To address the maternal mortality issue, ACOG is working on passing legislation through Congress that would give the federal government a role in funding these state-level committees.
“The main crux of the bill is to provide authorization for state maternal mortality, for funds to support state maternal mortality review committees,” said Rachel Tetlow, the director of federal affairs at ACOG. “We know that while a majority of states do have committees, there are still some who are struggling to stand them up and others that are struggling to fund them at full capacity. This legislation looks to support those state efforts to ensure that states really are able to move forward with reviewing maternal deaths and in some cases near misses in their states and recommend local state-based solutions.”
Another hot button issue that could affect maternal mortality is access to abortion.
“It is going to be interesting to see how those numbers shift as abortion providers are no longer available,” said Constance J. Bohon, MD, an ob.gyn. in Washington, D.C., and the ACOG state legislative chair from the District of Columbia. “For example, there is a concern that in states such as Texas, the maternal mortality rates may rise because of a lack of abortion providers.”
Attacks on abortion rights at both the state and federal level are expected in the coming year as well, Dr. Bohon said. She also expressed concerns over initiatives moving through some state houses that would hold doctors criminally liable for performing an abortion.
“What we have seen in the past is that these [abortion] bills come up really quickly without a whole lot of warning, so it’s difficult to say the specific legislation that we will see,” Ms. Tetlow said. “I am fairly confident that we will see at least one more vote in the House of Representatives and potentially one in the Senate … before the 2018 elections.”
Maternal mortality could be symptomatic of another key issue in women’s health – an overall lack of access to adequate health care.
riving some of those access problems are an increasing number of hospital closings. Dr. Bohon noted that Washington, D.C., has seen two hospital closures recently, and there have been closures in rural Georgia as well.
“One big issue is going to be how we get obstetrical care to women in communities where there is limited access,” she said. “We have got to figure out how to get all women, especially women in underserved areas who could be high risk into pregnancy care early on.”
Beyond that, ACOG is expecting that the women’s health services that have been in the cross hairs recently will continue to be so in 2018.
“2017 has been a year of just challenges and challenges and challenges for practicing ob.gyns. and patients, and we are expecting pretty much the same in 2018,” said Lucia DiVenere, a government and political affairs officer at ACOG.
Cuts to Medicaid, which House Speaker Paul Ryan (R-Wisc.) has identified as a key legislative priority for 2018, could create some significant issues for patients’ access to services.
“Roughly about 50% of deliveries are paid for by Medicaid,” Dr. Bohon said, noting that, for some states, that number can reach as high as 64%. “If those women don’t have access to care, it will be a disaster.”
The American Academy of Family Physicians will also be looking to maintain coverage of women’s health services in the Affordable Care Act.
“I think that our focus in 2018 is going to be around women’s continued access to comprehensive reproductive health care,” said AAFP President Michael Munger, MD. “Not only ensuring they have access to their breast, uterine, and cervical cancer screenings, prenatal maternity and postnatal care, but also preventive services.”
Dr. Munger singled out the Trump administration’s 2017 regulations allowing employers to opt out of providing contraception coverage for moral or religious reasons. “I think that is going to be a continued focus moving forward.”
In 2018, ACOG also wants to help bring access to paid maternity leave to more women.
“Three-quarters of women of childbearing age are in the workforce,” said Kandice Kapinos, PhD, of the Rand Corporation. “The studies on maternity leave show really positive effects of maternity leave on a wide range of child and maternal health outcomes.”
Not having an adequate amount of maternity leave can affect a woman’s ability to breastfeed her newborn, Dr. Kapinos added. “Breastfeeding can be difficult when you return to work,” she said. “Paid maternity leave would result in increases in breastfeeding. That has pretty big implications for health for women and children, which translates into pretty big cost savings.”