I’ve reported before about racial health disparities in the US, and unfortunately, I am back at it. Last week saw the release of several studies regarding racial discrepancies in infant and maternal mortality. In Maryland, the state’s Joint Committee on Children, Youth, and Families found that Black population suffers from higher rates of infant mortality, low birth-weight and teenage births. In North Carolina the infant mortality rate among minorities dropped to a historical low in 2006, but racial disparities between blacks and whites still remain, the Citizen-Times reports.
But it's a study out of Alabama that might be the one that gets at the crux of the issue. The Alabama Department of Public Health released a report that shows a link between birth outcomes and health insurance, as reported by the Decatur Daily. The report, by the department's Center for Health Statistics, examined birth certificates for 60,262 live births, and among other things:
- Infants born in Alabama in 2005 were more than three times likely to die in the first year if their mothers paid for their deliveries out-of-pocket than those with private health insurance;
- Infants in deliveries covered by Medicaid were 40% more likely to have low birth-weights and 60% more likely to die than infants with private insurance;
- White women were more likely to have private health insurance than minority women;
- Medicaid covered deliveries for nearly four out of every five births among teenage girls and 40% of births involving women ages 20 to 34;
- Private insurance covered nearly 80% of births among women ages 35 and older; and
- Nearly all women with private insurance received prenatal care within the first trimester, compared with 74.7% of women with Medicaid.
Now whether Medicaid has merely become a marker for things like education, age, race and economic status, is up to debate. What is clear, though, is the fact that these factors do indeed affect access to reproductive healthcare, and that Medicaid is not a sufficient solution for social inequities.
This, of course was no surprise. The US does not have an enviable record on the matter of infant mortality, which is directly connected to maternal mortality and the status of women in a society. And we already know how important a healthy mother is and many of the challenges they face in securing their own health and the health of their infants.
In a report from Save the Children released this May, entitled State of the World’s Children, 125 nations were ranked according to 10 gauges of well-being — six for mothers and four for children — including objective measures such as lifetime mortality risk for mothers and infant mortality rate and subjective measures such as the political status of women. Among industrialized nations, the US was second to last (ranked only above Latvia). Charles MacCormack, president and CEO of Save the Children, said the report "illustrates the direct line between the status of mothers and the status of their children.” He also encapsulated the lesson rather efficiently by saying, “In countries where mothers do well, children do well."
But this seems rather obvious, no? Looking at the studies from Maryland, North Carolina, and Alabama it is clear that access to comprehensive reproductive health care is critical to maternal and infant health. What these studies find, in no uncertain terms, is that in the US race and economic status are relevant factors in whether mother and baby survive. This is a lesson, alluded to by the international studies, that is one our policy makers need to hear. If we want to improve the success of new mothers and their children in the United States, it is a lesson we cannot ignore.