By Georgia Griffin and Tania Haag / For The Herald
At a routine four-month checkup, Kim, a new mother, celebrated her daughter learning to roll over (right on track for her age). But when her daughter’s pediatrician asked about Kim’s own mood, Kim shared that some things had been hard. When asked if she had ever thought about hurting herself, she replied, “Yes, all the time.”
Kim was struggling with her mental health but did not have access to health care. Her Medicaid coverage had expired several weeks earlier, typical for Medicaid. Her daughter’s pediatrician was the first health care provider she had seen since then.
Kim is not alone. Postpartum mood disorders (PPMD) affect 1 in 5 new parents and have profound effects on the health of parents and their children. In fact, the leading cause of pregnancy-related death between 2014 and 2016 was untreated PPMD, such as suicide and accidental substance overdose. In Washington state, about one third of pregnancy-related maternal deaths occur between 43 days and one year after delivery; and the majority are preventable. Disparities in these rates are staggering and unconscionable. In our state, the rates of pregnancy-related death for Black women are three times higher and for Indigenous women eight times higher than they are for white women.
Under current state law, many mothers like Kim who qualify for Medicaid during pregnancy lose this coverage just 60 days after giving birth. Statewide, this amounts to an estimated 10,000 mothers who lose their health care each year. The loss of postpartum health care coverage is an equity crisis. Across the U.S., nearly one-half of all non-Hispanic Black women, one-half of Indigenous women, and 80 percent of Hispanic Spanish-speaking women had disruptions in their postpartum health insurance. This loss of insurance comes at an incredibly vulnerable time for new families. Without coverage, new mothers are unable to see a doctor to identify and address behavioral health problems or other medical complications.
As pediatricians, we know that maternal health is integral to children’s health. There is robust evidence that adverse childhood experiences — including the death of a parent, mental illness, and community violence — increase the likelihood of physical and mental health challenges that persist into adulthood. A parent’s well-being is essential to provide a nurturing environment for child development. A child whose mother receives treatment and support for PPMD is more likely to be ready for school and have improved behavioral health.
Lack of access to post-partum care is solvable. Last year, the Washington State Senate and House of Representatives unanimously passed bills (SB 6128 and HB 2381) to extend Medicaid coverage from the current 60 days to 12 months after delivery. The legislation was ultimately vetoed due to economic pressures during the covid-19 emergency.
The 2021 legislative session gives us an opportunity to revisit the issue and extend postpartum Medicaid coverage. This issue is even more urgent due to covid-19. Psychological stress during the pandemic increases the need for crisis care. Fortunately, the federal government will provide 80 percent of the funding, so legislators can take action without putting undue stress on our state budget.
We urge Washington to join other states including California, Georgia, South Carolina and Virginia in extending maternal Medicaid coverage to one year postpartum. This will give new mothers like Kim the medical support they need to provide a healthy environment for their children.
Dr. Georgia Griffin and Dr. Tania Haag are pediatricians in Seattle and members of the Washington Chapter of the American Academy of Pediatrics.