Minnesota lawmakers are back at work for a new legislative session, and changes approved last year are now being implemented, including efforts to ensure new mothers get the health care they need.

Last Sunday, a new law expanded postnatal care by requiring public and private health plans to cover a series of care visits for up to 12 weeks after a baby is delivered. Two of those visits would have to involve comprehensive care.

Rep. Ruth Richardson, DFL-Mendota Heights, was the bill's sponsor and hopes it helps address the maternal mortality crisis.

"What we know about these deaths is that 80% of them are preventable," Richardson emphasized. "This is a step in the right direction to ensure that when people are in need of support that they can get it."

The U.S. has the highest maternal mortality rate among developed countries. In states such as Minnesota, the rates are higher for women of color.

A recent state health department report noted Black Minnesotans represent 13% of the birthing population but make up 23% of pregnancy-associated deaths. The disparities also exist within the infant mortality rate.

Richardson argued by expanding access to coverage in the weeks after the delivery date, there's hope for a better outcome for both the mother and child.

"It's part of that comprehensive visit," Richardson explained. "It will include things related to the infant's care; their feeding and other things as well."

Richardson acknowledged there is more work to do to close existing gaps. She pointed out another solution should involve expanding the scope of the Maternal Mortality Review Committee, which could enhance prevention efforts.

Separately, Minnesota last year joined the list of states to extend postpartum coverage for 12 months to those enrolled in Medicaid or the Children's Health Insurance Program. The option stemmed from provisions under the American Rescue Plan.

With concerning trends emerging for pregnant and postpartum women, frustration is growing that Idaho lawmakers could end the session without addressing these issues.

The maternal mortality rate doubled each year between 2019 and 2021 in Idaho. The state also ranks last for income eligibility for pregnant women on Medicaid.

House Bill 201 would have extended Medicaid coverage from 60 days to 12 months after birth but has not received a hearing.

Hilarie Hagen, health policy associate at Idaho Voices for Children, said a large coalition of health care organizations, providers and families supported the legislation.

"Providing access to affordable health coverage helps reduce maternal mortality rates, improves birth outcomes, and Idaho's maternal health trends are going to continue on their downward trajectory every year we don't take action," Hagen stressed.

Rep. John Vander Woude, R-Nampa, chairman of the House Health and Welfare Committee, said he was supportive of the bill, and he had received a number of calls in support of it. However, Vander Woude noted the committee will not hold a hearing on it this session because he believes the Legislature has to get control of the Medicaid budget first.

This week, Bonner General Hospital in Sandpoint announced it would no longer deliver babies because of a provider shortage. The hospital also cited Idaho's legal and political climate as part of the reason for closing its maternity ward.

Hagen pointed out the provider shortage has become exacerbated in recent years.

"We are increasingly seeing providers choose to leave the state because of policy decisions made by Idaho lawmakers," Hagen asserted. "It's really discouraging to see that we are reducing access for moms and their babies."

Another measure unlikely to pass this session is House Bill 81, which would have extended the federally funded Maternal Mortality Review Committee passed its sunset date in July. Hagen emphasized Idaho will be the only state in the nation without a Maternal Mortality Review Committee.


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Research from The University of Utah explores the physical- and mental-health implications of social belonging in women.
Study author Lisa Diamond said disproportionately high mental- and physical-health problems among marginalized people have been written off as "minority stress," the cumulative chronic stress experienced because of discrimination and unfair treatment and said the missing piece is what is known as "social safety," the reliable social connections, belonging and sense of protection individuals foster in their social networks.

Through her research, Diamond found women who occupied one or more marginalized categories such as those relating to race, sexuality and gender reported significantly lower social safety, leading to a greater risk for physical and mental problems.

"That sense that you have people around you that are connected to you, invested in you, that you matter to. That feeling is a critical component of human health," she said. "It is not optional. It's not like the icing on a cake. It's the cake."

Diamond added the mental and physical effects one can endure do not depend so much on what type of marginalization they experiences, but rather from the mere fact of being discriminated against and misunderstood. She said a crucial aspect to good mental and physical health is ensuring access to safe and affirmative social ties.

Diamond said the unpredictable and unprecedented COVID-19 pandemic ripped everyone's social safety right out from under them, leaving many feeling isolated. She added while remote work and online school ushered in by the pandemic have their benefits, many are still struggling to recuperate the sense of safety and normalcy they lost which has made many deficient to the "basic nourishment of affirmative social connection."

"We should think carefully about the way we structure our days and our lives, and make sure that we are prioritizing the face-to-face connections that are meaningful to us. We need that, a lot more than we thought we did," she said.

She encouraged state policymakers and community leaders to adopt what she calls a "safety first" approach which begins by identifying whether an individual has access to relationships and people who can provide them with affirmation, protection and belonging.


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New data from the Centers for Disease Control and Prevention show another increase in the nation's maternal mortality rate, and a Minnesota expert says there are several underlying factors.

The report, released last week, covers data from 2021. That year, deaths of pregnant women or new mothers in the U.S. went up by nearly 40% over the previous year.

The agency says it follows gradual increases leading up to the pandemic as well.

Dr. Stephen Contag is an associate professor in the Maternal-Fetal Medicine division at the University of Minnesota Medical School. He said improved reporting is playing a role.

But he added that there are other issues at play.

"Disparities in transportation," said Contag. "Getting to health care. Or differences in the number of obstetricians or health providers that can provide that care to patients in certain parts of the country."

The findings show that Black women are especially affected by this issue. The maternal mortality rate for this population rose by nearly 70%, compared with nearly 25% for white women.

Some health experts say COVID-19 likely played a role in the 2021 spike, and that the big jump may have peaked. But there's concern the other factors will keep pressure on these rates.

The maternal death disparities have been documented in Minnesota as well. Contag said he sees hope in reversing trends, including changing how the state's Maternal Mortality Review Committee works.

The panel is now operating under a mandate.

"Now that we have that mandate," said Contag, "it's much easier to obtain the information that we need to review these cases in a fair manner."

He suggested that will lead to more recommendations that get to the root causes of these deaths.

And earlier this year, a new Minnesota law took effect, expanding postnatal care by requiring public and private health plans to cover a series of care visits for up to 12 weeks after a baby is delivered.

Two of those visits would have to involve comprehensive care.




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