Health Policy Analysis

To:  Representative Alma S. Adam

From: Azline Exime 

Date: July 20th, 2022 

Re: Decreasing the Maternal Morbidity and Mortality Rate to Save Families

Statement of Issue: African American women are also dying three to four times more than white mothers after birth. Preeclampsia is a hypertensive disease that affects pregnant women and leads to complications to both the mother and infant. Preeclampsia is more common in African American Women than caucasians. However, whether this is due to African Americans having a higher rate of hypertension or because they are more predisposed to preeclampsia remains elusive. What is truly known about preeclampsia is that it still remains the leading cause of maternal and perinatal mortality and morbidity worldwide due to lack of patient education, clinician awareness and medical deserts. The Black Maternal Health Caucus’s (BMHC)  Momnibus policy aims to target all of these concerns and more which will lead to a decrease in mortality and morbidity in preeclamptic women. 

  • United States has one of the highest Maternal Mortality Rate (MMR) worldwide. Within the US between the years of 2019 and 2020 there has been a 20 percent increase and about 55.3 deaths in every 100,000 live births in MMR. The highest subgroup affected are Black women. 
  • Black women experience mental health illnesses such as postpartum depression (PPD) more than double the rate of the entire population. Socioeconomic status, education, lack of medical access and systemic racism play a role in increasing their risk of PPD.

Policy Options: 

Creating Health Policies focused on Maternal Postpartum Care: One of the policies currently waiting to be passed is the Postpartum Medicaid Coverage that last for 12 months after the mother gives birth. The postpartum Medicaid Coverage program 

  • Advantages: 
    • The Postpartum Medicaid Coverage plan explores models of care that can improve postpartum maternal care by increasing access to postpartum contraceptives, improve outcomes in postpartum complications and so much more. 
    • Postpartum Medicaid Coverage places Medicaid State agencies and participating members under a collaborative affinity group which increases the awareness and improves care for the patients
    • Policies can increase the interdisciplinary collaborative practice by including Social workers, Public Health entities, providers, etc. Increasing interdisciplinary Collaborative practice will effectively increase the mother and families activity in their own health. It will also make it easier for patients to have access to their care and smoother for them to receive care. 
  • Disadvantages: 
    • Medicare Postpartum coverage is state-dependent. So if the state does not approve of the program, it will not be implemented
    • Medical Postpartum coverage only last 12 months and then the coverage is suspended unless the family goes through another route for medicaid. This is a disadvantage for the families that cannot afford medical insurance but are not eligible for medicaid. 

Support Mothers Mental Health: During and after pregnancy multiple things change in a mother’s life making her more vulnerable to mental illnesses. Adding poverty to the mix can have an immense negative impact on a woman’s life and lead to even death. During the perinatal and postpartum period a woman has an increased risk of developing depression, Anxiety Disorder, OCD, Panic Disorder, Bipolar disorder, Birth-related PTSD and postpartum psychosis. Focusing on increased awareness, screening, prevention and treatment of postpartum mental health can lead to better health outcomes in mothers and families overall. 

  • Advantages:
    • Increases Awareness to a situation that is affecting as much as 1 out of 5 women in the world. 
    • Improves family Mental Health 
    • Increases positive intervention for long term development in children due to mothers being more readily available to nurture their children optimally. 
    • Programs such as Postpartum Support International (PSI) provide peer support to families, educate patients and train individuals to support maternal mental health. 
  • Disadvantages: 
    • Lack of funding 
    • Different cultures have mental illness stigmas and mothers from those cultures will not be able to benefit from this support. 

Improving quality measures and data collection processes: 

  • Advantages : 
    • Leads to Understanding maternal health problems and where the shortages are in their lives that is increasing their risk of dying. 
    • Improves maternal and family quality of life by reducing incidence and prevalence if the information is used to change what needs to be altered. 
  • Disadvantages: 
    • Takes a long time to implement and to perform the research. 
    • Knowing about health problems does not mean these problems will be fixed 

Policy Recommendation:  The number of maternal morbidity and mortality increasing leads to short- and long- term effects on not only families but society in general. Mothers need to be saved and protected so that they can continue to contribute to society.The Black Maternal Health Caucus’s (BMHC)  Momnibus policy has outlined multiple different areas that can make a difference and save maternal lives. Creating health care policies that focus on Maternal postpartum care like the Postpartum medicare coverage will decrease maternal mortality and morbidity. Creating these policies will focus on improving maternal care and filling in the gaps that are affecting mothers and causing them to lose their lives. Although some of these policies will be insurance runned, there can be a new health policy that can bridge the gap for families that cannot afford insurance. 

References: 

Black Maternal Health momnibus. Black Maternal Health Caucus. (2022, February 15). Retrieved July 22, 2022, from https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus 

Jeyabalan A. (2013). Epidemiology of preeclampsia: impact of Obesity. Nutrition reviews, 71 suppl (0 1), S18-S25. https://doi.org/10.1111/nure.12055

Seely E. et al (2014) Chronic Hypertension in Pregnancy. AHA journal Circulation, volume. 129 no. 11, 129:1254–1261 https://www.ahajournals.org/doi/10.1161/circulationaha.113.003904#d11139755e55

Mental Health America. 2022. Maternal Mental Health. [online] Available at: <https://mhanational.org/maternal-mental-health#:~:text=Maternal%20mental%20health%20disorders%20typically%20occur%20in%20what,first%20year%20after%20the%20baby%20has%20been%20born.> [Accessed 22 July 2022].

Mental health challenges black mothers face – UPMC HealthBeat. (n.d.). Retrieved July 22, 2022, from https://share.upmc.com/2020/07/black-maternal-mental-health/ 

Medicaid.gov. 2022. Postpartum Care | Medicaid. [online] Available at: <https://www.medicaid.gov/medicaid/quality-of-care/improvement-initiatives/maternal-infant-health/quality-improvement/postpartum-care/index.html> [Accessed 22 July 2022].

Position statement 49: Perinatal Mental Health. Mental Health America. (n.d.). Retrieved July 22, 2022, from https://mhanational.org/issues/position-statement-49-perinatal-mental-health 

Postpartum support international – psi. Postpartum Support International (PSI). (2022, May 6). Retrieved July 22, 2022, from https://www.postpartum.net/ 

Unite for sight. Cultural Perspectives on Mental Health. (n.d.). Retrieved July 22, 2022, from https://www.uniteforsight.org/mental-health/module7 

USAFacts. (2022, March 21). The US maternal mortality rate peaked during the pandemic and was highest for black women. USAFacts. Retrieved July 22, 2022, from https://usafacts.org/articles/the-us-maternal-mortality-rate-peaked-during-the-pandemic-and-was-highest-for-black-women/?utm_source=google&utm_medium=cpc&utm_campaign=ND-Healthcare&gclid=Cj0KCQjwz96WBhC8ARIsAATR25000gqSvnBxEsBv07GX2ZTlVDOjIN5cN0qpujfwLMsNVJxUbke4gLUaAgd2EALw_wcB 

World Maternal Mental Health Awareness Day. WMMH Day. (n.d.). Retrieved July 22, 2022, from https://wmmhday.postpartum.net/