Dr. Jennifer Kwon, a pediatric neurologist, tests 7-week-old Piper Droessler's strength at UW Hospital on Jan. 17, 2020. Born to Caiti and Ben Droessler (background), the Platteville baby was the first child in Wisconsin identified through newborn screening to have spinal muscular atrophy, a potentially fatal muscle wasting disease.
Women giving birth in the United States are twice as likely to die as women in Canada, and five times as likely as women in Germany. In fact, among developed countries, the U.S. has the highest maternal mortality rate and is the only country where that rate is increasing.
Wisconsin is facing an unacceptable maternal mortality crisis, with the number of maternal deaths in Wisconsin rising over the past 10 years. What’s especially alarming is that maternal mortality for non-Hispanic Black mothers is five times the rate for non-Hispanic white mothers. There are geographic disparities too. When controlled for sociodemographic factors, women living in rural areas face a 9% greater chance of severe maternal morbidity and mortality than urban residents.
More than half of all maternal deaths in the U.S. occur over 60 days after birth, and more than 60% are preventable. Babies born in Wisconsin to women enrolled in Medicaid have health insurance coverage for 12 months, but the new mother can lose her health insurance coverage as soon as 60 days after delivery, causing many women to become uninsured shortly after giving birth.
While some women can successfully transition to other sources of coverage, many are left in the unsafe position of being uninsured shortly after a major medical event.
As physicians we strongly support a state budget provision to extend Medicaid coverage during the postpartum period from 60 days to 12 months, thereby ensuring that mothers retain health insurance during a crucial window. If the measure remains in the final budget, Wisconsin will join a growing list of states — both red and blue — that are extending postpartum Medicaid coverage for new mothers.
Evidence tells us that the weeks following birth are a critical period for a mother and her infant, setting the stage for long-term health and well-being. The stress of pregnancy may bring on newly diagnosed conditions such as diabetes, hypertension, thyroid disorders, renal disease and significant cardiac conditions that need ongoing medical care. In addition, mental health conditions such as postpartum depression and substance use disorder require ongoing treatment. Yet despite knowing how essential timely postpartum care is, it’s estimated that 11.5% of new mothers lacked health insurance coverage, and 20% percent of uninsured new mothers skipped care because of cost. Half worried about not being able to afford their medical bills.
It’s not just the mothers who are affected when their health needs aren’t met. There is strong evidence that when well-being is disrupted on either side of the relationship it affects both mother and baby. For example, research studies show that babies whose mothers are depressed show poorer socioemotional and cognitive development, which can impact the infant’s growth through toddlerhood, preschool, and into the school-aged years. It is not uncommon for health care practitioners working with babies to be frantically problem solving around the mother’s lack of insurance coverage because of the profound impact it has on the child’s health.
As physicians on the front line, we see the societal impact of persistent health disparities for far too many babies and new mothers across our great state. Fortunately, our state lawmakers can take action to begin to address these disparities. Wisconsin can follow many other states and extend postpartum Medicaid coverage for new mothers — aligning the new mother’s health insurance coverage with her newborn baby. Extending this coverage would help women receive the standard of care consistent with medical guidelines for postpartum care.
When women have access to care, they are healthier, their babies are healthier, and health care costs go down. Without insurance and treatment, women are at higher risk of dying — including months after delivery — and so are their babies. As physician leaders in Wisconsin, we enthusiastically embrace evidence-based policies and encourage our state legislators to make a tremendous difference in the health and lives of Wisconsin families by extending postpartum Medicaid coverage for one full year following the birth.
Amy Domeyer-Klenske M.D. is vice chair and legislative chair of the American Congress of Obstetricians & Gynecologist Wisconsin. Elizabeth Pyne M.D. is president of the Wisconsin Academy of Family Physicians. Dipesh Navsaria M.D. is president of the Wisconsin chapter of the American Academy of Pediatrics.
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