1. 4 Numbers to Remember (plus a bonus)
Gene Declercq, PhD
Boston University School of Public Health
March for Moms
Washington, D.C.
May 14, 2017

2. The Numbers 1,263 counties 29% of women on Medicaid ~ 23 per 100,000
51 States and D.C.
Bonus: 15.2 percentage points

3. The Numbers 1,263 counties (40%) had no OB or midwife in 2011.
~ 23 per 100,000 – estimated maternal mortality rate
29% of women who have Medicaid coverage at birth who are uninsured 6 months after having given birth
51 states and D.C. – where policy initiatives have a greater chance of success than in Congress

4. Counties in 2011 with no OB or midwife
1,459 (46%) U.S. Counties with no OB
1,758 (56%) U.S. Counties with no CNM
1,263 counties (40%) had no OB or midwife
10.1% of women in U.S. reside in counties without an OB.

5. 1,459 (46%) U.S. Counties with no OB
OBGYN per 100K, 2011
3,142 U.S. Counties
1,459 (46%) U.S. Counties with no OB
SOURCE: Area Resource File

6. 1,758 (56%) U.S. Counties with no CNM
CNMs per 100K, 2011
3,142 U.S. Counties
1,758 (56%) U.S. Counties with no CNM
Listening to Mothers 2 was a national survey of 1573 mothers in early 2006 asking them about their childbirth experiences in The full report and questionnaire are available from the website noted on the slide.
SOURCE: Area Resource File

7. 1,263 (40%) U.S. Counties with no OB or CNM
CNMs & OBs per 100K, 2011
3,142 U.S. Counties
1,263 (40%) U.S. Counties with no OB or CNM
SOURCE: Area Resource File

8. Policy Initiative
S783 – “Improving Access to Maternity Care Act of 2017”.
A bill to amend the Public Health Service Act to distribute maternity care health professionals to health professional shortage areas identified as in need of maternity care health services; to the Committee on Health, Education, Labor, and Pensions.

9. Approximately 23 per 100,000 live births
This is one estimate of the U.S. maternal mortality rate1
Another is 25.4 per 100, 000(27 states)2
Another is 14 per 100, 0003
Another is 17.3 per 100,0004
MacDorman OBGYN, 2016; 128:447
MacDorman. OBGYN 2017; 129:811
WHO Global MMR Estim. 2015
CDC.

10. U.S. Maternal Mortality Rate
The key point is that we don’t know for sure what it is since there hasn’t been an official rate since Last official reported rate:
12.7 per
100K

11. U.S. Maternal Mortality (per 100,000 live births), 1951-2007

12. U.S. Maternal Mortality (per 100,000 live births), 1951-2007 by Race

13. U.S. Maternal Mortality Ratio of Black to White Rates 1951-2007

14. U.S. Infant & Maternal Mortality Black to White Ratios of 1980-2014
As disgraceful as the black/white disparity in Infant Mortality is,
the disparity in Maternal Mortality is greater

15. Pregnancy Related Mortality,
U.S.,
Racial Disparities
Rates for :
white women
black women
other races
Source: CDC.

16. Policy Initiative
HR1318 – The Preventing Maternal Deaths Act of 2017 was introduced in the U.S. House of Representatives by Representatives Jaime Herrera Beutler (R-WA), John Conyers, Jr. (D-MI), Ryan Costello (R-PA), and Diana DeGette (D-CO).

17. 29% of women who have Medicaid coverage at birth who are uninsured 6 months after having given birth
Source: Daw et al. “Women and Coverage Churn” Health Affairs : Appendix

18. Source: Daw et al. “Women and Coverage Churn” Health Affairs. 2017
Source: Daw et al. “Women and Coverage Churn” Health Affairs : Appendix

19. Policy Initiative
This is a rapidly changing area – here are some sources to stay on top of ACA resources and where your state stands.
Kaiser Family Foundation: &
eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty- level/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,% 22sort%22:%22asc%22%7D

20. Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level
Iowa
380%
District of Columbia
324%
Wisconsin
306%
Minnesota
283%
Maryland
264%
Connecticut
263%
New Mexico
255%
Georgia
225%
New York
223%
Pennsylvania
220%
Delaware
217%
Arkansas
214%
Maine
California
213%
Illinois
Indiana
Vermont
Alaska
205%
Massachusetts
205%
Ohio
Texas
203%
Missouri
201%
New Hampshire
North Carolina
Colorado
200%
Kentucky
Michigan
Tennessee
Mississippi
199%
Nebraska
New Jersey
South Carolina
Washington
198%
Florida
196%
Hawaii
Rhode Island
195%
Oregon
190%
Kansas
171%
Nevada
165%
West Virginia
163%
Montana
162%
Arizona
161%
North Dakota
152%
Virginia
148%
Alabama
146%
Utah
144%
Idaho
138%
Louisiana
Oklahoma
South Dakota

21. 51 States and D.C. – where the policy action is
Resources
state-activit.aspx

22. Bonus: 15.2 percentage points: the difference in cesarean rates in US states
Mississippi
38.0
Louisiana
37.5
Florida
37.3
New Jersey
36.6
Alabama
35.2
Maryland
34.9
West Virginia
34.8
Nevada
34.6
Kentucky
34.4
Texas
Connecticut
34.0
New York
33.8
South Carolina
33.7
Georgia
33.6
Tennessee
33.1
Virginia
32.9
Oklahoma
32.4
California
32.3
Arkansas
32.3
Michigan
32.0
Delaware
District of Columbia
31.8
Massachusetts
31.5
Nebraska
31.1
Illinois
31.0
Rhode Island
30.8
New Hampshire
Ohio
30.4
Missouri
Pennsylvania
30.1
Iowa
29.8
Montana
29.7
Indiana
29.6
Kansas
Maine
29.4
North Carolina
29.3
Arizona
27.6
North Dakota
27.5
Washington
Wyoming
27.3
Oregon
27.1
Minnesota
26.5
Wisconsin
26.2
Colorado
25.9
Hawaii
South Dakota
25.7
Vermont
25.5
Idaho
24.4
New Mexico
24.3
Alaska
23.0
Utah
22.8

23. Policy Initiative
Lobby your state Department of Public Health to publish cesarean rates by hospital
These can be refined to look at rates for lower risk births
Hospital VBAC rates can also be published
Don’t accept the argument that the differences are based on case-mix

24. Follow Birth by the Numbers on Social Media:
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Slides that can be shared will be on this site: