Saturday, May 13, 2017

We Saved Babies But We're Losing Their Moms: Women's Healthcare in Texas

We knew defunding Planned Parenthood would mean more babies, and we were right. 

27% more babies!

Following through on anti-abortion campaign promises, Texas legislators cut the state budget for family planning by two-thirds in 2011, while simultaneously diverting funds away from women's clinics that provide abortions, and poverty birth rates increased 27%.* (The state-wide birth rate decreased.)

As our poverty birth rate increased, so did our maternal mortality rate: doubling in just 3 years. Texas can now boast one of the highest maternal mortality rates in the developed world.

While maternal mortality isn't terrifyingly high (30 per 100,000 women), we should be concerned -- or at the very least, curious -- that the maternal-mortality rate in our state doubled in just three years, even as it decreases throughout the rest of the world.

What does it mean?

Well, it's not rich moms who are dying. And for the most part, it's not women dying during prenatal care, labor, or delivery. It's not immigrants crossing the border illegally and dying in the ER as they give birth to anchor orphans. (In fact, Hispanic maternal-mortality rates are lower than white maternal-mortality rates in Texas, so if anything, immigrants are helping our stats.)

Our problem is the state of Texas has no healthcare available for the poor.

Subsidies and tax credits through the Affordable Care Act were designed to serve the middle class, those earning from 138% - 400% of the federal poverty level ($33,949 - $98,400 for a family of four).

For those earning less than 138% FPL, states had the option to expand Medicaid, which the federal government would cover at 100% for the first three years, and 90% thereafter.

The same Texas legislature that sharply increased regulations for Planned Parenthood clinics, in the name of women's healthcare, opted out of expanded Medicaid.

Prior to the Affordable Care Act, not a single independent health insurance plan in Texas offered maternity coverage, even if purchased prior to pregnancy. 

This meant, for many poor women, whose employers would never think to offer health insurance, their only access to healthcare was a limited program called Medicaid for Pregnant Women, which cut healthcare coverage 2 months after a baby was born. 

Maternal-mortality rate is measured from pregnancy to one year after a child is born. Most maternal deaths in Texas occur in the gap between a child being 6 weeks - 1 year old.

The common denominator? Poor mothers losing health insurance coverage, being unable to obtain healthcare, including mental health services, and dying.

Maybe it's not an astronomical number of moms dying in Texas -- 30 per 100,000 -- but it's an upward trend, and indicates part of a bigger problem: inaccessible, unaffordable healthcare for poor women.

Interestingly, Medicaid for Pregnant Women pushes new mothers at birth to obtain permanent sterilization or longterm contraception. While Medicaid pays for a woman to have her tubes tied a day after giving birth, or to have an IUD inserted at her post-partum check-up, this same woman loses access to healthcare soon after, and has no recourse should problems occur -- and with IUD's, complications are common. (There are online threads about how to remove your own IUD, despite all medical advice to the contrary, for the many women who are sterilized by the state, in the name of healthcare, and then left without care.)

We can wring our hands about not having children we can't afford, about absentee fathers, about healthcare being fine the way it is, about drug-addict mothers, about poor people "abusing the safety net," about an over-burdened CPS system, about the working poor being ungrateful for minimum wage, maybe even wondering if it's a blessing-in-disguise for these babies that their mothers died...

...but who are we as a state and as a people, if we go to any legislative stretch to save a child, only to shrug at the loss of its mother?

Maybe Obamacare is failing. Maybe we hastened its failure by encouraging instability in the marketplace. Maybe it was never a good plan to begin with. But we need something. And it needs to be affordable and accessible for everyone, even and especially, the poor. 

Texas' maternal-mortality rate is at just over 30 per 100,000.
*The 27% birth rate increase is in counties with a Planned Parenthood that closed due to decreased funding and increased regulations. Birth rates in counties without a closed Planned Parenthood clinic remained constant or slightly decreased. 

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