Mississippi lawmakers just killed a bill that would expand postpartum care

“I can’t stress enough how much having Medicaid meant to me, post having my babies,” she said. “I don’t know if I would have made it otherwise.”

Today, Roberts is the co-founder of the Mississippi Reproductive Freedom Fund, an abortion rights organization, as well as a doula. The memories of her decades-old birth complications felt particularly fresh last week when leadership in Mississippi’s House of Representatives killed a bill to extend postpartum Medicaid coverage from the federally mandated two months to one year after giving birth.

The Associated Press reported that S.B. 2033 passed the state Senate 46 to 5 last month and then passed the House Medicaid Committee on March 1. But on March 9 — the deadline for House and Senate committees to consider general bills that had passed the other chamber — House Speaker Philip Gunn (R) and House Medicaid Committee Chairman Joey Hood (R) chose not to bring it up for a vote.

“As I’ve said very publicly, I’m opposed to Medicaid expansion,” Gunn told the AP of his opposition to the bill. “We need to look for ways to keep people off, not put them on.” (Neither Gunn nor Hood responded to requests for comment.)

The news hit maternal health advocates hard in a state where deaths as a result of pregnancy are almost twice as high as the rest of the country, according to a 2019 report by the Mississippi State Department of Health. It’s also where 60 percent of deliveries are funded by Medicaid — much higher than the national average rate of 42 percent, according to the Kaiser Family Foundation.

The Mississippi State Department of Health report found that Black women in the state were almost three times as likely to die of pregnancy-related causes as White women.

“Where you live should not make the difference between whether or not you live or die,” said Michelle Owens, a professor of maternal-fetal medicine at the University of Mississippi Medical Center. “If we can fill a gap that will help to make the difference between whether or not someone lives or dies by extending postpartum Medicaid coverage, why wouldn’t we?”

Rules vary from state to state, but many people become eligible for Medicaid coverage — the national and state program that provides health care to low-income people — for pregnancy-related services while they’re gestating and up to 60 days after they’ve given birth. For many, Medicaid coverage is the only way they’re able to attend prenatal visits, give birth in a hospital, or get preventive care before or after giving birth for the life-threatening conditions that pregnancy can cause.

Maternal health experts say a common misconception is that active labor is the only risky part of pregnancy. But according to the Mississippi State Department of Health, the vast majority (86 percent) of the state’s maternal deaths occur after giving birth, with 37 percent of those deaths occurring after six weeks postpartum.

“For a long time, we’ve arbitrarily considered the postpartum period to be six weeks after birth, but the risks to women for death extend well beyond that time frame,” said Owens, noting that the risk of cardiac events, hypertensive emergencies and blood clots all persist past the six-week postpartum period.

“If birthing people had more access to health care in that timeline, then perhaps we wouldn’t see the level of morbidity and mortality we do,” she added.

The state has also been in the national spotlight in recent months as the Supreme Court deliberates a 2018 Mississippi law that aims to ban most abortions after 15 weeks. The case, which many experts believe the conservative-leaning court is poised to uphold, could overturn or dramatically curtail Roe v. Wade. At the center of the case is Jackson Women’s Health Organization, which has been Mississippi’s sole abortion clinic since 2004.

According to some maternal health providers, such regulations on abortion, coupled with limits on postpartum care, do not bode well for reproductive health outcomes: “If we are in a situation where access to termination of pregnancy is limited but we also want to limit care for birthing people throughout the period at which they’re most vulnerable, that’s difficult for me to reconcile,” Owens said.

A 2021 study from the Tulane University School of Public Health and Tropical Medicine found that states with restrictive abortion laws have higher maternal mortality: States with a restriction on Medicaid funding for abortion were associated with 29 percent higher maternal mortality, it found.

While Owens and Roberts both believe that expanding postpartum Medicaid is a critical step in reducing the state’s high maternal death rates, they say it’s only the beginning of the interventions needed to keep mothers safe in Mississippi, the poorest state in the country, according to the U.S. Census, where the per capita income is $24,369. More than 18 percent of the population lives below the poverty line.

“Maternal health doesn’t occur in a vacuum,” said Owens, adding that it’s not uncommon for her patients to have to choose between buying food or medicine, and for new mothers to worry about whether they’ll have a place for themselves and their baby to live once they’re discharged from the hospital.

Roberts said that many people she works with experience postpartum depression, but without health-care coverage, they can’t access the therapy or medication they might need in the months preceding and following birth. The Mississippi State Department of Health found that approximately 11 percent of maternal deaths in the state are due to suicides and overdoses.

For Owens, getting more people covered by Medicaid could help decrease emergency room visits and the cost of caring for people forced to delay or avoid medical care that they can’t afford.

“People are really struggling, and I think sometimes we gloss over how difficult some of those situations really are,” Owens said. “Most of the people who are setting policy have the luxury of having most of their basic needs met, and I think that can sometimes limit our ability to fully understand and empathize.”