When our state is the fourth worst in the nation for something, it’s a call for change. At present, Indiana is fourth worst in maternal mortality, with 63 pregnancy-related maternal deaths in 2018 according to Indiana’s 2020 Maternal Mortality Report. 86% of those happened within the first year after delivery, and 37% within the first six weeks.
The number of deaths is extraordinarily high compared to California, Nevada, Connecticut and Colorado, which highlights that this is a problem we can and should fix. California studied the problem in 2006 and instituted rigorous professional education and drills to treat threats such as late state pre-eclampsia, hemorrhaging, and high blood pressure. Connecticut has over 200 nurse-midwives, who are proven to improve birthing outcomes. Colorado carefully studies causes of death, including mental health. Nevada instituted a maternal mortality review board, similar to Indiana’s to study its rates compared to its poor child and mother healthcare.
This year in Indiana, legislators proposed several bills to help pregnant women and new mothers. Sen. Jean Breaux (D-Indianapolis) and Rep. Maureen Bauer (D-South Bend) sponsored bills, including SB 298 that would require certain health plans to cover doula services to support pregnant and new mothers. Like nurse midwives, trained doulas improve maternal and infant health outcomes by providing support before and after pregnancy. Bauer also proposed a bill to avoid shackling incarcerated mothers during delivery.
One bill, HR 1309, was a kind of pregnancy discrimination act that should have required businesses to provide reasonable accommodations to protect the health of pregnant women — allowing women to carry a water bottle or sit during long shifts. Like the other bills proposed this session, it did not become law. Women’s advocacy groups opposed HB 1309 because it unduly burdened pregnant women. They would have to prove what accommodations were comparable and reasonable in their work environment, rather than requiring workplaces to adhere to professional medical recommendations.
SB 10 sponsored by Sen. Jean Leising (R-Oldenburg) will study why so many mothers are dying postpartum. SB 10 allows the Maternal Mortality Review Board access to personal patient information to determine if mental health, substance use, or other conditions are the cause. Over half of deaths in 2018 were substance use related. Indiana also has thirty-three regions that are birth center deserts, where no hospitals or hospitals with OB-GYN services are located within a thirty mile drive. Race and ethnicity further complicate maternal death rates. 53 of 100,000 Black mothers die from pregnancy-related causes, whereas 41 of 100,000 White mothers do.
Each death is a huge loss to families. Thousands more women suffer life-threatening and serious complications due to pregnancy. In a state that values women and babies, what does it mean to pass legislation related to maternal health? While lawmakers shouldn’t legislate how medicine is best practiced, they can use their roles to direct health professionals, insurance and medicare providers to fund services that save women’s lives. Financial stakeholders will be accountable to place lives before the bottom line.
Proven solutions include paying for doulas as part of maternal care, instituting more than one or two post-natal check ups, ensuring highly-trained OB-GYN professionals (nurses especially) are available in rural communities and drilling OB-GYN staff and educating mothers to know signs of dangers.
SB 10 asks for a lot of private information to solve a state-wide, complex problem. In exchange findings should address higher maternal mortality among Black, rural, low-income, and women with mental health or substance use needs. The League of Women Voters position is that health care should be equitably distributed by region and by under-served groups. It should be medically-proven, affordable and available to all. This year, some bills needed to be better written. Some needed to make it to the floor of both the House and Senate if Indiana is going to protect the health and life of its women and mothers.
The League of Women Voters, a non-partisan, multi-issue organization encourages informed and active participation in government, works to increase public understanding of major policy issues and influences public policy through education and advocacy. All men and women are invited to join the LWV where hands-on work to safeguard democracy leads to civic improvement. For information, visit the website www.lwvmontcoin.org or the League of Women Voters of Montgomery County, IN Facebook page.