Uncertainty. Anticipation. Fear.
These are just a few of the emotions that run through the minds of almost every expecting parent. And for many expecting Black parents, those feelings can be more acute. That’s because for far too many, having a child can be a life-threatening event. Across our country, we are facing a maternal health crisis.
This month is National Minority Health Month, an opportune time for all of us to recognize this crisis and engage in the national conversation about dismantling the systemic barriers to care for pregnant people of color. It’s a time to recognize the importance of providing comprehensive care — including oral care — to all.
Today, American women are 50% more likely to die in childbirth than their mothers were. Black women in the U.S. are three times more likely to die from a pregnancy-related complication than their white counterparts. And Black mothers in the U.S. are twice as likely to lose an infant to premature death. Taken together, those statistics point to a fact that gives me pause every time I read it: the United States has the highest maternal mortality rate of any high-income country in the world.
Most maternal deaths are preventable. One study found that 60% of pregnancy-related deaths were preventable. That same report found, not surprisingly, that access to quality care is a key step to reversing this trend.
While coverage alone will not address all the ways in which systemic racism in health care results in worse outcomes, including higher Black maternal mortality rates, access to affordable health coverage is essential. We can save lives if we ensure access to care before, during and after pregnancy. But for far too many families, affordable coverage, especially postpartum coverage, is simply not available.
Fortunately, our nation’s policymakers signed into law a mechanism to expand maternal health coverage that went into effect on April 1, 2022. The change, a provision in the American Rescue Plan, allows states to extend postpartum Medicaid benefits from the current 60 days to 12 months. This extended benefit means more low-income pregnant people will have access to essential health care throughout the first year of their child’s life.
But the new federal law only incentivizes states to extend this coverage; it doesn’t mandate it. Thirty-five states and Washington, D.C. have taken or plan to take action to extend this coverage, but that leaves 15 states that have taken no steps at all to implement this important policy. We need these state leaders to act immediately to address health equity among pregnant people and their babies and include this coverage in all Medicaid programs.
U.S. health policies have too frequently failed to recognize maternal health needs overall and historically demonstrated hostility toward women of color. State Medicaid programs across the country now have an opportunity to show that our values are evolving and that health care is a human right.
The American Rescue Plan’s postpartum provision also recognizes that oral health plays an essential, but underappreciated, role in protecting the health of babies and their mothers. The new law allows states to extend oral health coverage for one year postpartum, as well. This expanded view of postpartum coverage gives me hope — as a physician, mother and advocate — for a more accessible and equitable future where oral health is integral to overall health care.
For all states, this should be a no-brainer. Approximately four in 10 of all pregnant women have tooth decay or gum disease from changing hormones, and those that do are at higher risk for poor birth outcomes, such as low birth weight, preterm delivery and risk of preeclampsia. Poor oral health raises a pregnant person’s risk of high blood pressure, a precursor to preeclampsia, which can lead to major complications and even death. And children are three times more likely to have a dental disease if their mother was not able to receive dental care during pregnancy. These kinds of preventable complications and poor health outcomes place additional financial stress on individuals, the health care system and state budgets.
It’s no coincidence that Black women who face the highest mortality rates also face some of the highest rates of oral disease. Expanding access to oral and overall health care before, during, and after pregnancy will change lives and bring us closer to real health equity.
The act of having a child should be one of the most joyful moments of any parent’s life. State leaders have the opportunity to help make sure fear and anxiety don’t overshadow that joy. The only question left: Do we have the will to act while we have the chance?
Myechia Minter-Jordan, MD, MBA, is the president and CEO of the CareQuest Institute for Oral Health and former CEO of the Dimock Center in Roxbury, Massachusetts.