Every year approximately 700 women in the United States die from pregnancy and childbirth complications, one of the worst rates in the developed world. However, these numbers get even bleaker when you look at how these rates affect people of color, in particular, Black women. Most of these deaths are preventable, caused by poor access to healthcare, other social determinants and racial bias.
At the end of 2020, the U.S. Commission on Civil Rights began examining the federal role in addressing racial disparities in maternal health outcomes. Upstream USA submitted expert testimony to the commission to highlight the important role contraceptive access plays in reducing maternal mortality.
How Birth Control Plays a Role
There are multiple evidence-based strategies that help to improve maternal health and reduce pregnancy-related mortality. Equitable access to birth control is a fundamental strategy. Ideally, maternal care begins before a woman is pregnant. One report from the WHO found that when women received preconception care it reduced maternal and child mortality, prevented unintended pregnancy, prevented complications during pregnancy and delivery, and lowered the risk of diseases later in life.
Preconception care allows women to work with their provider to prepare mentally and physically for having a baby. They’re better able to shape the environment that they would like for their families. With their providers, they can ensure their bodies are in an ideal place to take on the work of creating a child, which leads to less risks for mother and baby.
For many women, this ability to shape their reproductive life planning starts with birth control. By working hand in hand with their providers using a person-led model, women can choose a birth control method that works best for their body and their plan for their family. In the United States, 45% of pregnancies are unplanned. In many of those cases, women were either using birth control that wasn’t working for them or weren’t using birth control at all. A recent survey from the Kaiser Family Foundation found that while nearly all OBGYNs offered their patients some forms of contraceptive care, only 18% offered their patients all methods of non-permanent contraception. Upstream has first-hand experience with this and more with the agencies that we partner with across the nation. We are working to ensure that patients have access to all forms of contraception at low or no cost.
Equitable access to all birth control is necessary to be able to tackle unintended pregnancies and maternal mortality.
Upstream knows that birth control is just one piece of the puzzle. There are many areas —from preconception to postpartum — that need to be addressed in order to fight against maternal mortality. In our testimony, we listed eight recommendations to address these areas. They include:
- Carving out reimbursement for provision of contraception from flat payment rates
- Closing the coverage gap through Medicaid Expansion in all states
- Expanding eligibility for Pregnancy Medicaid to include all uninsured women who make <300% FPL, regardless of citizenship status
- Extending the coverage window for Pregnancy Medicaid from 60 days postpartum to one year postpartum for all women on Medicaid regardless of the form of Medicaid they use
- Incentivizing reporting on NQF IPP measures
- Ensuring value-based payment models measure and incentivize maternal and newborn health postpartum, not just during labor and delivery
- Requiring that Medicaid for Pregnant Women be inclusive of Minimum Essential Coverage including screening and treatment for perinatal mental health and substance use
- Mandating full practice authority for Certified-Nurse Midwives in all states
This blog is the first in a series dedicated to contraception healthcare and maternal mortality. Stay tuned for the second blog of this series, and follow us on Twitter and LinkedIn to join the conversation.