Maternal Health Awareness Day: Advocacy, Policy Crucial for Protecting Access to Maternal Health

From policies that can drastically improve access in women’s health to the increasingly important need for more pharmacists in this space, there are significant gaps in maternal health care that still need to be addressed, despite the progress that has been made.

“We need to be thinking, not just about the pregnancy period, but both the time before and the time after. That continuity of care [is] really important and [makes] sure people have access to affordable health care,” said Natalie DiPietro Mager, PharmD, PhD, professor of pharmacy practice at Ohio Northern University and host of the Scripted for Her podcast powered by Drug Topics. “That's where policy around issues like Medicaid or health insurance plans can really come into play.”

However, as Mager stated, policies surrounding insurance and access to maternal care is just the tip of the iceberg. She also believes that no one issue is more important than any other gap in women’s health or access to maternal care. Discussing concerns of pharmacy deserts, rollbacks in government programs, and various pressures among health care providers, Mager explains that the proper path forward for greater access lies in champions of advocacy and patient-forward health care policies.

READ MORE: Maternal Health Awareness Day: Improving Maternal Health Through Preventative, Pharmacist-Led Care

Drug Topics: The theme for Maternal Health Awareness Day this year is “Holding Ground on Maternal Health.” Currently, what are the biggest threats to the progress we’ve made in maternal health?

Natalie DiPietro Mager: There are multiple issues that we need to be addressing simultaneously. It isn't to say one needs to be prioritized above the other, and frankly, a lot of these go hand in hand. One major issue is access issues. We have geographic regions that are either health professional shortage areas or maternity care deserts. Maternity care deserts are places where there are no OBGYNs and no hospitals that provide labor-and-delivery services. Those are growing in our country. It requires women to have to travel longer distances to get the care that they need. There's data that actually indicate that residing in a maternity care desert increases the risk of postpartum death up to 1 year after delivery.

Another major concern are these pharmacy deserts that we are seeing develop as well, because pharmacists often are that first point of care for patients and also provide a lot of important women's health needs, such as access to contraception. As pharmacies are closing, patients are also finding that they're not being able to access the health care that they need.

Seeing the rollback of different programs such as Medicaid and SNAP. Medicaid is actually the largest single payer for pregnancy in our country today. Overall, it covers about 41% of all births. But for some populations—such as rural populations, women living in certain states, or certain minoritized groups—Medicaid pays for nearly half, or over half, of all births. Any changes we make to that federal program is definitely going to impact women's health overall and their ability to get the care that they need.

We also have seen a loss of funding at programs like the CDC. They collected a lot of important surveillance data and provided a lot of important education for both health care providers and patients. Finally, unfortunately, health care professionals are really facing a lot of pressures not to talk about racial and ethnic health disparities. Yet, we know that maternal mortality disproportionately impacts women of color. We have to keep understanding and recognizing for our patients what their risks might be.

Drug Topics: One of ACOG’s missions during Maternal Health Awareness Day is to continue to advocate for health policies that will increase access to maternal care. What are some examples of past policies that have increased access and what policies would you like to see be enacted in the future?

Natalie DiPietro Mager: There's a lot of opportunities on the policy side. Again, thinking about Medicaid or thinking about insurance plans that are sold on through the Affordable Care Act; when there was Medicaid expansion and subsidies and other policies in place that made health insurance more affordable, we saw more people being able to get coverage. It's important to have this health care coverage before pregnancy to really have the best health outcomes, and then again, also postpartum, to monitor and continue to treat any effects of the pregnancy, as well as to help patients if they want to have contraception and plan their next pregnancy. We need to be thinking, not just about the pregnancy period, but both the time before and the time after; that continuity of care being really important and making sure people have access to affordable health care. That's where policy around issues like Medicaid or health insurance plans can really come into play.

[There’s] also funding support for quality improvement projects. These are data-driven systematic approaches to reducing complications related to pregnancy. Some of them have been demonstrated to be very effective. Continuing to study those programs, replicate them, and expand them is going to be important. [We need to be] thinking about policies that enable both payers and providers to address unmet social health needs for patients, whether that's food insecurity, poor nutrition, or housing. But we can't just stay in what we call the downstream; we have to think upstream. What are the different structural, community-level determinants? That's where policies really come into play that we could be addressing to help people achieve greater health overall.

Looking forward, workforce development; that has been very helpful for maternal health. There have been policies and changes that recognize and encourage the involvement of groups like midwives, doulas, and community health workers. We need to add pharmacists to that mix. Moving forward, we need provider status so that pharmacists can be able to more sustainably be reimbursed to provide care for women of reproductive age.

READ MORE: Women’s Health Resource Center

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