Analysis of Maternal Mortality and Morbidity Rates in States That Restrict Abortion Access and the Overturned Roe v. Wade
In states that ban abortions, there is more of a higher number of births in rural areas, where it is more difficult to get maternity care. Rural areas had 17% of births in abortion-restriction states but 8% 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.
In June the Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, holding that there is no longer a federal constitutional right to an abortion and paving the way for states to ban abortions.
She said that more people in the US die from complications of pregnancy and childbirth than anywhere else in the developed world. “So I think that’s just very important as we think of this maternal health crisis and this collision of crises with this impact and this Dobbs decision.”
The analysis also revealed that 39% of counties in states restricting abortion access fit the criteria to be considered “maternity care deserts,” meaning there is limited or no access to maternity health care services, such as an ob/gyn, hospital or birth center with obstetric care or certified midwives. In comparison, 25% of counties in abortion-access states can be considered maternity care deserts.
The Maternal Mortality and Morbidity Review Committee works to develop statewide data reports on causes of maternal death and intervention strategies. The committee is part of a group of people that want the legislative session this year to extend Medicaid for moms after their babies are born.
She had found a welcoming and supportive birth team. But the Medicaid coverage ended not long after her daughter arrived — just two months after giving birth. She lost insurance when her baby was young.
But applying for Medicaid didn’t come with an instruction manual. She had a lot of forms. She spent a lot of time on the phone figuring out where she should go to get care.
“That was a really huge privilege because it took so much time, and then sometimes the representative that I would speak to wouldn’t know the answer,” she says. I would have to wait and hope that they followed me up.
The bureaucracy of Medicaid: How much do pregnant Texans have to pay for medically necessary abortions? An analysis by TxPEP
For Ferrell Ortiz, the hospitals and clinics that accepted Medicaid near her in her Dallas neighborhood felt “uncomfortable, uninviting…and a space that wasn’t meant for me,” she says. Medicaid would pay for her to give birth in an enrolled birthing center.
But pregnancy-related Medicaid coverage ends just two months after childbirth — and advocates and researchers say that strict cutoff contributes to high rates of maternal mortality and morbidity in the state. A bill will move through the current legislative session that would allow Medicaid to cover a full year after a baby is born.
In Texas childless adults aren’t eligible for Medicaid. If the child is receiving Medicaid and the parents have low income limits, they can be eligible for Medicaid. The household with two parents can’t make more than $251 a month.
“I went to Lovers Lane Birth Center in Richardson,” she says. I’m thankful that they were able to connect me to other resources that the Medicaid office didn’t.
That extension was denied by the federal government in the fall of 2022; The Texas Tribune reported some legislators believed the application was rejected “because of language that could be construed to exclude pregnant women who have abortions, including medically necessary 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 study found that over 1,500 pregnant Texans used public insurance. It found that “insurance churn” — when people lose health insurance in the months after giving birth — led to worse health outcomes and problems accessing postpartum care.
“People are either having to wait 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.
“It’s the chance to have access to healthcare to address issues that maybe have been building for a while, those kinds of things that left unaddressed build into something that would need surgery or more intensive intervention later on,” she says. It 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
Amelie Ortiz: Getting Through the Hardest Experiences of Physical Education and Public Health, and how to make the most out of it
“I think there’s still going to be a few little legislative issues or landmines that we have to navigate,” she says. I feel like the pace is going well.
The daughter of Ferrell and Cynthia Ortiz 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.
“Giving birth was the hardest experience that my body has physically ever been through,” she says. “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.”
“If I was able to talk to people in the legislature about extending Medicaid coverage, I would say to do that,” she says. It is an investment in people who are raising our future and completely worth it.