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Children's Health

Medicaid Expansion Would Improve Birth Outcomes, Report Says

By Taylor Sisk

Approximately 36 percent women of childbearing-age in North Carolina suffer from one or more chronic diseases. About 13 percent of those women are in very poor health before they become pregnant.

The result, according to a report titled “Healthy Women, Healthy Babies,” released on Tuesday by Action for Children North Carolina, is higher-risk pregnancies that can cause health issues for newborns and infants. These issues include birth defects, preterm labor and low birth weight.

Infant mortality map

Source: State Center for Health Statistics

The risks are particularly high for black women and their babies.

Preventive care – including regular doctor visits, birth control, information about making healthy food choices, mental health services and help in stopping smoking – can make a big difference, said the report’s author, Laila Bell, in a Wednesday interview.

And Medicaid expansion, she said, would go a long way in making that care more available.

“North Carolina has the opportunity to counteract rising infant mortality rates and reduce racial disparities in birth outcomes through Medicaid expansion,” Bell writes in her report.

Medicaid expansion, she said, would provide health care coverage for 178,000 of the state’s low-income women of childbearing age.

But that expansion isn’t on the immediate horizon.

Earlier this year, the state legislature turned down the opportunity to expand Medicaid to all individuals earning up to 138 percent of the federal poverty level, even though the federal government would pick up the full tab through 2016.

The offer stands should the legislature choose to reverse its decision

Infants at risk

As Medicaid in North Carolina is currently designed, low-income women up to 200 percent of the federal poverty level – $39,060 for a family of three – are covered once they become pregnant and for three months after delivery.

However, working parents qualify only if they earn less 45 percent of the federal poverty level – $8,788.50 for a family of three – and most unemployed parents only if they earn less than 34 percent.

As a result, Bell said, most women aren’t eligible for Medicaid until they become pregnant, and that puts their newborns and infants at risk.

“The key factor is having continuity of care throughout your childbearing years,” she said.

According to the “Healthy Women, Healthy Babies” report: “The imperative for continuous insurance throughout a woman’s childbearing years is even greater given that half of all pregnancies in Carolina are unplanned, and 47 percent of report that they were unsure or unaware their pregnancy until midway through the first trimester, a key period in development when systems including the brain, lungs and liver form.”

Blacks at heightened risk

A quarter of a century ago, North Carolina had the highest infant mortality rate in the country, with nearly 12 babies under a year old dying for every 1,000 live births. Infant deaths in the state have since declined by some 40 percent, but the rate has gone up each of the past two years.

In 2012, for every 1,000 live births, there were 7.4 deaths. That’s an increase from an all-time low rate of 7.0 infant deaths per 1,000 live births in 2010; the 2011 rate was 7.2.

The report states that infant mortality is two-and-a-half times higher for babies born to black women in North Carolina. It further attests that about 30 percent of babies born to black women last year were caused by prematurity or low birth weight. That’s compared with 18.7 percent for white babies and 13.2 percent for Hispanics.

A number of issues that reach beyond the nine months of pregnancy can factor into these high rates, Bell said, including prolonged stress, adverse childhood experiences, higher rates of poverty and exposure to crime and violence.

“All of these experience that can affect a woman’s long-term health outlook and life experiences are being born out in the birth outcomes,” Bell said, and could be more effectively addressed with more comprehensive preventive care.

“Researchers say that to the extent that we can increase protective factors for African-American women, we can really start to move the needle in a significant way in terms of reducing premature births and reducing low birth weight in the African-American community,” she said.

Money saved too

The report also asserts that expanding Medicaid would mean significant cost savings for the state, in that “studies show preconception and prenatal health care can reduce the incidence of costly premature births” among high-risk women. According to the report, Medicaid covers half of all births in North Carolina.

Bottom line, preconception health care is the “weak link in the continuum of care” for mothers and babies, Bell said.

“It’s exciting to see this body of research emerge that puts more emphasis on how healthy women are before they become pregnant,” she said, “because it really does provide strong evidence for interventions like, in this case, the expansion of Medicaid.”

“This whole system of waiting until pregnancy occurs to try to intervene means that we only have a small window of opportunity to act to try to correct those longstanding health issues,” Bell said, “and it’s just not enough time.

“It’s so important that women enter into pregnancy in good health so that they can have safer pregnancies, safer deliveries, and have healthier babies as a result.”

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