When the Department of Health and Human Services (DHHS) asked North Carolina how it could help improve maternal health issues, the agency got plenty of feedback from caregivers, patients, administrators and health care advocates who came to the state Division of Public Health offices on Jan. 27.
“We need to hear from all of you in order to help us do our jobs,” said Tom Engels, administrator for the federal Department of Health and Human Services’ Health Resources and Services Administration. “We’re here looking for ways to improve.”
Engels’ office is responsible for improving health care access for those who are medically vulnerable and have economic challenges in isolated areas. In North Carolina, many individuals who fit this description live in rural areas, but that’s not the only space. Some are also in the urban and suburban areas. Topics discussed in a panel discussion throughout the event included prominent racial disparities in the state’s infant mortality rates, maternal death rates in the weeks and year after childbirth,
Mandy Cohen, the state secretary of health and human services, has assigned task forces, commissions and others to develop plans for closing the gap. Health care advocates involved in creating those plans are working to create a stronger safety net for black women and children and finding more ways to support women in rural North Carolina who struggle financially.
Providing top-notch care for incarcerated pregnant women, providing coverage and care for women throughout the fourth trimester, and a new focus on Long-Acting Reversible Contraception, which was controversial. Some questioned whether family practitioners could help to solve some of the issues discussed.
While the state is closing obstetrics units, many women might be able to find help through local health department facilities, but they will have to travel to find a hospital to give birth.
Greg Griggs, executive Vice President and CEO of the North Carolina Academy of Family Physicians, has said that almost 30 percent of rural primary care physicians practice obstetrics around the country, but that’s just 11 percent of doctors in North Carolina.
The wishlist for steps to improve health care include increased funding and focus on programs to reduce maternal mortality, especially those that can help reduce the racial disparities; Medicaid coverage of doulas, particularly in rural counties, where they can help advocate for pregnant women and new mothers; and better collection, streamlining of and use of data that can highlight successes and expose deficiencies.