Rylea Luckfield
Maternal mortality rates are rising in the United States, part of the myriad consequences from state abortion bans and, to a lesser extent, the impact of the shrinking maternal health workforce. Across the U.S., these issues are interconnected. Missouri is no different.
Maternal health outcomes worsen without access to comprehensive reproductive health services. Maternal health providers are wary of working in abortion-restrictive states where they cannot provide adequate care for their patients, a reality that exacerbates the workforce shortage.
In Missouri, 70 people on average die annually while pregnant or within one year of pregnancy, and the majority of these deaths are preventable.
In December, Gov. Mike Parson announced that the Missouri Department of Health and Senior Services would invest $4.3 million in new funds to reduce maternal mortality and increase access of health services provided to people during pregnancy and postpartum. These funds will support Missouri’s maternal quality care protocols; development of standardized trainings to maternal care providers; creation of a standardized assessment for mental health; the creation of the Maternal Health Access Project; and improved collection of maternal health data.
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While this is a positive first step toward tackling the maternal health crisis in our state, more must be done to address the lack of access to reproductive health services.
Many Missourians have limited access to prenatal and maternity care and a very high vulnerability to adverse outcomes due to the availability of reproductive health care services. Lack of access to high-quality maternal care contributes to negative maternal health outcomes, such as premature birth, low-birth weight, maternal mortality and severe maternal morbidity, and increased risk of postpartum depression.
Nearly half of Missouri’s counties lack maternity care services. There are several reasons, including but not limited to lack of funding for mental health services, particularly for pregnant and postpartum people; hospital closures over the last 10 years, which have left 50 rural counties without a hospital; low reimbursem*nt from Medicaid; and maternal health workforce shortages.
To make matters worse, Missouri bans nearly all abortions. While there is an exception for medical emergencies, there are no exceptions for rape or incest.
States with abortion bans have fewer maternity care providers, more counties without maternity care services and higher rates of maternal mortality and severe maternal morbidity.
Since the overturn of Roe v. Wade in 2022, medical students going into obstetrics and gynecology reported being less likely to apply for residency in states with abortion restrictions.
Additionally, our maternal health crisis does not affect all pregnant and postpartum people equally. Black women in Missouri are three times more likely to die from a pregnancy-related cause than white women. This is due to the fact that Black, Indigenous and people of color often face structural racism and bias in health care settings. In the U.S., the perinatal workforce does not reflect the diverse racial and ethnic identities of the birthing population.
Such a crisis calls for decisive action. Missouri lawmakers should consider enhancing the obstetric workforce by expanding Medicaid coverage to doula and midwifery services, which leads to improved health outcomes and patient experience, as well as may potentially reduce costs.
One promising measure moving through the Missouri House proposed by Missouri Rep. Wendy Hausman, R-St. Peters, would do just that by allowing doulas registered with the state to be reimbursed by health insurance. While the bill has made it out of committee, it has not yet come to the floor for a vote. Lawmakers must prioritize getting this legislation through the chambers and to Gov. Parson’s desk for signature.
Registered Missouri voters should also keep their eye out for the Missourians for Constitutional Freedom abortion rights coalition, which is gathering signatures through the end of April to bring abortion to the Missouri ballot later this year. If successful, this campaign would amend the Missouri constitution so that the state government cannot interfere with a person’s right to reproductive freedom.
Access to comprehensive reproductive health services, including abortion, is crucial for improving maternal health in Missouri.
Information about Missouri’s pending reproductive rights ballot initiative, including scheduled upcoming petition signing events, is available at moconstitutionalfreedom.org.
Luckfield is a Master of Public Health candidate at George Washington University and a University of Missouri alum with a background in maternal and reproductive health.
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