New data show opportunities to improve women’s health care

July 30, 2024

The Commonwealth Fund’s new analysis of women’s health care shows large differences among US states, and documents characteristics of states with better health outcomes for women. 

The report found that mental health issues were the most common cause of maternal death, which included deaths from overdose and suicide. They also found large increases in cases of congenital syphilis, which can be easily cured if diagnosed early in pregnancy. Congenital syphilis increases risk of infant mortality, and children born with syphilis can suffer permanent congenital abnormalities, even if treated at birth.

Characteristics of states with good maternal outcomes generally had high insurance rates, more prenatal care, and more postpartum visits. They also note that state perinatal quality collaboratives, like the California Maternal Quality Care Collaborative, help improve hospital care.                                                                                                                                                                                                                                                               

Here are a few of the charts from this report:

1. All-cause mortality is highest in the Southeast

Deaths per 100,000 women between ages 15-44

Source:  Collins, et al KFF, July 18, 2024 LINK

The researchers noted that many of the states with high maternal mortality had many rural counties with no maternity providers. The states with the highest maternal mortality rates have rates similar to those in developing countries like Indonesia or Yemen. Fewer obstetricians remain in states which have enacted abortion restrictions.

2. Low risk cesarean section deliveries are most common in the East
   

   Low risk cesarean births as percentage of total deliveries

   

   Source:  Collins, et al KFF, July 18, 2024 LINK

3. Maternity providers are in shortest supply in states which have restricted abortion

   

   Source:  Collins, et al KFF, July 18, 2024 LINK

4. Syphilis rates are increasing in almost all states

   

   Source:  Collins, et al KFF, July 18, 2024 LINK

   Implications for employers:

   -        Encouraging early prenatal visits can improve pregnancy outcomes and allow early diagnosis of syphilis. People with high deductibles are more likely to delay their prenatal care.

   -        More prenatal care is also associated with better screening for peripartum depression, a major cause of adverse maternal and infant outcomes.

   -        Employers can ask for reporting from medical carriers on maternal complications and low risk Cesarean sections, and can request that employers include information on provider performance in member directories and consider this information when they provide navigation.

   -        Employees in states with fewer medical resources might need employer support to travel for reproductive care. However, traveling long distances for delivery is not practical for most expectant plan members.

   Here’s a link to a more complete guide to what employers can do to improve childbirth from Harvard Business Review.

   
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   Tomorrow: COVID vaccines decreased incidence of Long COVID