Another report, this time focused on premature births, concludes that the United States — and Indiana in particular — is one of the most dangerous developed nations in which to give birth.
The March of Dimes report concludes that 10.5% of all births in 2021 were premature, a number that predates the reversal of nationwide abortion protections and includes stark racial disparities. Indiana fared slightly worse, with a preterm birth rate of 10.9% or roughly 8,458 children – up from 10.4% in 2020.
Stacey D. Steward, president and CEO of March of Dimes (Photo from March of Dimes website)
“This year’s report sheds new light on the devastating consequences of the pandemic for moms and babies in our country,” said Stacey D. Stewart, the president and CEO of March of Dimes, in a release. “While fewer babies are dying, more of them are being born too sick and too soon which can lead to lifelong problems… it’s clear that we’re at a critical moment in our country and that’s why we’re urging policymakers to act now to advance legislation that will measurably improve the health of moms and babies.”
Stewart said pregnant parents with COVID-19 had a 40% higher risk of premature births but the report also identified inadequate prenatal care and other pre-existing maternal health conditions as contributing factors.
The costs of premature births
A 2020 Indiana Department of Health report on the emotional, health and economic costs of perinatal care for infants shortly after birth, said the financial costs for premature births in Indiana are estimated to be between $655-678 million annually.
Costs to parents average $64,713, compared to $15,047 for an uncomplicated birth.
“Preterm and low birthweight are associated with long-term disabilities like cerebral palsy, autism, mental retardation, vision and hearing impairments and other developmental disabilities,” the report said. “(Low birthweight) infants tend to have lower educational attainment, poorer self-reported health status, and reduced employment and earnings as adults relative to their normal weight counterparts.”
Innovations in healthcare mean that a premature birth doesn’t mean the child will die but the impacts of that poor health outcome can follow children as they grow into adults. The U.S. infant mortality rate is 5.4 deaths per 1,000 live births, compared to Indiana’s 6.6 deaths per 1,000 live births.
But the preterm birth rate among Black women is 42% higher than among all other women in Indiana, according to the March of Dimes. For women of Asian/ Pacific Islander descent, 8.7% of live births are born premature, following by 9.9% for white women and 10.1% for Hispanic women. But 14.1% of births for Black women are preterm.
Jarnell Craig, the interim executive director of the Minority Health Coalition of Marion County, is part of a group of organizations that seeks to spread information about services for mothers in Indianapolis. Efforts include safe sleep classes, parenting classes and even lists Black physicians in zipcodes with high mortality rates.
But Craig said funding or staffing isn’t the limiting factor for their influence, but rather getting parent buy-in.
“We believe that really it is a lack of understanding,” Craig said. “You can only provide them what they’re ready to receive so it just depends on their attitudes. Are they hearing us and what we’re saying to them?”
Still, Craig believed that there’s been an upward tick in interest, especially with the expansion of classes on Saturdays.
The importance of prenatal care
One reason why new parents might not be getting the appropriate prenatal healthcare during their pregnancies: there simply isn’t any in their area.
Another 2022 report, also from the March of Dimes, found that 6.9 million women were affected by and almost 500,000 births occurred in these “maternity care deserts” with no or low access – a 2% increase from the 2020 report.
“Access to quality maternity care is a critical component of maternal health and positive birth outcomes, especially in the face of a lingering pandemic,” said Stewart and Dr. Zsakeba Henderson, the interim chief medical and health officer for March of Dimes, in the report. “In maternity care deserts there is a higher risk for poor maternal and infant health outcomes.”
On average, an estimated two women die every day due to pregnancy or childbirth complications and two babies die every hour, the report said.
Though the report doesn’t include a state-by-state breakdown, a graphic reports that roughly half of Indiana’s 92 counties have full access to maternity healthcare.
Nationwide, Black women and Native American women had far less access to quality care. One in five Black women and one in four Native American women didn’t receive adequate prenatal care, compared to just one in ten for white women.
In Indiana, the maternal mortality ratio is 93% higher for Black women compared to white women. Typically, educated women are less likely to die during pregnancy or childbirth but a Black woman who graduates college is still at a higher risk than a white woman who didn’t finish high school.
The Indiana Maternal Mortality Review Committee report from earlier this year reported that 92 Hoosier women died in 2020, and that 73 of those deaths were considered preventable. Just half of those women who died in 2020 access prenatal care during their first trimester while another 15.2% received no prenatal care at all.
Compared to the state’s live births, 69.3% of mothers accessed care, leading the committee to conclude that inadequate prenatal care could be a contributing factor to maternal mortality in Indiana.
But those appointments serve another equally important purpose of assessing the health of the expected child, whether screening for health conditions or analyzing third trimester movement.
Proposed solutions
A program to partially alleviate that disparity in healthcare access – My Healthy Baby, which finds community partners for pregnant women – expanded to its 82nd county last month in Porter County. In 2022, it was launched in 35 counties, including Porter.
The March of Dimes report applauded Indiana for expanding Medicaid to 12 months postpartum for mothers and having committees to study maternal and infant health. But dinged the state for not allowing Medicaid to reimburse 90% or more for services rendered by certified nurse midwives.
While the state report analyzing the economic costs of premature births considered several health interventions for mothers, including prescribing the hormone progesterone to expectant mothers, which it says could reduce preterm births by 20-40%. Additional suggestions include establishing group prenatal care organizations, utilizing home visiting programs, reducing teen pregnancy, expanding telemedicine and investing in smoking cessation programs.
“… the costs of perinatal morbidity are staggering – both financial costs to the state of Indiana and the human, social and emotional costs to its Hoosiers,” the state’s report concludes. “Investments in Indiana-specific research and programs to reduce perinatal morbidity will pay dividends far beyond the costs.”