Maternal and infant death rates are much higher in states that don’t allow abortion

Advancing Prenatal Health Care Reform in the US After the Supreme Court Decision of November 2018: The Roe v. Wade Amendment is Back

The report also says that, between 2018 and 2020, the infant and perinatal mortality rates were 6.2 deaths per 1,000 births in abortion-restriction states, compared with 4.8 per 1,000 in abortion-access states. Across all racial and ethnic groups, infant mortality in the first year of life was higher in abortion-restriction states than in abortion-access states.

The researchers analyzed data on deaths and other health outcomes using the most recent data available – from 2020 and earlier – and compared rates based on states’ current abortion access policies, as of November, after the Supreme Court decision this summer that overturned Roe v. Wade.

“Making reproductive services inaccessible to women and families can have dire consequences, and particularly, it varies by state,” said obstetrician/gynecologist Dr. Laurie Zephyrin, a co-author of the report and senior vice president for advancing health equity at the Commonwealth Fund.

The Supreme Court ruled in the summer that there is no federal constitutional right to an abortion, and paved the way for states to ban it.

“More people in the US die from complications of pregnancy and childbirth than any other developed nation, and most are preventable – and our rates are on the rise,” she said. That is important as we think of a maternal health crisis, a collision of crises, and the Dobbs decision.

“It also means, similar to states that have only one abortion clinic, that the places where there are only one or a few labor and delivery units or prenatal care centers, those facilities will become overwhelmed with patients and that may create delays in care,” Brandi said. “This is not how healthcare should be. People should be able to access all reproductive health care services, regardless of their zip code.”

Maternal mortality continues to increase in the US, but the maternal death rate in states that have expanded Medicaid has increased at a slower rate than in states that have not.

Victoria Ferrell Ortiz found out she was pregnant during the summer of 2017. The Dallas resident finished her AmeriCorps job with a local nonprofit, which offered her a small living stipend, but no health coverage. She applied for Medicaid so she could be insured during the pregnancy.

But applying for Medicaid didn’t come with an instruction manual. She had a lot of forms. She spent weeks on the phone trying to figure out what she would get, where she could get it, and when she would get it.

She says it was a huge privilege because it took so much time and the representative wouldn’t know the answer. “I would have to wait for a follow up and hope that they actually did follow up with me.”

State Policy and Black Women in Texas: The Importance of Pregnant Women’s Health Insurance Coverage for Birth-Between Children

The coverage for immigrants who are illegal in Texas won’t be available when the baby is born.

Medicaid covers pregnant women only for two months after childbirth, leading to high rates of maternal mortality and morbidity in the state. They support the extension of pregnant Medicaid coverage for a full year after birth.

But in Texas, childless adults don’t qualify for Medicaid at all. Parents can be eligible for Medicaid if they’re taking care of a child who receives Medicaid, but the income limits are low. For a three-person household with two parents, they can’t make more than $251 a month.

“I went to Lovers Lane Birth Center in Richardson,” she says. And I’m so grateful that I found them because they were able to connect me to other resources that the Medicaid office wasn’t.”

The Texas Tribune reported that some legislators believed the application was denied because of language that could be construed to exclude pregnant women who have abortions.

Kari White, an associate professor at the University of Texas at Austin, says the bureaucratic challenges Ferrell Ortiz experienced are common for pregnant Texans on Medicaid.

TxPEP studies the various impacts that state policy has on people’s reproductive health. A March 2022 TxPEP study surveyed close to 1,500 pregnant Texans on public insurance. When people lose health insurance in the months after giving birth, they end up with worse health outcomes.

“People are either waiting until their condition gets worse, they forgo care, or they may have to pay out of pocket,” White says. “There are people who are dying following their pregnancy for reasons that are related to having been pregnant, and almost all of them are preventable.”

For example, chronic disease accounted for almost 20% of pregnancy-related deaths in Texas in 2019, according to the latest report from the Texas Maternal Mortality and Morbidity Review Committee (MMMRC). Chronic disease includes conditions such as high blood pressure and diabetes.

Stark disparities such as that can be traced to systemic issues, including the lack of diversity in medical providers; socioeconomic barriers for Black women such as cost, transportation, lack of childcare and poor communication with providers; and even shortcomings in medical education and providers’ own implicit biases — which can “impact clinicians’ ability to listen to Black people’s experiences and treat them as equal partners in decision-making about their own care and treatment options,” according to a recent survey.

She says that it’s the opportunity to address issues that have been building for a while, those that are left unaddressed, which could lead to surgery or more intensive intervention later on. It just feels like that should be accessible to everyone, when they need it.

Source: https://www.npr.org/sections/health-shots/2023/03/05/1158813214/texas-medicaid-limits-after-childbirth

“The Momentum is There”: An Empirical View of Amelie Ortiz’s Journey to a Mom’s Dream

She thinks there will be a few little legislative issues or “land mines” that we have to navigate. “But I feel like the momentum is there.”

Ferrell Ortiz’s daughter is turning 5 this year. Amelie is artistic, bright, and vocal in her beliefs. When she thinks about being pregnant, she remembers how hard it was and how much she learned about herself.

She says giving birth was the hardest experience her body has ever had. “It was a really profound moment in my health history — just knowing that I was able to make it through that time, and that it could even be enjoyable — and so special, obviously, because look what the world has for it.”

She said she would want to talk to people in the legislature about extending Medicaid coverage. It’s an investment in the people who are raising our future and completely worth it.