Advocates spotlight Kansas maternal health shortfalls, possible remedies

TOPEKA — Kansas maternal health stakeholders are advising state lawmakers to strengthen government financial backing of maternal health providers to counteract preventable deaths.

More than a dozen providers, citizens and advocates reported Wednesday to the Joint Committee on Home and Community Based Services and KanCare Oversight on worsening outcomes for Kansas women during pregnancy, at the time of birth and in the entire 12 months postpartum. They said many outcomes are not equitable, and in many areas of the state quality care is not accessible to mothers and infants.

Terrah Stroda, a coordinator for Fourth Trimester Initiative of Kansas Perinatal Quality Collaborative, has been working with stakeholders to identify issues before and after birth and brainstorm ways to address them. She implored legislators to address the maternal health crisis and outdated support systems.

Most concerning to Stroda was data gathered from the Kansas Maternal Mortality Committee demonstrating that 92.3% of the pregnancy-related deaths in Kansas were preventable.

“Why in our great state would these horrific events be happening, and how can we stop the tragedies with research-based, quality improvement strategies?” Stroda said. “The systems-level problems that we know contribute to adverse health outcomes for women in our state are in our face: access to health care, a health care model in our state that no longer improves outcomes … and a lack of regionalization of health care so that moms have top-rate medical care no matter where they live.”

Stroda also pointed to data from the Kansas Pregnancy Risk Assessment Monitoring System, a survey of Kansas women with a recent live birth, that provided insight into the prevalence of chronic disease, smoking, and socioeconomic disparities within maternal health. Specifically, she referenced the prevalence of postpartum depressive symptoms, which were highest among women under the age of 24, those who had less than or equal to a high school diploma, and women who had been enrolled in Women, Infant and Children grants during pregnancy.

In the 2020 March of Dimes Premature Birth Report Card, referencing data from 2016 to 2018, the premature birth rate for African-American women in Kansas was 51% higher than the rate among all other women, at 13.6%. According to the Kansas Maternal Mortality Report from those same years, African American women accounted for 14% of pregnancy-associated deaths but only 7.1% of births in Kansas.

Elizabeth Lewis, director of maternal and infant health for March of Dimes, said rates of perinatal depression of up to 50% have been documented in African-American women in one 2017 study.

“Women living in poverty and women of color are more likely to experience maternal mental health conditions and less likely to get help due to lack of access to health care,” Lewis said, “including culturally appropriate mental health care, cultural and racial biases in the health care system, more barriers to care, such as lack of transportation or child care and fear that child protective services or immigration agencies will become involved.”

Provider shortages

Advocates said pregnant mothers didn’t receive treatment because of a shortage of accessible services.

Kansas has 45 counties classified as maternity care deserts, with 35,317 women 15 to 44 years old lacking those essential services, especially in rural communities. Additionally, there are 24 counties with low access to maternity care, representing an additional 58,131 women.

Carla Moralez, a community health worker for Community Health Council of Wyandotte County, told about a woman named Bella. Bella, who resides in Olathe, was referred to a maternal community health worker to assist her with finding primary care for her pregnancy.

Bella was unable to obtain health insurance and thus wanted a low-cost facility that she could afford. Due to a language barrier, the worker did most of the searching, but each of the first three clinics required payment of $1,500 either as a deposit or at the time of the first visit, out of Bella’s range.

The final option the worker contacted was New Birth Company, which only required a $175 payment during the first visit. At that time, a payment plan would be discussed. Bella was quickly scheduled for a visit.

“Please consider that over 200 pregnant women delivered in Kansas without documented prenatal care,” Moralez said. “Kansas taxpayers pay for the hospital and baby costs, no matter how little care the mom receives. This story describes what the gap in services left by the closure of more birth centers would mean.”

New Birth Company was formed to offer safe, holistic natural childbirth and the birth center concept to women in its community. However, even New Birth Company experienced difficulties keeping the doors open.

On July 1, its Wyandotte County location closed after the birth center did not obtain KanCare utilization or the reimbursement needed to remain sustainable. Kendra Wyatt, CEO and co-founder of New Birth Company said that policy environment risks to itsOverland Park birth center, where Bella was seen, and the other three Kansas birth centers remain high.

New Birth Company is one of a dwindling number of entrepreneurs and small business providers serving KanCare members. Since opening in 2016, the maternity center targeted improving Black, Hispanic and new immigrant mother and infant outcomes in Wyandotte’s Healthy Start ZIP codes.

“Why does a birth center closing in Wyandotte County matter?” Wyatt said. “The midwife-led Kansas Birth Center remains an underutilized, resilient Kansas solution to the problem of achieving better birth outcomes and the efficient use of Kansas taxpayer dollars.”

Addressing postpartum outcomes

Aside from addressing prenatal care, health care advocates pushed for extended postpartum coverage for Kansas mothers enrolled in KanCare.

In 2018, Medicaid covered 39% of all births in Kansas – 14,145 newborns. Before the COVID-19 pandemic, most new mothers enrolled in KanCare would have lost their coverage 60 days after giving birth.

Recent federal policy changes have created the opportunity for Kansas to extend coverage. Already, other states such as Indiana and Tennessee have extended postpartum coverage.

As a result of the ongoing public health emergency, Kansas cannot discontinue coverage for new mothers after 60 days, said David Jordan, president and CEO of United Methodist Health Ministry Fund.

“The emergency extension of postpartum coverage during the pandemic has affirmed the value of extending a mother’s coverage,” Jordan said. “Mothers have been able to access critical health and behavioral health services. Extending Medicaid coverage for a continuous 12 months postpartum can improve health outcomes for mothers, children and families across the state.”

Jordan said it is critical for the health of the mother and child during the 12 months postpartum that both access health care. He cited a 2017 study on the spillover effects for adults of Medicaid expansion that indicated parental enrollment in Medicaid is associated with a 29% higher probability a child will receive an annual well-child visit.

Increased coverage is also vital so mothers have access to mental health and substance use services because the postpartum period is when they are most susceptible to substance use relapse, Jordan said.

“According to KDHE, between the years 2012 and 2017, parental substance use was the primary reason that 70% of children under the age of 1 entered foster care,” Jordan said. “Extending coverage to enable mothers to get substance use services can prevent interaction with the child welfare system.”