Improving access to maternal care
We are happy to see that the current U.S. maternal morbidity and mortality crisis is recognized as an issue that must be addressed at the highest levels of government (Dec. 8, “Maternal Health Focus of Toomey, Brown Bill”). Severe maternal morbidity rates have been on the rise, and the burdens of racist policies have produced vastly worse outcomes for Black and Indigenous people compared with white people.
State Medicaid programs are the largest single payer for pregnancy and delivery in the U.S., and Medicaid beneficiaries experience higher rates of pregnancy-related mortality and morbidity compared with pregnant people with private insurance.
While quality improvement efforts in Medicaid are important, we believe that approaches that aim to better identify and mitigate risk only during pregnancy and delivery will not achieve the maximum improvement in public health. Instead, we hope that Sens. Pat Toomey, R-Pa., and Sherrod Brown, D-Ohio, appreciate the pronounced and cumulative effects of social and structural influences on health, including poverty, environmental pollution and residential racial segregation.
Recognizing the contribution of these influences on health means that broad efforts to advance economic, environmental and educational justice are paramount to improving pregnancy health and equity. It also means fully accepting that the effects of social injustices are reflected in the higher burden of chronic medical and mental health conditions observed in low-income populations and that management of these conditions requires access to health care throughout one’s life, long before a pregnancy and continuing beyond pregnancy.
We hope the senators will help to transform Medicaid policies in a way that shifts the focus away from pregnancy-specific benefits and toward a comprehensive approach that enables management of chronic conditions before, between and after pregnancies; enhances the ability to access and use contraception to avoid or delay pregnancy; and allows for people to obtain abortion care when faced with an undesired or medically risky pregnancy.
SONYA BORRERO, M.D. Director MARIAN JARLENSKI, Ph.D. Associate Director Center for Women’s Health Research and Innovation University of Pittsburgh Oakland