The COVID-19 pandemic, which has disproportionately affected communities of color in South Carolina and around the nation, has highlighted the racial disparities that continue to permeate our state’s health care system. And while we may finally be turning a corner in our battle against the pandemic, we must continue to work toward uprooting underlying racial health inequities — including in maternal and prenatal care for South Carolinians who rely on our state’s Medicaid program to stay healthy.
Data from the Centers for Disease Control and Prevention show that the maternal mortality rate for black women is more than twice that of white women nationally. The black infant mortality rate also remains double that of non-Hispanic white infants. These disparities stem not only from inadequate post-pregnancy coverage and care but also inadequate prenatal care.
One critical component of prenatal care is screening tests that allow expectant mothers to identify genetic disorders in their babies. Testing options include traditional serum or combined screening as well as newer options, such as noninvasive prenatal screening tests that use a mother’s blood sample to analyze a baby’s DNA.
Because noninvasive prenatal screening requires only a blood sample, these tests are safer than traditional screening methods and pose no risk to the fetus. Additionally, these tests have been proven to provide far more accurate results than traditional screening methods. A 2015 study published in the New England Journal of Medicine showed that 21% of Down syndrome cases in pregnancies were missed with traditional screening, while noninvasive prenatal screening tests had a 100% success rate for detecting Down syndrome. The same study showed that older screening methods resulted in 95% increase in false positive results for common chromosomal abnormalities, causing undue stress on expectant mothers, as well as unnecessary referrals to specialists for further diagnostic or invasive testing.
Noninvasive prenatal screening is clearly the safer and more accurate option for mothers. The leading medical societies representing physicians who treat mothers and expectant mothers — including the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine — recommend noninvasive prenatal screening tests for all pregnant women as part of their prenatal screening guidelines. But while most private insurers cover these noninvasive tests regardless of risk factors, South Carolinians who receive medical benefits from Medicaid remain limited in their ability to access them.
Currently, only mothers deemed “high-risk” — meaning that they are over 35 years of age, have had a prior pregnancy with a trisomy or have had an ultrasound that indicated an increased risk of an abnormal number of chromosomes — are eligible to access these safer and more accurate tests. Further, even for those few expecting mothers who can access the noninvasive tests, South Carolina Medicaid has introduced another bureaucratic hurdle — prior authorization — which further delays access to critical care. With more than 50% of the our state’s Medicaid recipients identifying as black or Hispanic, once again communities of color find themselves at a disadvantage, unable to access medical services recommended by doctors.
Increasing accessibility to safer and more effective prenatal options, including noninvasive prenatal testing, for all mothers is one critical step we can take to address the racial disparities in our health care system. Public officials in Columbia — who themselves can receive noninvasive testing for any pregnancy through their health care provider PEBA — must take concrete steps that ensure all women in our state, including those who receive Medicaid benefits, have access to the safest and most accurate prenatal screening options.
State Rep. Patricia Moore Henegan represents District 54, which includes Chesterfield, Darlington and Marlboro counties. She is chair of the S.C. Legislative Black Caucus.