Through my ongoing collaborations with Medicaid and commercial health plans, as well as hospital NICU teams across the country, I am fortunate to witness the tremendous ongoing passion for improving maternal and infant health and health care equity.
However, passion alone will not propel us forward toward the kind of progress that women, their children, and their families rightfully deserve. What is really needed today is greater continuity of care that holistically supports mothers and their newborns from conception through the first year after birth.
Support for this full continuum of care is based on decades global evidence to suggest that a fully integrated program of care provides baseline levels of routine monitoring and a consistent opportunity for critical intervention when needed throughout pregnancy, in the critical months after birth and throughout the postnatal period. Colloquially known as the “fourth trimester,” this cardinal window for healing, restoration, and bonding is essential to the long-term health of both mother and baby.
Unfortunately, the United States today has highest maternal mortality rate from all developed countries and experiences significant disparities in maternal health outcomes, particularly when broken down by race and ethnicity. For 2020, CDC released data revealing that our nation’s maternal mortality rate has increased again, this time by 14% from 2019 to 2020. And for these reasons, expanding maternal care is appropriate.
While these annual figures continue to paint a very bleak picture, I believe there remains significant opportunity to drive change and improvement in our healthcare system. This is an opportunity for us to take a more holistic view of maternal and infant health care.
The new policies are beginning to lay the groundwork for real systemic change as 19 states, plus the District of Columbia, now collect funds from the America’s Economic Rescue Plan Act. expand postpartum Medicaid coverage from 60 days to a full year after delivery. Under the current program, this expansion of care is slated to last five years, an inspiring step forward toward more holistic maternal and infant care for all. This brings the total number of states adopting the Medicaid expansion to 39. For more than 42% of women covered by Medicaidthis ensures access to vital health services, including breastfeeding support, chronic disease management, postpartum mental health screenings, home visits, community education and other services.
In more ways than one, achieving a full continuum of care enables us to create better standards for all. Regardless of the method, we want to achieve quality outcomes that protect our mothers and the most vulnerable among us, our newborns. By implementing a more comprehensive maternity journey, we are able to address the social determinants of health that vary by population, geography and community – and measure impact 80% of an individual’s overall, long-term health. We can tailor coverage to suit circumstances and ensure that all mothers and newborns have a safety net of care and community.
Using this framework and contextual, community-based understanding will be critical to ensure that our continuum of care is not designed as a “one size fits all”. What is likely to work in New York may not work in rural Louisiana. Factors such as limited public transport or a lack of trust in the health care system have a large impact on whether or not new mothers are likely to follow their care plan and attend follow-up appointments. Additional proactive outreach methods, appointment reminders, and home visits may have greater impact in these areas.
When we start reaching women earlier and providing more – and more relevant – interactions during pregnancy and beyond, our actions will have an impact. Moving toward a comprehensive, community-based approach to care that focuses on improving quality outcomes will finally help us move the needle on our maternal and infant health indicators. We will finally start to see healthier, happier and more empowered mothers and babies.
Photo: FatCamera, Getty Images