This commentary originally appeared in the Austin American-Statesman.
"I just have a passion for pregnant women,” says Jennifer Johnson.
The community health worker in the city of Austin’s Maternal and Infant Outreach Program explains: "I’m usually in a mom’s life for less than two years, including her pregnancy and the first year of her baby’s life — but those two years set them on track for the rest of their lives.”
State legislators meeting on Thursday for a hearing on birth outcomes could learn a lot from what Johnson sees in those two years.
Pregnant moms tell Johnson they want their kids to be healthy, get a good education, and go further than their parents. But more than anything, Johnson says, they just want their kids to be healthy.
"They’re nervous. They’re excited – at least most of them. They want to learn more about what they should do to have a healthy baby,” she says. "If they can’t get to a doctor, they go by what they can Google, or what’s on TV. Of course, it’s not always correct.”
Why the delay seeing a doctor? Many women don’t get insurance from their employers, and, with few exceptions, women in Texas can’t apply for Medicaid coverage until they’re pregnant.
So they often miss the opportunity for preconception care, such as diabetes treatment or access to contraception, which would help them plan a healthy pregnancy. If diabetes is identified and controlled three to six months before a woman becomes pregnant, for example, she has a lower risk of birth complications.
But once they know they’re pregnant, Johnson explains, then they start working their way through the Medicaid application. After submitting it, processing takes up to 30 days. Then they wait for a Medicaid card with the insurance number the doctor’s office requires. Then they can start calling doctors to see who has an opening soon — and who accepts the Legislature’s low Medicaid reimbursement rates.
"Meanwhile, a lot of women don’t know about prenatal vitamins. They don’t know what they’re supposed to do to take care of their body,” Johnson says.
It’s a statewide problem. Two of every five pregnant women in Texas don’t start prenatal care during their first trimester.
The lack of access to care before and during pregnancy is a big reason why the Texas rates of premature and low birth weight babies – 10.4 percent and 8.2 percent respectively — are higher than the national average.
Prematurity and low birth weight can deflate a mom’s dreams of a healthy child that does well in school. They also wrack up high costs for taxpayers. The Medicaid childbirth costs alone total an average of $63,000 for an extremely preterm infant, compared to $400 for a healthy baby.
Worse than that: Prematurity and low birth weight, along with pregnancy complications, are the leading causes of African-American infant mortality, which remains disproportionately and tragically high.
Fortunately, most Texas babies are born healthy. Then the next year is critical for keeping them healthy, although the mom’s Medicaid coverage expires 60 days after a child’s birth.
In fact, during his 2014 campaign, Gov. Greg Abbott highlighted the importance of helping moms stay healthy after their baby is born. He called for action on postpartum depression, which can affect a baby’s brain development, among other consequences. Many other health outcomes, such as the risk of childhood obesity, are shaped by both the prenatal experience and the baby’s first year of life.
In other words, legislators should support healthier birth outcomes by improving maternal access to care before, during and after pregnancies. They could make significant progress by using federal funds to expand access to Medicaid. They can also make improvements by further streamlining Medicaid eligibility and enrollment procedures and boosting outreach to pregnant women. They should also continue investing in evidence-based home visiting programs, such as Nurse-Family Partnership, in which nurses provide one-on-one counseling on nutrition, breastfeeding and accessing prenatal care.
By taking these steps, the Legislature can support healthier moms and healthier babies throughout Texas.
Adriana Kohler is Senior Health Policy Associate for Texans Care for Children.