THE UNITED STATES has the highest maternal mortality rate of any high resource country, with Black women being three times more likely to die in childbirth than white women, and it is the only country (outside of Afghanistan and Sudan) where the rate is rising (Tikkanen et al., 2020). Missouri’s maternal mortality rates are double the national average, placing the state 38th in the United States (Nickelson, 2023). More than half of pregnancy-related deaths occur after 43 days postpartum, and most pregnancy-related mortality is considered preventable (up to 80%). Primarily a rural state, Missouri has ten rural counties with the highest rates of maternal morbidity (Missouri Department of Health and Senior Services, 2021; The Missouri Pregnancy-Associated Mortality Review, 2018). Access to care is complicated by fragmented geographic availability and the growing number of hospital closures. From 2014 to 2020, 15 hospitals closed in Missouri, 10 of which are in rural counties (Missouri Department of Health and Senior Services, 2021). Of note, between 2014 and 2018, more than one in four Missouri mothers did not begin prenatal care in the first trimester (Missouri Department of Health and Senior Services, 2021). Additionally, rates of chronic conditions such as obesity, diabetes, and hypertension continue to rise among women of childbearing age (Health in Rural Missouri Biennial Report, 2022-2023).
Maternal health is attracting increased interest by key stakeholders in the United States; they are attempting to change the dismal and increasing rates of maternal mortality. The first federal policy proposed is the Build Back Better Act (BBBA) (passed in House 11/19/21; then renamed the Inflation Reduction Act of 2022 and passed 8/2022). This bill originally provided funding for a variety of projects, some of which include free childcare for children six and under, free preschool, and up to four weeks of paid family and medical leave per year. The BBBA also promoted maternal health homes by incentivizing states through an increase on the federal match of 15% for two years if they use maternal health homes. Finally, the BBBA authorized approximately one billion dollars in grant funding for the Black Maternal Health Momnibus Act to stop racial and ethnic maternal health disparities while improving birth equity (Ranji et al., 2021). The second federal policy is Medicaid Postpartum Coverage Extension (passed in Missouri 7/2023). More than 40% of births are insured under Medicaid. Federal law mandates that states lengthen Medicaid eligibility to pregnant women with household incomes up to 138% of the federal poverty level through one year post birth. The third federal policy closely related to Medicaid Coverage Extension is the 2021 American Rescue Plan Act (passed 3/2021). This policy gives states the opportunity to prolong Medicaid postpartum coverage to 12 months for up to five years. Finally, if passed, the Care for Her Act (Referred to the federal Subcommittee on Courts, Intellectual Property, and the Internet on 11/2022) would establish the Pregnancy Support Collaborative, a clearinghouse of information on pregnancy support services and education opportunities for new parents and pregnant women. This bill would also direct the Department of Health and Human Services to award grants for mentoring pregnant 17 women and new mothers as well as enhance the availability of maternity housing.
On a state level, Missouri offers increased benefits to pregnant women compared to standard adult coverage. Under extended Medicaid coverage, mothers are eligible for increased benefits through the end of the 12-month period, which permits mothers to stay insured even if they undergo changes in income. Postpartum health insurance can markedly decrease costs due to complications from untreated diabetes, perinatal mood and anxiety disorders, and cardiomyopathy. Additionally, Missouri passed the Cora Faith Walker Doula Training Program and a prison nursery program initiative. The bill directs the Missouri Department of Corrections to establish a nursery within a women’s prison by July 2025 (Generate Health, 2022). Yet, perinatal mental health has yet to be brought to the ballad. The cost of NOT treating mental health conditions was $32,000 per mother and infant pair, adding up to $14 billion nationally (Luca, 2020). Women with untreated mental health conditions were more likely to fail to manage their own health, had inadequate nutrition, abuse substances, experience abuse, were less responsive to their baby’s needs, had fewer positive interactions with their baby, experienced difficulties breastfeeding, and questioned their abilities as a mother (Sriraman, 2017). Consequently, babies born to mothers with untreated mental health conditions were at increased risk for low birth weight or smaller head size, preterm birth, longer stays in NICU, excessive crying, and behavioral, cognitive, and emotional delays (Sriraman, 2017). Crusading for mothers is a movement to make the United States the best country in the world for mothers to thrive. We must fight for changes at every level (federal, state, healthcare system, practice, provider, and parent).
References
Generate Health End of Session Overview (2022). Generate Health: Champions of Family and Community. Retrieved from https://generatehealthstl.org/end-of-sessionoverview/
Health in Rural Missouri Biennial Report 2022-2023. Retrieved from https://health.mo.gov/living/families/ruralhealth/pdf/biennial2022.pdf
Luca, D. L., Margiotta, C., Staatz, C., Garlow, E., Christensen, A., & Zivin, K. (2020). Financial toll of untreated perinatal mood and anxiety disorders among 2017 births in the United States. American Journal of Public Health, 110(6), 888–896. https://doi.org/10.2105/AJPH.2020.305619
Missouri Department of Health and Senior Services. (2021). Welcome to WIC. Missouri WIC Income Guidelines – April 1, 2021. Retrieved from https://health.mo.gov/living/families/mch-block-grant/pdf/maternalmortalityandmorbidity_final.pdf
Missouri Pregnancy Associated Mortality Review 2018 Annual Report. Missouri Department of Health and Senior Services. (June 2021).
Nickelson P. F. (2023). Missouri’s public health at a glance. Missouri Medicine, 120(1), 4–7.
Ranji, U., Frederiksen, B., Salganicoff, A. & Long, M. (2021). Women, work, and family during COVID-19: Findings from the KFF women’s health survey. In Kaiser Family Foundation. Retrieved from https://www.kff.org/womens-healthpolicy/issue-brief/women-work-and-family-during-covid-19-findings-from-thekff-womens-health-survey/.
Sriraman, N. K., Pham, D.-Q., & Kumar, R. (2017). Postpartum depression: What do pediatricians need to know? Pediatrics In Review, 38(12), 541-551. https://doi.org/10.1542/pir.2015-0133
Tikkanen, R., Gunja, M., FitzGerald, M., Zephyrin, L. (2020, November 18). Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries.
