American Forum Op-Ed

By Maureen P. Corry, MPH

“I don’t need maternity care.” Sen. Jon Kyl (R-AZ) lobbed this comment against Sen. Debbie Stabenow’s (D-MI) efforts to guarantee maternity coverage as a basic benefit in health care reform. “Your mom probably did,” Stabenow famously shot back. That exchange and the wave of support that followed for Stabenow’s proposals illustrates how out of step Kyl is with a huge majority of Americans, including those in his own party.

Voters across the political spectrum are almost universal in their support for making maternity care an essential health insurance benefit through health care reform, according to a new poll conducted by Mark Mellman and commissioned by the Communications Consortium Media Center and the Women Donors Network. Fully 86 percent of voters strongly support a guaranteed maternity care benefit, and 95 percent believe that women should have the right to decide when to have a child, where to give birth and the health care provider who will attend their birth.

At Childbirth Connection, a 91-year-old national organization advocating high quality, evidence-based maternity care, we are not surprised by these results. We’ve known for years that rapid gains in the quality, value and cost of maternity care are well within reach. Health care reform is our opportunity to ensure that all women and babies get higher quality care with better results, and savings from following best practices can be put toward providing coverage for all.

It’s a fact: Maternity care is an essential component of women’s health care across their lifespan, and it represents a major segment of the health industry. Eighty-five percent of all women give birth, and childbirth is the No. 1 reason for hospitalization. With 4.3 million births per year, maternal and newborn charges are the runaway leader in hospital costs – topping $86 billion in 2006. Employers and private insurers pay for 49 percent of all births, and taxpayers pay for 43 percent. Although the U.S. spends more on health care than other developed nations, our performance lags way behind other countries on quality indicators including low birthweight, prematurity, and maternal death rates. According to the United Nations, 40 other countries have lower maternal death rates.

While the vast majority of childbearing women and their babies are healthy and at low risk, the current style of maternity care is procedure-intensive, costly, and entails unnecessary risk, including elective induction and cesarean surgery. Proven practices that are generally safer and cheaper are underutilized, including continuous support during labor, smoking cessation programs and breastfeeding.

Most Americans agree that access to care must be broadened, quality and value improved and costs reduced. These are achievable goals for maternity care today by simply putting into practice what we already know is good for women and babies from comparative effectiveness research. Many provisions of the health care reform measures passed by committees in Congress are a good first step toward better maternity care in this country, and by extension, better care for all Americans. Key provisions include:

• prohibiting insurers from excluding pregnancy as a pre-existing condition and using past birth experiences (e.g., cesarean section) to justify ineligibility and higher premiums;

• widening access to certified nurse-midwives by eliminating Medicare reimbursement inequities;

• measuring and publicly reporting maternity care performance and using results to improve care;

• paying for family home visits by nurses during and after pregnancy via Medicaid;

• expanding access to primary maternity care by improving Medicaid coverage of free-standing birth centers;

• expanding coverage for prevention and wellness services; and

• offering incentives to maternity care providers under Medicaid to care for underserved women and their families.

These proposals are geared toward bringing about the rapid gains in coverage, quality, value and cost of maternity care, improved maternal and newborn outcomes, and reduced health care costs overall. They are both cost-effective and compassionate.

America’s women and families are expecting real health care reform. Now it’s time for Congress to deliver.
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Corry is the executive director of Childbirth Connection.
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Copyright (C) 2009 by the American Forum. 10/09