Ohio Health Policy News

The number of women struggling to access maternal care in the U.S. continues to grow, with Ohio having the most women impacted by overall reductions in access to care, according to a new report released by March of Dimes (Source: “Millions of Americans live in maternity care deserts. Access continues to worsen, report shows,” USA Today, Aug. 1).

The nonprofit organization's 2022 report shows that nearly 7 million women are affected by areas of no to low access. In Ohio, the report estimates that more than 97,000 women were impacted by overall reductions in access to care.

The report also found that 36% of U.S. counties (1,119) qualify as maternity care deserts, marking a 2% increase from the 2020 report or an additional 15,933 women who have no maternity care.

March of Dimes defines maternity care deserts as "any county in the United States without a hospital or birth center offering obstetric care and without any obstetric providers."

"The challenges faced by the health care community have created additional gaps and challenged maternal care providers to find creative ways to continue to provide quality care," the report reads. "We must continue to work to amend the obvious disparities in care experienced throughout the U.S."

The number of U.S. women who died within a year after pregnancy more than doubled between 1999 and 2019, with the highest death rates among Black women, researchers said this week (Source: “U.S. maternal mortality more than doubled since 1999, most deaths among Black women, study says,” Reuters, July 3).

There were an estimated 1,210 maternal deaths in 2019, compared with 505 in 1999, according to a study published in the medical journal JAMA.

The number of deaths per 100,000 live births rose from 12.7 to 32.2 overall, from 26.7 to 55.4 among Black women, 14.0 to 49.2 among American Indians and Alaska Natives, 9.6 to 20.9 among Asians, Native Hawaiians and Other Pacific Islanders, 9.6 to 19.1 among Hispanics, and 9.4 to 26.3 among whites, they estimated.

The Health Policy Institute of Ohio has released an action guide that highlights policy options for improving employment, one of the social drivers of infant mortality in Ohio. 

HPIO recently produced the Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio report as an update to the 2017 A New Approach to Reduce Infant Mortality and Achieve Equity report.
 
The action guide takes a closer look at the employment recommendations in the Action and Accountability report and provides state and local health stakeholders with additional information and tools to support next steps.

“Employment that pays a self-sustaining wage and offers health insurance and other benefits can pave the way for good health and positive birth outcomes,” according to the guide.
 
The action guide highlights policies prioritized by HPIO’s Social Drivers of Infant Mortality Advisory Group. For example, one policy recommendation in the brief is for state and local policymakers to expand paid family leave benefits to 12 weeks or more and eliminate or mitigate the impact of waiting periods to access paid leave for public employees. Sixteen states and the District of Columbia have paid family leave laws, as illustrated above.

HPIO recently released similar action guides on housing, education and transportation. In the coming weeks, HPIO plans to release another guide on eliminating racism.
 
The guide and additional tools posted on HPIO’s website can be used to prioritize, advocate for and implement the recommendations.

New data shows that in the past two years, Ohio has had more women impacted by overall reductions in access to maternity care than any other state (Source: “Babies delivered in cars: Rural Ohio's lack of maternity care affects nearly 100,000 women,” Columbus Dispatch, May 11, 2023).
 
According to March of Dimes data 13 of the 88 counties in Ohio are maternity care deserts and approximately 97,000 women in the state have been impacted by reduced access since 2021. The lack of any maternity care in those counties, coupled with barriers to access care further away, leads to poor health outcomes for mothers and babies.
 
Experts are calling for a comprehensive solution that not only includes more hospitals and doctors, but an increase in health education.
 
Since June 2022, the Ohio Hospital Association has counted 10 maternity wards closing across the state. Some merged or moved to a partner hospital, but other reasons given for the closures included workforce issues, operational costs and a decline in use due to fewer births in Ohio.

Maternal death rates surged by nearly 40% during the second year of the pandemic, widening disparities as Black women again faced alarmingly high, disproportionate rates, a new federal analysis shows (Source: “The rate of women dying in childbirth surged by 40%. These deaths are preventable.,” Columbus Dispatch, March 16).  

In 2021, there were about 33 maternal deaths per 100,000 live births – a 38% increase from the year before, according to the report released Thursday from the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Experts say COVID-19 likely contributed to the increases, but that the sobering rates continue to reveal deep flaws in health systems, such as structural racism, implicit bias and communities losing access to care. 

Most maternal deaths – which happen during pregnancy, labor or within 42 days of birth, per the CDC – are preventable. The United States' maternal death rate continues to be higher than other wealthy, developed countries, and the new data shows a roughly 60% increase in overall rates in 2021 from 2019, the year before the start of the pandemic.

States that expanded Medicaid under the Affordable Care Act (ACA) saw a 17% drop in hospitalizations among women during the first 60 days postpartum, new research shows (Source: “Medicaid expansion linked with fewer postpartum hospitalizations: research,” The Hill, Jan. 11).

According to a study published in the journal Health Affairs, states with expanded Medicaid coverage for residents with lower incomes saw a 17% drop in post-partum hospitalization within the first 60 days.

Expansion states included in the study were Iowa, Maryland, New Mexico and Washington. Rates were compared with non-expansion states Florida, Georgia, Mississippi and Utah.

Currently, 40 states (including Ohio) and Washington D.C., have expanded Medicaid under the ACA. Much of the Southeast region of the country continues to hold out on adoption, along with Texas, Kansas, Wyoming and Wisconsin.

Gov. Mike DeWine, who just won his bid for re-election, said he’s going to focus on improving the physical and mental well-being of Ohioans in his second term in office (Source: “DeWine's plans for improving mental health services in Ohio includes paid internships,” Statehouse News Bureau, Nov. 30).

At an Ohio Chamber of Commerce event focusing on health care Wednesday morning, DeWine said his office is working with lawmakers in three key areas during his second term.

“One, growing our behavioral health force so it is the most robust in this country. Two, leading the nation in mental health research and innovation. And three, providing Ohioans with the best access to behavioral health care in this country," DeWine said.

DeWine wants the state to invest more in high school workforce programs and he wants to invest $85 million dollars in federal funds to pay students for internships and residencies for those who are studying to work in these areas at Ohio's universities.

DeWine said he wants the state to do a landmark study on mental health barriers. That information can then be used to come up with ways to break those barriers down. He also said he wants to build a statewide center of innovation for behavioral health along with increasing research capacity for Ohio’s universities. DeWine said these changes would make mental and behavioral health services more accessible for Ohioans.

Urban centers are seeing the highest rates of pregnancy complications for Ohio women, followed by Appalachia, with Black women being impacted the most, a report from HPIO found (Source: “Severe pregnancy complications are affecting Black women in Ohio the most,” Ohio Capital Journal, Nov. 28).

The brief, Racial and Geographic Disparities in Maternal Morbidity and Mortality, points to systemic racism, a lack of health care access and poor community conditions as reasons for the disparities.

Not only are there disparities in general maternal health, but also in maternal morbidity: severe complications that happen during or after labor and delivery that can lead to other major health problems, including hysterectomy or the need for a blood transfusion, according to the brief.

Analysis by HPIO earlier this year found that stark differences in maternal health outcomes signal that not everyone has what they need to live a healthy life before, during and after pregnancy.

The graphic above, from the HPIO fact sheet “Racial and Geographic Disparities in Maternal Morbidity and Mortality,” shows urban and Appalachian counties have the highest rates of maternal morbidity in Ohio. Additionally, across both urban and Appalachian counties, Black mothers have the highest rates of maternal morbidity

According to the fact sheet, “High maternal morbidity and mortality rates are preventable. State and local policymakers have many options to address racism and discrimination, inequitable community conditions, toxic stress and poor prenatal care access.”