Maternal & Infant Health
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Maternal and infant health remains top priority in state budget

Natasha Takyi-Micah
Treuhaft Fellow for Health Planning
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March 15, 2021
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For the past several years, Community Solutions has been committed to examining and improving maternal and infant health for families in our state. By analyzing disaggregated maternal mortality data, infant mortality reports and other critical statistics such as birth records, we’ve developed policy solutions to help combat an escalating maternal and infant health crisis and continue to advocate for rule changes and administrative waivers state departments can pursue to improve outcomes.[bctt tweet="How can pairing policy recommendations with appropriations help address infant and #maternalhealth?" username="CommunitySols"]  

During this time, the state has also made considerable strides in this space, dedicating an immense amount of resources, and creating new statewide groups, to examine the scope of the problem. Presently, staff members from Community Solutions serve as members of the Ohio Council to Advance Maternal Health. This council was formed to implement a statewide strategic plan to reduce maternal mortality and morbidity, as well as to eliminate maternal health disparities. We are also members of the Ohio Collaborative to Prevent Infant Mortality, a statewide partnership devoted to community engagement, data management and advocacy, amongst other exercises, to improve birth outcomes.

 Ohio’s Black Maternal Health Caucus promotes and introduces statewide legislation in Ohio’s General Assembly that aims to close gaps, make birth support persons more accessible and amplify community-driven policy.

Additionally, we have spent a considerable amount of time engaging with members of Ohio’s Black Maternal Health Caucus (OBMHC). The OBMHC was formed in 2019 to focus exclusively on the disparities between Black and white maternal health outcomes across the state. The first of its kind at the state level in the country, the OBMHC promotes and introduces statewide legislation in Ohio’s General Assembly that aims to close gaps, make birth support persons, such as doulas and midwives, more accessible and amplify community-driven policy.

 While the statewide attention on Ohio’s maternal and infant health has been refreshing, the work must continue.

In the previous state budget, we were pleased to see that data collection in the maternal health arena was prioritized with the strengthening of the Pregnancy Associated Mortality Review (PAMR) Board, however, we maintain that data collection and oversight remain a concern. The latest data on pregnancy-related deaths in Ohio was released in 2019 but only covers deaths until 2016, more than five years ago. In the past, creating policy around antiquated data has proved to be counterproductive and a waste of resources. In order for other areas in the maternal and infant health space to improve, such as coverage, benefits and care delivery transformation, data collection including reporting requirements must improve. In addition to advocating for annual reporting of maternal mortality data, we also believe that public annual disaggregated reporting of maternal morbidity data is crucial to identifying gaps in care and services, studying the racial disparities gap between Black and white mothers and determining evidence based-solutions for both the community and organizational levels throughout Ohio.  

The American College of Obstetrics and Gynecologists (ACOG) has continuously recommended insurance coverage policies are aligned to support a tailored approach to “fourth trimester” care. While Medicaid is required to cover pregnant individuals with incomes up to 133 percent of the federal poverty level for 60 days following birth, in West Virginia, for example, 62 percent of all maternal deaths from 2007-2013 occurred more than 60 days after birth. [1] For this reason, we recommend all individuals whose pregnancies are covered by Medicaid be able to maintain their Medicaid coverage for at least one year after giving birth, including coverage for services like case management and outreach, substance-use disorder treatment and mental health screening and treatment. Research has shown that extending Medicaid coverage does help to eliminate preventable maternal deaths.

 We recommend all individuals whose pregnancies are covered by Medicaid be able to maintain their Medicaid coverage for at least one year after giving birth.

Because of the state’s earlier investment to reduce infant mortality, the data surrounding infant deaths and disparities is the most robust. According to the Health Policy Institute of Ohio (HPIO), the gap between the Black and white infant mortality rate widened from 2014 to 2019. Even though the rates between the two groups fluctuated over time, there is a huge gap, with white babies having an infant mortality rate of 5.1 deaths per 1,000 live births, whereas the rate for Black babies was 14.3 deaths per 1,000 live births in 2019. As far as geographical disparities, it is difficult to compare infant mortality rates between rural and urban areas because the data in rural areas is suppressed.  

As previously mentioned, data on maternal mortality is outdated in Ohio. The Ohio Department of Health (ODH) released a report on maternal mortality, but the information is from 2008 to 2016. Nonetheless, ODH’s report showed disparities existed between races and geographical locations across the state. From 2008 to 2016, the pregnancy-related mortality ratios were 29.5 deaths per 100,000 live births for Black women compared to 11.5 deaths per 100,000 live births for white women. While the data on maternal morbidity in Ohio is outdated, data on severe maternal morbidity is nonexistent.

 Home-visiting programs allow community health workers to communicate with pregnant mothers about their concerns and needs for their babies.

To address both racial and geographical disparities, ODH provides home-visiting programs to help expectant mothers have healthy pregnancies and receive parental education. As an evidence-based intervention, home-visiting programs allow community health workers to communicate with pregnant mothers about their concerns and needs for their babies. In order to support home visiting programs, Governor Mike DeWine and ODH plan to invest more funding into the Help Me Grow program, a home-visiting program, as noted in the proposed state budget. Specifically, they proposed $41,242,281 to be invested for each fiscal year (FY) of 2022 and 2023, a 5 percent increase from FY 2021 ($39,292,281). If the Ohio General Assembly allows this provision to pass, then this program will continue to combat issues within maternal and infant health.  

In addition to the state’s efforts, some local organizations across Ohio have taken matters into their own hands by conducting a community approach in determining best practices for saving lives. Restoring Our Own Through Transformation (ROOTT) in the Columbus area and Birthing Beautiful Communities in Northeast Ohio offer doula services for Black women. Cradle Cincinnati and First Year Cleveland both convene with various stakeholders within their communities to make sure babies live to see their first birthdays. Queens Village, a program within Cradle Cincinnati, gives Black women an opportunity to talk about motherhood. Finally, Pathways Community HUBs connect at-risk expectant mothers to the services they need (e.g. housing, health care and transportation) with the help of community health workers. There are currently ten HUBs across Ohio.

 The state budget offers a unique opportunity to pair policy recommendations with appropriations to implement actions.

While Ohio has come a long way in recognizing and prioritizing maternal and infant health in a short amount of time, it’s crucial that the momentum continues, and the conversation deepens so we can save more lives. The state budget offers a unique opportunity to pair policy recommendations with appropriations to implement actions. With continued investment in infant and maternal health, we can ensure not only a decrease in maternal and infant deaths, but a decrease in deaths across all of Ohio’s women and children.

  1. https://www.acog.org/advocacy/policy-priorities/medicaid#:~:text=In%20West%20Virginia%2C%20for%20example,more%20than%2060%20days%20postpartum
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