Submitted February 14, 2007

Remember ALL Pregnant Women in Prescription for Pennsylvania
Letty Thall

It shouldn’t be hard for a pregnant woman to find prenatal care.

     In September 2006, the Maternity Care Coalition shared with the greater Philadelphia community our findings on what it was like to be pregnant and have a baby in our region. Not surprisingly, we found that having health insurance, and speaking English, paved the way for access to physicians.  Lacking health insurance, having a low income, being African-American, or Asian, or Hispanic, or having a chronic medical or mental illness, could make things more difficult.

     Our report, Childbirth at the Crossroads, reminded people in our region that simply being born to an African-American mother doubles a baby’s chances of dying in the first year of life. We called attention to the decreased number of hospitals offering maternity services, and the lack of obstetricians willing to serve low-income women and immigrant populations. We called for concrete actions in five major areas – actions needed to assure that we welcome all babies in the best possible way.

     Last month, Governor Rendell announced his Prescription for Pennsylvania - a comprehensive plan addressing all three major components of public health policy – access, cost, and quality.  As the details of the Governor’s plan unfold, all of us want to know – what does it mean for me? What does it mean for the people in the communities in which we live and work? At the Maternity Care Coalition, we are asking the Governor and the General Assembly, what will it mean for the women, the practitioners, and the communities who appear in our Childbirth at the Crossroads report?

     We identified the increasingly diverse population of our region, and called for practitioners to meet national standards for culturally and linguistically appropriate services. The Governor noted that fewer than 3% of our doctors and 2% of our nurses identify as Hispanic. He called for broadening the diversity of the health care workforce, and supporting translation services and cultural competency programs. We hope that such initiatives will mean an end to security guards in health centers serving as medical translators for private health information.

     We highlighted the many women who lack access to care, either because they do not have health insurance, or because obstetrical providers with appointments do not accept Medicaid, and those who accept Medicaid have unacceptable waits. Prescription for Pennsylvania proposes to offer “affordable basic health insurance” through the private health insurance market. We hope this means the young woman who does part-time temporary office work and the one who works for the corner grocer will both have health insurance before, and after, a pregnancy. We want the self-employed woman who cleans a different suburban house each day to have health insurance.. Currently, these women are eligible for Medicaid if their incomes are less than 185% of poverty level, but their eligibility starts with pregnancy, and ends 60 days after pregnancy. We want them to have pre-conception coverage, and well woman care after birth. We want funding for all women to receive prenatal care, regardless of their immigration status. We want obstetricians and midwives in all neighborhoods who accept the new insurance, and we want them to have timely available appointments. We hope  this “affordable basic coverage” provides for the diagnosis and treatment of post-partum depression. We are not asking a lot. This  is basic care, and an investment in our region’s future.

     We appreciate the Governor’s discussions of a smoke-free Pennsylvania, and the recognition that smoking cessation requires a concerted effort at the public health, practitioner, and individual level. We see the connection between this call, and our goal of reinstating the comprehensive Medicaid Healthy Beginnings Plus benefits package. This would allow pre-natal providers in Medicaid managed care to spend the time with women to address fully such problems as smoking and pregnancy.

     We identified the declining pool of practitioners, and the lack of support for, and understanding of, the role of midwives. We hope his call for nurse midwives to practice to the fullest extent of their training will translate into more options for pregnant Pennsylvania women.

     When we look at our Crossroads report, we see the uninsured woman in Chester County, looking for a prenatal provider. We see the insured woman in Norristown, looking for an appointment before her first trimester ends. We see the midwife in Philadelphia, overbooked with appointments and no time or reimbursement to adequately work on smoking cessation. We hope the Governor and the legislature see them too, and remember.

Learn about the childbirth crisis through our Maternity Care in Southeastern PA pages, or visit our Maternity Services Advocacy pages to find out how communities are advocating and how you can take action!

MCC's full Childbirth at a Crossroads report can be viewed here.