The Nebraska Legislature’s Health and Human Services Committee heard testimony on LR154, introduced by State Senator Jen Day (District 49) to examine maternal care deserts in Nebraska and to highlight this critical issue in our state. State senators heard how insufficient maternity care options and lack of timely maternal and child health data lead to adverse outcomes for Nebraska mothers and their babies.
Maternity care deserts are counties in which access to maternity health care services is limited or absent, either due to lack of services or barriers to a woman’s ability to access care. According to the March of Dimes, over 50% of counties in Nebraska are considered maternity care deserts, which is significantly higher than the national average of 32%.
Dr. Bob Rauner
Dr. Bob Rauner with Align Nebraska said Nebraska does not perform well compared to many other states when it comes to infant mortality, and our trend is getting slightly worse over time. To improve that rate, we need to improve our rates of adequate prenatal care in Nebraska. He told state senators there are a multitude of barriers to receiving prenatal care, including distance to health care services. He said birth data show that the lowest rates of adequate prenatal care are in three locations in the state: urban low-income and minority communities, Indian reservations and any county with a meat-packing plant.
Lack of current data
Accurate data is key to making decisions to help reduce maternal care deserts, but a lack of current data is a problem in the state, said Dr. Rauner. “We cannot fix a problem like this with data that is years old.”
We can improve rates of adequate prenatal care across Nebraska, which would save the lives of pregnant women and babies, but we need better access to timely data, said Dr. Rauner. “At the present time, the best we can do is two-year-old data that we can only access via the Centers for Disease Control.” Rauner said producing the data quarterly is feasible, and is already being done by the health department in Lincoln.
Challenge not insurmountable
While the challenge of maternal care deserts for moms and babies is substantial, it is not insurmountable. The Nebraska Legislature could play a significant role in improving access to care. Some policy solutions for this problem include:
- Ensure every mother has adequate access to postpartum care coverage for up to a year, including mothers covered for their prenatal care by the Children’s Health Insurance Program in Nebraska;
- Expand access by ensuring Medicaid coverage of alternative care models such as centering pregnancy or midwifery care;
- Reimburse doula care and the services of lactation consultants;
- Provide coverage for evidence-based telehealth services for pregnant and postpartum women (of note: Nebraska provides Medicaid coverage for live-video telehealth, but not for audio-only);
- Increase loan repayment opportunities for health professionals working with mothers and babies if they choose to serve in maternal care deserts;
- Improve transportation services and coverage;
- Ensure the payment for services meets the actual cost of care;
- Support postpartum service models, such as evidence-based home visiting;
- Improve data collection, aggregation and release to ensure accurate information is used to inform policy;
- Address the social determinants of health to reduce disparities by ensuring every provider in the state is trained in implicit bias.
