senators try to stop EPA rule projected to save consumers millions of dollars

GOP senators try to stop EPA rule projected to save consumers millions of dollars

By Oliver Willis - October 20, 2023
Democratic bill would increase housing access for formerly incarcerated Michigan residents

Democratic bill would increase housing access for formerly incarcerated Michigan residents

By Alyssa Burr - October 18, 2023
AJ News
Latest
Republican Bernie Moreno’s rags-to-riches story exposed as a lie

Republican Bernie Moreno’s rags-to-riches story exposed as a lie

By Jesse Valentine - May 24, 2024
What happens to clinics after a state bans abortion? They fight to survive.

What happens to clinics after a state bans abortion? They fight to survive.

By Chabeli Carrazana and Shefali Luthra - May 22, 2024
Former Sen. Kelly Ayotte took job at Caterpillar after tax fraud probe

Former Sen. Kelly Ayotte took job at Caterpillar after tax fraud probe

By Jesse Valentine - May 21, 2024
Alabama OB-GYN residencies dropped over 20% after Dobbs, state abortion ban, says analysis

Alabama OB-GYN residencies dropped over 20% after Dobbs, state abortion ban, says analysis

By Alander Rocha, Alabama Reflector - May 21, 2024
House GOP celebrates National Police Week while pushing to defund local law enforcement

House GOP celebrates National Police Week while pushing to defund local law enforcement

By Jesse Valentine - May 16, 2024
Evolution denier Mark Robinson could reshape North Carolina’s education system

Evolution denier Mark Robinson could reshape North Carolina’s education system

By Jesse Valentine - May 16, 2024
Republican Jay Ashcroft backs anti-abortion clinics that push lies and disinformation

Republican Jay Ashcroft backs anti-abortion clinics that push lies and disinformation

By Jesse Valentine - May 14, 2024
Republican Sam Brown’s assault on teacher unions could backfire

Republican Sam Brown’s assault on teacher unions could backfire

By Jesse Valentine - May 09, 2024
Florida abortion ban puts GOP Rep. Anna Paulina Luna’s anti-choice views in spotlight

Florida abortion ban puts GOP Rep. Anna Paulina Luna’s anti-choice views in spotlight

By Jesse Valentine - May 07, 2024
Trump leaves door open to banning medication abortion nationwide

Trump leaves door open to banning medication abortion nationwide

By Jennifer Shutt, States Newsroom - April 30, 2024
Republican Caroleene Dobson wants Alabama abortion ban to go nationwide

Republican Caroleene Dobson wants Alabama abortion ban to go nationwide

By Jesse Valentine - April 30, 2024
Ohio Gov. DeWine said he didn’t know of millions in FirstEnergy support. Is it plausible?

Ohio Gov. DeWine said he didn’t know of millions in FirstEnergy support. Is it plausible?

By Marty Schladen, Ohio Capital Journal - April 29, 2024
GOP Rep. Zach Nunn suggests laws against hate crime aren’t needed

GOP Rep. Zach Nunn suggests laws against hate crime aren’t needed

By Jesse Valentine - April 15, 2024
GOP Senate candidate Hung Cao blames racial equity for Baltimore bridge tragedy

GOP Senate candidate Hung Cao blames racial equity for Baltimore bridge tragedy

By Jesse Valentine - March 29, 2024
GOP Rep. Jennifer Kiggans donates thousands to far-right extremists

GOP Rep. Jennifer Kiggans donates thousands to far-right extremists

By Jesse Valentine - March 08, 2024
Ohio senate candidate Bernie Moreno: “Absolute pro-life no exceptions.”

Ohio senate candidate Bernie Moreno: “Absolute pro-life no exceptions.”

By Jesse Valentine - March 07, 2024
Anti-China Republicans pocket thousands from Chinese owned conglomerate

Anti-China Republicans pocket thousands from Chinese owned conglomerate

By Jesse Valentine - March 04, 2024
Republican Eric Hovde makes inconsistent statements about family history

Republican Eric Hovde makes inconsistent statements about family history

By Jesse Valentine - February 26, 2024
Republican David McCormick invests millions in website that platforms Holocaust denial

Republican David McCormick invests millions in website that platforms Holocaust denial

By Jesse Valentine - February 09, 2024
Lawmakers will again take up bills expanding, tightening gun laws

Lawmakers will again take up bills expanding, tightening gun laws

By Annmarie Timmins, New Hampshire Bulletin - January 31, 2024
UAW delivers rousing presidential endorsement for Biden over ‘scab’ Trump

UAW delivers rousing presidential endorsement for Biden over ‘scab’ Trump

By Ashley Murray, States Newsroom - January 24, 2024
Republicans Sam Brown and Jeff Gunter sling mud in Nevada senate primary

Republicans Sam Brown and Jeff Gunter sling mud in Nevada senate primary

By Jesse Valentine - January 17, 2024
A Young Texas Woman Almost Died Due To The Texas Abortion Bans – Now She’s Battling To Save Other Women

A Young Texas Woman Almost Died Due To The Texas Abortion Bans – Now She’s Battling To Save Other Women

By Bonnie Fuller - January 10, 2024
Health care legislation preview: Maryland advocates want to focus on access, patients in 2024 session

Health care legislation preview: Maryland advocates want to focus on access, patients in 2024 session

By Danielle J. Brown, Maryland Matters - January 08, 2024
How GOP senate hopefuls try to excuse the  January 6 insurrection

How GOP senate hopefuls try to excuse the  January 6 insurrection

By Jesse Valentine - January 05, 2024
NH lawmakers will be taking up major voting bills this year. Here are some to watch for.

NH lawmakers will be taking up major voting bills this year. Here are some to watch for.

By Ethan DeWitt, New Hampshire Bulletin - January 04, 2024
Republican US Senate candidates want to make Trump’s tax cuts permanent 

Republican US Senate candidates want to make Trump’s tax cuts permanent 

By Jesse Valentine - December 22, 2023
Rand Paul went all in on the Kentucky governor’s race. It didn’t work.

Rand Paul went all in on the Kentucky governor’s race. It didn’t work.

By - December 15, 2023
Texas governor and attorney general do little to curb state’s chemical plant crisis

Texas governor and attorney general do little to curb state’s chemical plant crisis

By Jesse Valentine - December 08, 2023
Likely GOP Senate candidate Eric Hovde proposed tax hike for poorer workers and retirees

Likely GOP Senate candidate Eric Hovde proposed tax hike for poorer workers and retirees

By Jesse Valentine - December 07, 2023
Whitmer signs specific criminal penalties for assaulting health care workers into law

Whitmer signs specific criminal penalties for assaulting health care workers into law

By Anna Liz Nichols, Michigan Advance - December 06, 2023
105 Republicans voted to expel Santos for things Trump has also done

105 Republicans voted to expel Santos for things Trump has also done

By Jesse Valentine - December 05, 2023
For Texas Sen. Ted Cruz, another Trump term is another chance to kill Obamacare

For Texas Sen. Ted Cruz, another Trump term is another chance to kill Obamacare

By Jesse Valentine - December 04, 2023
Florida Sen. Rick Scott backs Donald Trump in revived push to repeal Obamacare

Florida Sen. Rick Scott backs Donald Trump in revived push to repeal Obamacare

By Jesse Valentine - November 30, 2023
Tate Reeves took donations from power company that hiked customer rates

Tate Reeves took donations from power company that hiked customer rates

By Jesse Valentine - November 06, 2023
Daniel Cameron ran on depoliticizing the Kentucky AG’s office. He made it more political.

Daniel Cameron ran on depoliticizing the Kentucky AG’s office. He made it more political.

By Jesse Valentine - November 03, 2023
Republican operatives sound every alarm on current trajectory of 2023 governor’s race

Republican operatives sound every alarm on current trajectory of 2023 governor’s race

By Adam Ganucheau, Mississippi Today - October 24, 2023
Louisiana declares abortion drugs ‘dangerous substances’ to add harsher penalties

Louisiana declares abortion drugs ‘dangerous substances’ to add harsher penalties

By Greg LaRose, Louisiana Illuminator - May 24, 2024
These U.S. Supreme Court cases could affect abortion access nationwide

These U.S. Supreme Court cases could affect abortion access nationwide

By Charlotte Rene Woods, Virginia Mercury - May 24, 2024
Mike Rogers’ ties to Chinese telecom giants fuel hypocrisy scandal

Mike Rogers’ ties to Chinese telecom giants fuel hypocrisy scandal

By Jesse Valentine - May 23, 2024
New rules protect pregnant workers, but red states sue over abortion provisions

New rules protect pregnant workers, but red states sue over abortion provisions

By Anna Claire Vollers - May 22, 2024