State seeks input for maternal health plan

 For Pennsylvanians, there are a few days left to complete the Maternal Health Strategic Plan Survey, part of the Shapiro administration’s approach to tackling the state’s poor maternal health outcomes.

The governor traveled to Scranton Primary Health Care Center where he held a roundtable discussion with patients and staff to inform the strategy. The center serves the Scranton region in Lackawanna County, specifically targeting the poor and underinsured. It had 16,000 patients last year including pregnant and postpartum mothers.

“Making sure that women receive the care they need before, during, and after their pregnancy is critical to their lifelong health and wellbeing,” said Val Arkoosh, secretary for the Department of Human Services. “Sadly, in Pennsylvania and across the country, having a child can be life-threatening when people do not receive high-quality, accessible, and equitable care when they are pregnant and postpartum.”

According to the Department of Health’s 2024 Maternal Mortality Review, the state had 83 deaths per 100,000 live births in 2020. A total of 107 people died during pregnancy, delivery, or postpartum. The leading cause of pregnancy-associated death was mental health conditions, including substance abuse, which was a contributing factor in 41% of cases.

The report concluded that better screening for behavioral and mental health needs to be implemented, with connections to appropriate services made directly by health care providers. It also called for increased coverage for mental health care services through both public and private insurance.

“To improve maternal health outcomes, women need access to quality health care services before, during, and after pregnancy, like the comprehensive health care being provided at the Scranton Primary Health Care Center,” said Secretary of Health Dr. Debra Bogen.

Earlier this year, the Shapiro administration expanded Medicaid access to doulas. Doulas are health care providers who guide expecting parents through the pregnancy process. In addition to providing emotional support, doulas offer individualized care informing, preparing, and advocating for patients as they move through a life event and health care system that can be overwhelming. Doulas’ involvement significantly reduces clinical procedures and complications.

In order to be covered by Medicaid, doulas in Pennsylvania must be certified through the state. The expansion came with a $2.6 million infusion toward maternal mortality prevention through the 2024-25 state budget, while the state continues to seek other openings to extend coverage to vital pregnancy and postpartum resources.

“The Pennsylvania Insurance Department continues to explore consumer needs, misconceptions, and opportunities regarding coverage in our regulated insurance market for women’s health and maternal health services, to include doula care, surrogacy benefits and human breast milk storage,” said Shannen Logue, PID Deputy Insurance Commissioner for Product Regulation.

Improvements like these are especially important for women of color. The mortality for Black women specifically is 148 in 100,000 births, twice that of white women. According to a report released by United Health Foundation earlier this year, infant mortality rates were significantly worse for Black and Hispanic mothers than women of other races in Pennsylvania as well.

The state’s survey seeks insight not only for how to better provide care for Black women but also for drawing more Black people toward health care professions. A 2023 study published in JAMA, a peer-reviewed medical journal published 48 times a year by the American Medical Association,  found that increased representation in primary care led to improved mortality rates for the Black community.

Other major factors cited in the negative outcomes for both mothers and infants were poverty and housing insecurity, both of which have been on the rise for women in the state. Though uninsured rates have continued to decline, women with less than a high school education are 6.8 times more likely to be uninsured than their peers who have received college education, underscoring the negative health outcomes created by poverty and gaps in education.

Even many women across the state who have coverage for care still lack access to receiving it. Maternity wards in rural areas have been closing their doors, leaving only 17 of the state’s 42 rural hospitals with labor and delivery services. Women living in these areas are often forced to drive 40 minutes or more to deliver or respond to emergencies during their pregnancies, increasing their risk for complications.