LOUISVILLE — Carol Johnson, administrator of the Biden Administration's Health Resources and Services Administration, visited Louisville on Thursday to discuss ways Kentucky can improve maternal health outcomes.
After moderating a roundtable discussion on the topic, Johnson spoke to The Lantern about the maternal and child health issues facing Kentucky. The conversation has been edited for length and clarity.
Kentucky Lantern: Maternal health issues are very complex and very interconnected, but have you ever been in a situation in your work where there was one issue that was like a domino effect, so to speak, and if you could address that issue, the others would fall into place?
Carol Johnson: This is a longevity issue. And that's why we're taking this seriously: We have to support women of reproductive age in our communities. We have to make sure our clinical environments are as high quality as possible and prepare for complications. We have to have systems in place to get people prenatal care and postnatal care as early as possible.
We have to understand that parenting is hard and make sure people get the support they need, and we also have to address issues like maternal depression, so we see it as a continuum.
When it comes to health policy issues, we tend to think, “So what happens inside the four walls of the clinic?” But this isn't about that. This isn't about that, but about all the other ways we ensure the health of pregnant women and new mothers.
KL: I know Kentucky is not unique, but in Kentucky, many of the maternal health statistics affect Black women and other women of color more than white women. Does racism play a role in driving that fact, and if so, how do you address racism in your policies?
CJ: What we know is that the data shows that Black and Indigenous women are two to three times more likely to die than white women, and these disparities persist even when you take into account factors like education and income. So there are systemic issues here that we need to address, and part of it is clearly about access and being heard in the health care system.
As we hold these roundtables across the country, we hear again and again that women's voices are not being heard. Women know when something is wrong or when they need something, but their voices are not always heard.
It's important to center this work on women's experiences, which is why we do things like investing in community-based doulas so women can become advocates and have a voice in the health care system. Especially during pregnancy, women should be focused on taking charge of their own health, not fighting for the access and services they need.
That's why we're investing in more midwives. That's why we're investing in more[obstetricians]who come from the communities that we want to support. That's why we're so focused on what access looks like. And access isn't just checking a box on a map, it's trusted community providers who are actually listening to and supporting women's needs.
KL: Over the past few years, there has been a bipartisan debate in Kentucky about whether to pave the way for free-standing birth centers. Does that tend to help maternal mortality statistics?
CJ: Depending on the scope of services offered by a freestanding birth center, different levels of discussion can arise.
If there are independent birth centres in places where maternal health is poorly served that can cater for less complicated births, we should consider doing so.
In too many counties across this country, access to maternal and child health services means a long drive and a trip to a local hospital emergency room that may not be equipped with the preparations or strategies needed for the healthiest births.
KL: Part of our discussion revolves around concerns that local hospitals may lose revenue as a result of patients choosing to go to alternative facilities. Do you generally see that as a problem?
CJ: I actually think rural hospitals can think creatively about what kind of partnerships they can develop in their communities, so I don't think it has to be an either/or question as to whether we can think about partnerships that allow rural hospitals to be part of the solution.
HRSA Roundtable in Louisville (Kentucky Lantern photo by Sarah Ladd)
KL: We've heard a lot about mental health and substance use disorders today. How important is it to talk about mental health when talking about maternal mortality?
CJ: Mental health and substance use disorders are the leading causes of maternal mortality, and the data clearly shows that approximately 80% of maternal deaths are preventable. This is a call to action for all of us to address maternal mental health and substance use disorders.
It's really sad that there is still stigma surrounding these issues. Often, women think that when they become pregnant, they have to become superwoman. We need to lower the barriers to accessing mental health and substance use disorder support and services.
We're fighting right now in Washington, DC, to make mental health and substance use disorder a required service in primary care settings. Because that's what we should do. We need to make it part of the equation. We don't want to be in a situation where someone raises their hand for help and all they get is a referral that says, “Call these numbers and see if you can get someone.”
KL: A key aspect of Kentucky's mumnibus bill that passed this year is that the state made pregnancy a qualifying condition for insurance coverage. How important is it to have insurance and to have prenatal care?
CJ: One of our proudest accomplishments as the Biden-Harris Administration has been bringing health insurance to more people.
It's critical that we do that, and we'll do everything we can to help people get insurance, and we need to make sure that there are places where they can use their insurance card, and that the places where they can use their insurance card are quality places.
Coverage is important, but it's not enough. We need more coverage.
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