Expecting mothers in Alabama — particularly mothers of color — faced dual crises this past year: potential exposure to a deadly virus alongside ongoing disparities in access to the quality prenatal and maternal care needed during pregnancy.
And as COVID-19 disproportionately impacted communities of color across Alabama and shined a light on the racial disparities that continue to plague our healthcare system, we must address these systemic inequities. These inequities are especially stark in our state’s maternal and prenatal healthcare outcomes — issues that I have long championed.
In fact, just this session, I introduced and sponsored House Bill 431, which aimed to extend postpartum coverage for eligible pregnant women who receive their health care benefits through Medicaid for up to a year after birth — but there is certainly more that we can and must do.
Data collected by the Centers for Disease Control (CDC) shows that the mortality rate for Black women during childbirth is more than double that endured by white women nationwide. On top of this, the Black infant mortality rate is also two times that of non-Hispanic white infants. These differences stem from inequities experienced during post-pregnancy coverage and care, but unfortunately, disparities in coverage begin to appear at the earliest stages of a pregnancy. Focusing on their root causes during this prenatal care period is among the best first steps we can take down the road toward eliminating racial disparities.
An especially critical component of prenatal care includes the screening tests that allow expecting mothers to identify genetic disorders in their babies. These tests range from the traditional serum method or combined screening to newer options like noninvasive prenatal screening tests (NIPT), which use a mother’s blood sample to analyze their baby’s DNA.
NIPT analyzes the DNA in a pregnant women’s blood to detect genetic abnormalities in the baby and have proven to be safer and provide more accurate results than traditional screening methods. In one study, 21% of Down Syndrome cases were missed by traditional tests, compared to a 100% accuracy rate with NIPT. Older testing methods also resulted in a 95% increase in false positive results for common chromosomal abnormalities, prompting more unnecessary tests and creating unneeded stress during what’s already a stressful time for women and their families.
Top maternal and prenatal care physicians and medical societies like the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) already recommend NIPT for all pregnant women as part of their prenatal practice guidelines. These recommendations, however, don’t match the reality on-the-ground in Alabama, where many Alabamians who rely on Medicaid remain limited in their ability to — or go entirely without — access to NIPT.
Today, only mothers in Alabama deemed “high-risk” — meaning that they are over the age of 35, have had a history of a prior pregnancy with a trisomy, or have had an ultrasound that indicated an increased risk for an abnormal number of chromosomes — are eligible to access NIPT, leaving the majority of expectant mothers covered by Medicaid without access. The few who qualify for NIPT access face additional hurdles, such as prior authorization requirements, which only further delays their access to care. And with nearly half of our state's Medicaid recipients identifying as Black or Hispanic — and furthermore nearly half of all annual births in Alabama covered by Medicaid — communities of color find themselves again at a disadvantage, unable to access crucial services recommended by providers.
Our policymakers in Montgomery must continue to address the persistent racial inequities in our healthcare system. We can start by increasing accessibility to the safest and most accurate prenatal and maternal care options available for every mother in Alabama.
State Rep. Laura Hall represents District 19, which includes Madison County, and serves as the Ranking Minority Leader on the Health & Ways and Means General Fund Committees.