Tag: Medicaid

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Anti-racism work Canada Health Care Maternal Mental Health Uncategorised

2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health

[vc_row][vc_column][vc_column_text title=”2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health” css=”.vc_custom_1718910346497{margin-bottom: 0px !important;}”]In the United States, publicly-funded healthcare is provided through Medicaid and CHIP (Children’s Health Insurance Program). These are joint programs of state and federal governments that provide health insurance to low-income people, children, people with disabilities, and pregnant people. These eligibility parameters mean that there are individuals who are eligible for coverage during their pregnancies and the postpartum period who are not eligible at other times. Medicaid finances 41% of births in the United States. Federal law requires states to provide coverage up to 60 days postpartum. A bill in 2021 gave states the option of participating in an extended coverage program offering coverage up to one year postpartum.

Medicaid Insurance card with thumb holding it

In May 2024, Centres for Medicaid and Medicare Services (CMS) released an infographic summarizing beneficiaries’ maternal health data. CMS collects demographic data on age, race and ethnicity, and geography. They collect outcome data on maternal mortality and severe maternal morbidity (SMM), underlying causes of maternal mortality, dental care access, postpartum contraceptive utilization, spacing between pregnancies, chronic conditions, timeliness of prenatal and postpartum care, smoking, behavioral health and substance use, neonatal abstinence syndrome, postpartum depression (PPD), preterm birth, and low-risk cesarean delivery. Additionally, they collect health system data on healthcare service provider distribution, state quality improvement activities, and state participation in an opt-in extended postpartum coverage program.

Key Take Aways

The data highlight key areas of disparity for Medicaid beneficiaries and provide an important road map for healthcare policymakers and system designers regarding where care could be enhanced. For example, the data show that Black birthers experience mortality 2.6 times more often than their white counterparts. This finding corroborates other research and supports advocacy efforts for publicly funded doula care as an intervention to reduce Black maternal mortality rates.  Another useful observation is that birthers under the age of 19 experience higher than average rates of PPD (22% compared to an average of 17%). This suggests that in addition to universal PPD screening, additional attention should be paid to this group during the postpartum period.

Black pregnant person with long braids and mustard coloured dress

This 9-page resource provides invaluable information to support US birthworker advocacy on expanded access to birth and postpartum doula care, freedom of provider choice and birth location, and mental healthcare. For birthworkers in Canada and other jurisdictions, it is an illuminating example of what can be learned from comprehensive demographic and outcome data collection practices.

 

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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Canada community Health Care

Learning from US Healthcare on Doula Access

[vc_row][vc_column][vc_column_text css=”.vc_custom_1706711380769{margin-bottom: 0px !important;}”]I vividly remember “The Greatest Canadian”, a 13-part  competitive series produced by CBC in 2004. Each week, a biographical documentary on individuals who have made a great contribution to Canada aired, including Terry Fox, David Suzuki, and Tommy Douglas. Viewers got to vote on who the greatest Canadian of all time was. Tommy Douglas, recognized as the father of publicly funded health care in Canada, emerged victorious. 

Douglas’ win says a lot about the value we attach to our healthcare system and the national pride we take in making sure that every Canadian has access to the care they need. We often look to our American neighbours with pity when we hear about $700+ a month insurance plans ($2000+ for a family plan) or families going into debt or going bankrupt to pay for life-saving treatment. But if the Canadian healthcare system is so superior to that of the US, why is publicly-funded doula access expanding by leaps and bounds in the US, while progress on the same front has been stagnant in Canada?

Over the last few years, an increasing number of jurisdictions in the US have made doula care payable via Medicaid. Medicaid is public health insurance for people who are unable to access private coverage. 11 States that have introduced Medicaid-funded doula care programs include New York, California, and Michigan. California cites familiar research as the rationale for its decision: “doula care was associated with positive delivery outcomes including a reduction in cesarean sections, epidural use, length of labor, low-birthweight and premature deliveries. Additionally, the emotional support provided by doulas lowered stress and anxiety during the labor period”. 

One reason why advocates for publicly funded doula care have gained more traction in the US is that the US collects race-based healthcare data, along with information on many other social determinants of health. This data has demonstrated significant disparities in perinatal outcomes based on race, income, and other factors. The Black maternal and neonatal mortality crisis has emerged as a system disaster that requires urgent solutions. Combined with a growing body of health research demonstrating that doulas are an effective intervention that improves outcomes for Black birthers and babies, this has made a strong case for access to doula care for Black and other at-risk communities.

In Canada, we have the same research to show that doulas solve a problem, but we don’t have the same amount of data to show that there’s a problem to solve. That being said, while our race-based data collection needs to improve, we do collect data on other topics. In 2023 OBGYN researchers at McMaster University published findings on operative deliveries and 3rd and 4th-degree tears in Canada. They found that “among high-income countries, Canada has the highest rate of maternal trauma after births in which tools like forceps and vacuums are used”. Sadly, their research only compares operative deliveries (forceps/vacuum) to surgical deliveries (cesarean sections). They do not take into account the ample evidence that California and other US jurisdictions considered showing that support from a birth doula reduces the likelihood of any of these interventions. 

Not only do we need to collect data that demonstrates the impact of the social determinants of health, we need to put the research we do have into action. This action needs to encompass the role that all care providers play in improving conditions and outcomes for birthing people. This includes ensuring that all birthers can access the reduction in medical interventions and related increases in good birth outcomes and satisfaction that skilled doula support can achieve. [/vc_column_text][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1706711516822{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]