Over the last several years, Texas has made great strides towards improving the health of its mothers and babies, investing dollars and resources to promote early prenatal care, help women better plan and space their pregnancies, and reduce the state’s rates of low-birth weight babies, preterm births and infant mortality.
But Texas has more work to do. Too many babies are born too soon or too small. Many low-income women still go without primary and preventive health care between pregnancies because they lack health insurance. The latest medical evidence confirms that planning for a healthy pregnancy begins well before conception. Without health care coverage, however, uninsured women often forego the very services they need to prepare for a healthy pregnancy.
Texas Medicaid provides critical health care services for eligible pregnant women, but ‘pregnancy related’ Medicaid ends 60 days after the mother gives birth. Women receiving pregnancy coverage through the Texas CHIP Perinatal program are able to receive only two visits postpartum. Typically, these routine visits provide a limited array of services, such as a physical exam and contraception counseling. However, national studies indicate that about 33 percent of mothers did not feel these visits addressed their health concerns or common problems encountered by new mothers (Postpartum Maternal Health Care in the United States: A Critical Review, the Journal of Perinatal Education, 2006).
Nationally, over half of women who receive maternity care through Medicaid lose their coverage entirely at the end of the 60 days (Commonwealth Fund). Yet, the need for postpartum services extends well beyond 60 days and is a critical time to help women who intend to have more children get and stay healthy. This includes managing chronic conditions, such as cardiovascular disease, hypertension, and diabetes; providing lifestyle and nutrition counseling to reduce obesity and tobacco usage; screening women for substance abuse and postpartum depression, which often goes undetected; providing basic dental care to reduce dental caries, which studies show can contribute to heart disease, stroke; and preserving access to contraception and health screenings.
Extended postpartum care is vital for all women, and a comprehensive package of services is particularly important for women at risk for a preterm delivery, either because they had a previous premature birth or have risk factors for delivering early. With 56 percent of Texas births covered by Medicaid, Texas has an opportunity to improve women’s health and birth outcomes by extending the period for postpartum coverage.
Our organizations recommend extending coverage to 18 months postpartum coverage through Medicaid or by expanding benefits available under the Expanded Primary Health Care and Texas Women’s Health Programs. Such a program would build on Texas’s current initiatives to improve women’s health:
Reduce the rate of low birth weight and premature births among low-income women.
- Studies show that women who have at least 18 months between pregnancies have healthier babies and are less likely to deliver early. Optimal birth spacing also improves maternal health.
Improve maternal health
- When women go without postpartum care for issues such as hypertension and diabetes, they may end up in the hospital with serious conditions that are expensive to treat and could have been prevented with regular physician care.
- Excessive weight gain in pregnancy and failure to return to pre-pregnancy weight postpartum are risk factors for long term obesity, which is in turn a risk factor for preterm birth. With the proper postpartum care women can be counseled to return to a healthy weight.
Promote early detection and treatment of postpartum depression
- As many as 15 percent of postpartum women will develop postpartum depression (PPD), which manifests itself anywhere from just before delivery to months after delivery (National Institute for Mental Health, NIMH). According to NIMH, if left untreated, PPD may ‘interfere with [a mother’s] ability to connect with and care for her baby and may cause the baby to have problems with sleeping eating, and behavior as he or she grows.’
- Women often do not recognize their own PPD symptoms, such as sleeplessness, lack of appetite, and mood swings. Regular primary care increases the likelihood of early detection and treatment.
Reduce health care costs
- In 2013 in Texas, 12.3 percent of babies were born prematurely, compared to 11.4 percent nationally. According to the Health and Human Services Commission, Texas Medicaid spends on average 18 times more on babies requiring neonatal intensive care (NICU) services compared to babies born healthy with no NICU stay. The state estimates a one percent reduction in NICU usage would result in $3.1 million in general revenue savings.
- Women with postpartum depression have higher health care costs, including emergency room usage. Early intervention may reduce these costs. (Postpartum depression and health services expenditures among employed women, Journal of Occupational & Environmental Medicine, 54(2):210-215, February 2012)
Ensuring a health pregnancy does not start the day a women gets pregnant. Women who are already at a healthy weight, are not smoking, and who manage their chronic conditions such as diabetes are much more likely to have a full term healthy pregnancy than those who do not start out as healthy. Caring for women beyond 60 days postpartum will help ensure the health of women during their subsequent pregnancies, improve birth outcomes, and ultimately reduce costs for the state.