Maternal Mortality: A Hoosier Crisis

The number 39 represents a significant statistic in Indiana. It is a number that many healthcare professionals say could be zero or at least significantly less— but it is not.

39 refers to the number of mothers who died from pregnancy-related complications in 2017, the latest year on record with the Indiana State Department of Health. According to America’s Health Rankings by the United Health Foundation, in 2018, 7.4 infant deaths occurred per 1,000 live births in Indiana compared to 5.9 infant deaths per 1,000 live births that occurred nationwide.

According to research done by Indiana’s Maternal Mortality Review Committee, 63 percent of all pregnancy-related deaths are preventable, meaning a majority of mothers who’ve died would still be alive had we had a better healthcare system in place.

Amy Meek is a Registered Nurse and Program Manager at IU Health Bloomington Hospital and she is on the frontline of Indiana’s battle against maternal mortality. Meek cites access to care facilities and transportation as two of numerous reasons for Indiana’s high maternal mortality rate.

Meek works in Monroe County and four others that she said are a lot more rural, like Orange and Owen counties for examples.

“Where there’s an issue is maybe you get outside of Monroe County, you get into our rural areas, where people don’t have transportation, no bus system, things like that,” Meek said.

According to Indiana Public Media, 27 percent of Indiana counties are maternal care deserts, meaning they do not have a single hospital or clinic.

State Sen. Jean Leising, R-Oldenburg represents Franklin, one of 27 counties without a hospital in Indiana. Leising said Fayette and Rush counties, both in her district, have hospitals but not obstetrics, meaning mothers have to travel outside of their counties for pregnancy-related treatment.

Rural moms’ lives are being put at risk due to the combination of lack or limited access to care and a lack of transportation. This is why Meek and her colleagues are trying to remove some of the hurdles that make pregnancies challenging for them.

Leising said she supports transportations initiatives because some of her constituents have to travel more than an hour in some cases in order to receive proper care.

According to a study conducted by BMC Health Services Research, distance matters. The study found that women who have to travel more than an hour for maternity services have increased chances of pregnancy complications or possibly death. However, according to Meek, there is a way around the transportation dilemma that many mothers are unaware of.

“A lot of times, moms have benefits with their insurance that they don’t know about,” Meek said. “So a lot of their Medicaid plans will pay for transportation to and from treatment, to and from providers, and there’s just a lot of benefits to their program and they usually don’t have any idea that they have them.”

This problem of being unaware of benefits is not limited to rural mothers. Meek said Indiana moms are generally uneducated or misinformed when it comes to the subject of birth. Perhaps one reason for that could be that according to Guttmacher Institute, roughly half of all pregnancies in Indiana were unplanned in 2011.

Unintended pregnancies mean that mothers are not aware of their preexisting conditions and do not have a treatment roadmap in place to properly anticipate complications. According to the Centers for Disease Control and Prevention, nearly 50-percent of mothers that experience an unintended pregnancy, nationally, do not seek prenatal care during the first trimester.

Without proper planning and foresight, moms can miss vital and lifesaving information relating to insurance and their general wellbeing.

“That’s one piece, just educating the mom about the insurance that they have, so first getting them insurance, if they don’t have it,” Meek said. “And then educating them about what comes with that, not just your doctor visit but there are other parts to that insurance plan that can help you with treatment.”

Education, for Meek, is an important strategy for combatting the Hoosier State’s problem with maternal mortality. She said she wants to start educating future mothers and parents about their options and also create more programs for schools.

Meek advocates for a bottom-up strategy.

“It’s how we impact infant mortality and maternal mortality,” Meek said. “We start teaching young people about health and not just health in today but how it affects them over a lifetime, how it affects their mortality when they do decide to have babies.”

At least 24 of 39 mothers who died in 2017 should still be alive, according to Indiana’s Maternal Mortality Review Committee. The committee was started in 2018 with Senate Bill 142 and served as the legislature and Gov. Eric Holcomb’s response to the maternal mortality crisis in the state.

Leising was an author of SB 142 and said she is hopeful about what will come out of the committee. She said she knows that her colleagues on both sides of the aisle as well as the governor are committed to resolving the issue of a high maternal mortality rate.

The committee is expected to be funded through 2023 but Leising said there is no reason to wait that long to act and that in fact, some of the committee’s findings have already been used to implement programs and policy.

“I don’t think we’ll have to wait 5 years to do something about this,” Leising said.