Insurance

Abortion ruling means more and riskier births in Mississippi

October 24, 2022
Jacob M. Paul

GREENWOOD, Mississippi (AP) — In Mississippi, where health officials expect 5,000 more births each year because the Supreme Court overturned abortion laws, children are more likely to die before their first birthday than in any other state.

Mississippi has the highest fetal mortality rate in the country, the highest infant mortality rate, the highest rate of preterm birth and is one of the states with the worst maternal mortality rates. Black women are nearly three times more likely to die from childbirth than white women in Mississippi.

As the state’s Republican leaders led the legal fight against abortion, Gov. Tate Reeves said he would do everything in his power to make Mississippi the “safest state in the nation to have an unborn child.”

But access to antenatal and postnatal care has shrunk in Mississippi since the June ruling, making childbirth even more dangerous for poor women and children. The state’s only neonatal intensive care unit in the impoverished Delta region closed in July under financial pressure and life-saving care for sick or premature babies was relocated about a two-hour drive away.

And now the state-owned Greenwood Leflore Hospital has announced the permanent closure of its labor and delivery unit, saying it cannot pay competitive wages and retain experienced nurses. The women of the region have to travel about 45 minutes to give birth in a hospital.

“If there’s an emergency and someone lives in Greenwood or in the country, where do they go? It could be catastrophic,” said Dr. Mark Blackwood, a Delta-based Obstetrician-Gynecologist.

Another hospital on the Mississippi coast also closed its labor and maternity ward, and several hospital systems are looking for buyers. All are under greater pressure due to the state’s refusal to accept the expansion of Medicaid and the billions of federal dollars it would allocate to health care in the state.

Months after the Dobbs ruling forced the closure of the state’s last remaining abortion clinic, Mississippi Attorney General Lynn Fitch credited the state’s Republican women with “leading the cause” and Reeves celebrated “100 Days of Baby Protection & Breaking the Abortion Lie.”

But health care analysts, doctors and pregnant women are alarmed as maternity care options are disappearing.

According to an Oct. 11 March of Dimes report that focuses on mothers and infants, more than 2.2 million women of childbearing age in the US live in “maternity care deserts,” and another 4.7 million live in restricted counties Access to Maternity Health Care. The nonprofit organization defines maternity deserts as counties with no hospitals offering obstetric services, no maternity centers, no OB/GYN, and no certified midwives.

The organization provided AP with data showing that of any state, Mississippi has the eighth-highest percentage of such counties that meander through the Delta, an agricultural flatland where persistent poverty shapes daily life.

Infrequent prenatal visits can put mothers and babies at risk, according to the Kaiser Family Foundation, which tracks health statistics.

“If parents have to travel longer and longer distances, they have to give up more work. It costs more money, more gas and more free time,” said Dr. Anita Henderson, President of the Mississippi Chapter of the American Academy of Pediatrics. “Our concern is that their ability to get those routine prenatal visits in a timely manner will also decrease.”

Greenwood Leflore Hospital, whose slogan is “The Right Care at the Right Time,” is warning mothers-to-be to make arrangements to go to another hospital once they go into labour. Meanwhile, pregnant women who arrive in crisis are being stabilized in the emergency room and then transferred to another facility that provides maternity care, hospital spokeswoman Christine Hemphill said.

Greenwood Leflore is now directing expectant mothers to a hospital in Grenada, about 53.1 kilometers away. Brenda Palmertree had two children there before moving closer to Greenwood and finds it hard to imagine traveling that far while she is about to give birth. “When you go into labour, you can’t just stop it. For example: ‘Hello, stop by, I have to drive 45 minutes.’ It doesn’t work that way,” she said.

“When it comes to pregnancies and births, especially high-risk or emergency births, we know minutes matter,” Henderson said.

Reeves and other Republican leaders have rejected many proposals to expand Medicaid primarily to low-income workers whose workplaces don’t offer private health insurance, saying they don’t want to encourage relying on government help for people who don’t require.

About 60% of Mississippi births in 2020 were funded by Medicaid, the foundation found — only Louisiana had a higher rate at 61% — and Mississippi offers the federal minimum of two months of postpartum insurance. Mothers in Mississippi can access postpartum insurance coverage for 12 months while the federal emergency declaration on COVID-19 is in effect. Unless state legislatures make the extension permanent, coverage will revert to two months when the emergency order is lifted.

Advocates of low-income women say expanding this coverage could reduce maternal deaths.

But the Republican legislature this year rejected a bill that would have allowed mothers to keep Medicaid coverage for a year after childbirth. When asked if it could save lives, House Speaker Phillip Gunn said “that wasn’t part of the discussions that I heard.”

Reeves’ office did not respond to an Associated Press request for comment on how his administration plans to deal with the recent closure of maternity wards.

Social services in Mississippi are already strained, which Dr. Daniel Edney, the state health commissioner, may be ill-prepared for the consequences of an additional 5,000 pregnancies being carried to term each year. Child Protection Commissioner Andrea Sanders said in September her agency may lack the staff to care for more foster children.

But in the Delta, providers and patients now have more immediate concerns as OB/GYN services are harder to come by.

Greenwood Leflore Hospital ceased operating an OB/GYN clinic across the street on October 15. The University of Mississippi Medical Center has agreed to operate the clinic, and the hospital is negotiating with UMMC for a long-term lease for the entire hospital.

A nurse at Greenwood Leflore Hospital who requested that her name not be used because she wasn’t authorized to speak about her employer wonders how the clinic is supposed to operate without a maternity unit nearby.

“It’s bad. We’re all shocked by her decision. What point would it make for her to have a clinic and then you have to drive 30-40 miles away?” the nurse said.

Two obstetricians have already decided to leave the clinic, according to Greenwood Commonwealth. At least one said the distance between the clinic and the nearest delivery unit was too great to bear.

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Michael Goldberg is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that brings journalists into local newsrooms to cover undercover topics. Follow him on Twitter at twitter.com/mikergoldberg.

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