Maternal health care faces challenges in Washington

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When Dwhani Patel gave birth to her son, she had to pay a lot of the hospital costs out of pocket — even though she had private insurance. On top of that, her employer gave her no maternity leave.

“I did have to pay a lot,” Patel said. “I really feel sad with the state of how maternity care works here in the United States.”

Though she managed to accumulate three months of paid time off thanks to saving her vacation and personal days, she was upset by the experience. Now, with what some are saying are threats to women’s health in the proposed Republican health care bills, Patel says she worries even more.

“That’s why the fear of having a second child is too much,” she said. “I just cannot think about how I will manage with work and everything.”

Patel is just one of many women who feel this way prompting Montefiore Medical Center to make maternal health a high priority. 

Last December, Montefiore released a community service plan explaining the hospital network would focus on improving women’s health over the next two years.

“We’re serving over 1,000 patients this year from all over the borough,” said Nicole Harris-Hollingsworth, assistant vice president of the office of community and population health. “People are quite excited about what we can do to improve the health of women and children.”

After looking over the data that brings to light the problems facing women’s health in the borough, Harris-Hollingsworth and her team worked with local neighborhoods and community organizations to decide the best course of action.

“We have a very high-risk population, including everything from social needs to having complications during pregnancy that require special care,” said Dr. Sharmila Makhija, chairman of the OB-GYN and women’s health department at Montefiore. 

The Bronx has the highest infant death rate out of the five boroughs, according to the Bureau of Vital Statistics. Between 2013 and 2015, for every 1,000 live births in Riverdale, four newborns died. Hispanic and African-American women are the most at risk when it comes to experiencing complications during pregnancy.

“Many people think that child health or death rates is something that only happens in other countries or Third World countries,” Makhija said. “But in fact, in the U.S., those rates are on the rise.”

Montefiore has 13 outpatient sites where pregnant women are given a priority when it comes to making appointments and seeing specialists, according to Makhija.

Mothers-to-be are given a complete overview of what tests will be performed as well as what the results will indicate, so they know they cannot skip appointments. Nutritional needs also are discussed to ensure women stay healthy.

 Even with these efforts, Makhija said it is difficult to prepare for what may happen with the introduction of a new Republican health care bill. 

In both proposed health care bills this year, there were cuts to federal funding to Planned Parenthood, a major resource for women’s health services. In 2015, 43 percent of Planned Parenthood’s revenue — about $550 million — came from the federal government, according to the organization. 

Abortion only accounts for less than 4 percent of Planned Parenthood’s services. On the other hand, the health care provider performs nearly 600,000 cancer screenings each year. From that testing, 70,000 women are diagnosed with precancerous lesions or flat-out cancer, Makhija said.

“The problem now with an already overburdened health care system is that they will shift the screenings back to us,” Makhija said. “That means my specialists, who would have focused on treating cancerous lesions are now having to perform screenings, making it difficult to provide better care for patients who are diagnosed.”

Along with the concerns of cancer screening, with cuts to Planned Parenthood there could be less access to birth control and other contraceptives. This could spark a rise in unintended pregnancies, Makhija said. 

Her patients already are feeling the threats of the proposed replacements to the Affordable Care Act. The uncertainty of what services will and will not be covered by insurance is a major source of concern.

“I think that uncertainty is causing more anxiety right now, and rightfully so,” Makhija said. “It’s a difficult situation to be in when you’re not sure what your health care is going to look like.”

Under Obamacare, insurers were required to provide coverage for maternity care. But under the latest proposed Republican bill, insurance companies could have decided for themselves whether or not they want to provide that coverage. 

The Senate stalled the coming vote on the bill because it lacked the votes to open debate, and it is unclear what step will be taken next by the lawmakers in Washington, although word early Tuesday was the Senate could simply vote to repeal the ACA without a replacement. But whatever happens,  Harris-Hollingsworth said support for women’s health needs to come from all sides.

“This is not what we could call ‘women’s work,’” she said. “It’s the work of families and men, everyone needs to be just as involved. We need to make sure that we’re looking at this from a larger perspective of people in the Bronx.”

Montefiore Medical Center, maternal health, Affordable Care Act, Bureau of Vital Statistics, Alexandra Hutzler

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