Mind the Gap

Family Issues, Health Care

Fascinating information from Eesha Pandit at Reproductive Health Reality Check:

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.

The simple-minded might read this as an endorsement of private health insurance over “government” health care. In April, Erik Eckholm wrote in the New York Times about a rise in the deaths of babies born to poor and mostly black mothers in southern states — Alabama, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. Focusing mostly on Mississippi, Eckholm said Medicaid patients had a difficult time finding and getting to providers.

But social workers say that the motivation of poor women is not so simply described, and it can be affected by cuts in social programs and a dearth of transportation as well as low self esteem.

“If you didn’t have a car and had to go 60 miles to see a doctor, would you go very often?” said Ramona Beardain, director of Delta Health Partners. The group runs a federally financed program, Healthy Start, that sends social workers and nurses to counsel pregnant teenagers and new mothers in seven counties of the Delta. “If they’re in school they miss the day; if they’re working they don’t get paid,” Ms. Beardain said. …

…In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent.

As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling.

One former Medicaid official, Maria Morris, who resigned last year as head of an office that informed the public about eligibility, said that under the Barbour administration, her program was severely curtailed.

“The philosophy was to reduce the rolls and our activities were contrary to that policy,” she said.

The outcomes described by Eesha Pandit at Reproductive Health Reality Check speak loudly and clearly — babies born to women who are cut off from decent health care are at greater risk. Eckhold continues,

Whether the rises continue or not, federal officials say, rates have stagnated in the Deep South at levels well above the national average.

Most striking, here and throughout the country, is the large racial disparity. In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.)

That racial discrepancy has a lot to do with why the overall infant mortality rate in the United States is high compared to other industrial first-world nations. Eesha Pandit writes,

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).

See also:Haley Barbour, Baby Killer,” “At Least We Beat Latvia.”

Infant mortality in the U.S. has been relatively high for many years. Yet most Americans either don’t know this or dismiss the statistics as fake. We do have The Best Health Care System in the World™, after all.

It’s true that some of the problem with our infant mortality rates can be attributed to different standards in what’s considered a live birth. In a small percentage of births, a birth that would count as a live birth by U.S. medical standards would be considered a stillbirth in other countries, and thus would not count as an infant mortality. But my understanding is that when these births are taken into account, the U.S. doesn’t move up much. What’s really cranking up the death rates of U.S. babies is the high infant mortality rate among the poor, especially the poor and black, in the United States.

There are also significant differences in infant mortality rates among the states. According to a recent release from the Center for Disease Control:

Three years of data (2002-2004) were combined to get specific estimates of infant mortality rates by state, race and Hispanic origin. For the three-year period there were significant differences in infant mortality rates by state, ranging from a rate of 10.32 [per 1,000 births] in Mississippi to 4.68 in Vermont. For infants of non-Hispanic black mothers, rates ranged from 17.57 in Wisconsin to 8.75 in Minnesota. For infants of non-Hispanic white mothers, the infant mortality rate ranged from 7.67 in West Virginia to 3.80 in New Jersey.

As I wrote here, American hospitals generally provide excellent care for newborns. But too many American babies are born prematurely, or with low birth weight or other preventable problems. And many of these problems can be traced to a lack of basic prenatal care.

Today UNICEF declared that the rate of child mortality worldwide has dropped considerably. Happy news. A table showing rates by country 1960-2005 shows a slight drop in deaths of children under 5 in the U.S. also. But all of the western European nations on the list have lower rates, as do Australia, Canada, Cyprus, the Czech Republic, Japan, South Korea, New Zealand, Singapore, and Slovenia. Shit, people, we don’t even beat Slovenia.

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  1. c u n d gulag  •  Sep 14, 2007 @7:06 am

    Is religion at fault here? To some degree I think may be. Because in Dominionist, or, as I prefer to call it, “Christianista” America(can I trademark that?), blastocyst’s and fetus’s matter. Actual children, uhm, not so much… Until we wake up and realize the threat that these people pose in all aspect’s of our lives, we will continue our downward spiral. It’s a very sad day when Slovenia is next our goal for improvement in terms of child mortality. And that’s not the only place we’re well behind the rest of the civilized world.

    I want my old America back. It was far from perfect, but at least I could defend some of its aspects and actions. Today, I can’t think of a single thing that I could say to defend us. I don’t understand this country anymore.

    America under King George IV is like a drunk with a credit card on a bender, drinking martini’s like water. The first martini is to unwind. The second, to unravel. The third, to unhinge. And we’re well beyond the third! All the rest of the world can hope for, is that we pass out soon.

    The reckoning for our actions will come. And I, for one, fear that reckoning…

  2. sniflheim  •  Sep 14, 2007 @11:53 am

    Several years back, I remember hearing that American white had a decent overall quality of life standard as assessed by the UN, incorporating such things as infant mortality, and black America was right around Trinidad and Tobago.

  3. dr.steveb  •  Sep 14, 2007 @12:26 pm

    This statement is false:

    “Now whether Medicaid has merely become a marker
    for things like education, age, race and economic status,
    is up to debate.”

    There is no debate. It is exactly knowable. Of course Medicaid is a marker for economic status, it is by definition. It is means tested. You can only get it if you are very poor. And the health statistics could have been analyzed to statististically control for multiple colinear effects (which type of insurance, race, income), though no doubt under the current governor the health dept. professionals won’t be allowed to.

  4. k  •  Sep 14, 2007 @7:26 pm

    the income level for a family of three to get medicaid on OK is 2648 monthly and for family of 4 is 3148 monthly. That includes the unborn child and is after 240 per working adult is taken off the gross. Legal residents have to have been here 5 years, illegal residents are eligible for birth coverage only , no prenatal months. All in all the program is generous. Teens under 18 are rearely if ever covered for pregnancy by private insurance , so even if mom and dad have their dependent children covered, the insurance won’t help . So the working parents may have it worse if they are a little over the income level and have insurance, they have to pay out of pocket. Looking at the info you gave , medicaid is really a function of where you are by age especially. Older workers tend to have stabler jobs with insurance. The young have jobs with no insurance and the teens aren’t coverable anyway. Unfortunately the creator made us women to be fertile at the under age 38 crowd, the most likely to not have insurance, of course the creator did not design the private insurance system…

  5. Doug Hughes  •  Sep 14, 2007 @8:49 pm

    I find myself wanting to build comparative numbers, excess infant mortality vs the numbers of abortions. Which is higher? Where is the outrage about excess infant mortality which definately involves a viable life – both sides of the abortion debate would agree. But not a peep from the ‘right to life’ crowd.

  6. maha  •  Sep 14, 2007 @11:03 pm

    I find myself wanting to build comparative numbers, excess infant mortality vs the numbers of abortions.

    It may not be a coincidence that some of the nations with the lowest infant mortality rate also have the lowest abortion rates, in spite of liberal abortion laws. The Netherlands comes to mind. The countries in north-west Europe generally have among the lowest infant mortality rates and the lowest abortion rates on the planet. I suspect these nations also have low rates of unwanted pregnancies because of widespread use of birth control.

    In the U.S., I believe there is a pretty strong correlation (not a perfect one) between states with high infant mortality and very restrictive abortion laws.

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