By Anne Blythe
Health care administrators traveled from the nation’s capital to the state capital this week as part of a listening tour on how the federal government could help North Carolina address some of its thornier maternal health issues.
They got plenty of feedback from the dozens of North Carolina caregivers, patients, administrators and health care advocates gathered at the state Division of Public Health offices on Monday.
“We need to hear from all of you in order to help us do our jobs,” said Tom Engels, administrator for the federal Department of Health and Human Services’ Health Resources and Services Administration. “We’re here looking for ways to improve.”
The federal office that Engels became head of in late 2019 is responsible for enhancing health care access for the economically and medically vulnerable in the country’s more isolated areas.
Much of that population in North Carolina lives in rural areas, but they also are scattered among the more populous urban and suburban areas, too, speakers told Engels and other federal administrators at the listening session.
Between Engels’ opening and closing remarks, Michael Warren, associate administrator of HRSA’s Maternal and Child Health Bureau and a Sampson County native who went to college and medical school in North Carolina, and Cara James, director of minority health at the Centers for Medicare and Medicaid Services, moderated a panel discussion.
Among the more weighty topics: The prominent racial disparities in North Carolina’s infant mortality rates, as well as in the maternal death rates during childbirth and in the weeks and year afterward.
Mandy Cohen, the state secretary of health and human services, often calls those poor birth and maternal outcomes a “black eye” for North Carolina. She has assigned task forces, commissions and others to develop plans for closing the gap.
Those plans, as the federal administrators heard, pull from many threads across the state as health care advocates work to stitch together a stronger safety net for black women and children, along with finding ways to support financially strapped women in rural North Carolina.
The ideas and suggestions ran the gamut, ranging from making sure the state’s incarcerated pregnant women have access to top-notch care to providing coverage and care for women through what they call a fourth trimester — the year after birth when caring for a new baby can be emotionally and physically draining.
Another idea that came up during the discussion, one that drew some skeptics, was a new focus on Long-Acting Reversible Contraception, or LARCs. In a state still stained from a eugenics program in which more than 7,000 people were sterilized — and many against their wills — panelists stressed that any such programs should be fully explained and opted into only with full and educated consent.
Most of the discussion focused on the racial disparities in maternal and infant mortality and the diminishing access to health care for many of North Carolina’s rural residents.
Can family practitioners fill gaps?
In recent years, North Carolina’s rural hospitals have struggled to stay financially afloat, creating a closure trend that has left many pregnant women in the far eastern and western parts of the state in a pickle.
Many women might be able to get perinatal and postnatal care at local health department facilities, health care provided in large part through county taxes and grants. But the loss of obstetricians and gynecologists in those areas near the shuttered hospitals means many women are forced to travel great distances to give birth in a hospital setting. Some forgo that option for riskier choices, decisions that can lead to problems during birth for the mothers and infants.
Greg Griggs, executive vice president and CEO of the North Carolina Academy of Family Physicians, suggested a fix that could evolve if family physicians were to add obstetrics to their practices.
“We are closing OB-units,” Griggs said at the listening session. “At the same time, we’re losing family practitioners to other states.”
Griggs has said previously that though almost 30 percent of rural primary care physicians throughout the country practice obstetrics, that number dwindles to about 11 percent in North Carolina.
Lengthy wish list
Others on the panel and in the audience, which included North Carolina first lady Kristin Cooper, had suggestions for the federal administrators to keep in mind as they shape the next federal budget.
Among them were:
- More funding and focus on programs to reduce maternal mortality, especially those that can help reduce the racial disparities.
- Medicaid coverage of doulas, particularly in rural counties, where they can help advocate for pregnant women and new mothers.
- Dedicated funding for programs to connect mothers and families to community resources for those experiencing poverty, including federal housing and food programs, as well as health services designed to treat the mind and body.
- Create Centering Pregnancy/ Parenting programs designed especially for black women, who share harrowing stories about health care providers who do not always respond to their questions or listen to their needs.
- Better collection, streamlining of and use of data that can highlight successes and expose deficiencies.
- Don’t forget the local health departments, which in North Carolina, have facilities in each of the 100 counties and provide what they call “wrap-around care.”
“HRSA’s mission is to make the United States one of the safest nations in the world for women to give birth,” HRSA’s Engels said.
Cohen, the state’s secretary of health since 2017, noted progress made in recent years, such as drops in the infant mortality rate by 47 percent since 1991. But she also stressed that North Carolina continues to struggle with the fact that African American births result in infant mortality at a rate 2.5 times the rate of white births.
“We also know there’s a lot of work and opportunity ahead,” Cohen said.