Help for young mothers

Our view: For healthy babies, women need quality medical care throughout their childbearing years, not just during pregnancies

that's where expanded Medicaid can save lives

December 22, 2008

At 19, Gloria Carr learned she was three months pregnant during a walk-in exam at Maryland General Hospital. Because she lacked health insurance and hadn't seen a doctor in more than a year, a social worker signed her up for free medical care at an East Baltimore clinic where a midwife nurse practitioner could monitor her progress.

A few weeks later, the midwife sent Ms. Carr to another hospital for a sonogram. There, she was shocked to learn that she was carrying twins. Yet the midwife assured Ms. Carr that she was fine. And this young mother of two was fine, until she began cramping in her sixth month, grew alarmed and called for help. Told not to worry, she went into premature labor and lost the babies.

Ms. Carr's experience is a private tragedy at the center of a public health crisis, Baltimore's unacceptably high infant mortality rate. It's a crisis that gets too little attention in part because the solution is so costly: ensuring that thousands of low-income women of childbearing age have consistent access to the health care that would produce better birth outcomes for them.

In Baltimore last year, 11.3 infants died for every 1,000 live births - a rate higher than in Hong Kong, the Czech Republic or Malaysia. Health officials already know improving birth outcomes and reducing the number of infant deaths depend not only on better care for women during and immediately after pregnancy but also on long-term efforts to improve health throughout their lives. Yet despite what the experts know, there is no comprehensive initiative targeted at that goal.

In Ms. Carr's case, had she continued to get regular medical checkups after she delivered her second child, doctors might well have discovered that she had a weakened cervix, which could complicate future pregnancies. When Ms. Carr was working, at a $6-an-hour job, she had health insurance but couldn't afford the co-pays and stopped seeing a doctor regularly. As it was, she learned of her condition only after losing the twins.

She went on to have another baby, a healthy son named Joshua who was born in 2006, and is expecting a fourth child in May. Ms. Carr plans to marry the baby's father next year. Poor general health among women of childbearing age is a major factor in Baltimore's high infant mortality rate. Ms. Carr, for example, also suffers from asthma. Maryland's decision this year to expand Medicaid to give more low-income residents access to health care may have a positive effect on infant mortality. As a result of the expansion of the Medicaid program that went into effect July 1, Ms. Carr is now eligible for the kind of care that might have prevented her heart-breaking loss of the twins and a subsequent lost pregnancy this spring. She is now enrolled in the program and gets free health care through Mercy Hospital.

But at present, Medicaid only provides full medical and hospital coverage for women with children under 21 living at home. That leaves out an important group: single adults who may become parents in the future. Next year, officials hope to widen the coverage to include childless adults. Those plans could be put on hold by Maryland's ballooning budget deficit, however. That would leave thousands of women at risk of becoming statistics in the infant mortality crisis. The real cost of leaving things as they are will be counted in lives not saved.

Ms. Carr's daughter and two sons are already covered under Maryland's subsidized health insurance program for children whose families can't afford it on their own. Having grown up in a close-knit, churchgoing family, she admits that this isn't how she once envisioned her life unfolding. But as a mother of three expecting a fourth, she's come to realize that taking care of her own health is as important as caring for that of her children. Having enrolled in the expanded Medicaid program, she now feels that for the first time she may be able to do both.

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