Health Care

Missouri among worst nationally in maternal deaths. Reps. say no to study on issue

In the waning days of the legislative session, Missouri Rep. Sarah Unsicker stood up during a long stretch of floor action and urged her colleagues to establish a committee to study the state’s rising maternal mortality rate.

She reminded them that Missouri’s rate of deaths due to pregnancy and childbirth is one of the highest in the United States, a country with one of the highest rates in the industrialized world.

And it’s only getting worse.

After about an hour of debate, the Missouri House of Representatives voted down Unsicker’s proposal, 49-78. She said she plans to try again next year, but there are costs associated with every delay.

“We lose moms, of course, who are the center of the family, and we have adverse health outcomes for a lot of women in pregnancy,” the Democrat from St. Louis said in a phone interview Wednesday. “We lose family structure, and economically there’s a big burden to the state from women who die and the health care costs of taking care of this.”

Opponents of Unsicker’s proposal cited several concerns during the May 3 floor debate.

She was proposing the maternal mortality review committee as a floor amendment late in the session, without information about what it would cost, and there was confusion about whether Missouri already had a committee like the one she proposed.

Those questions could have been answered with a hearing on a similar bill that Unsicker introduced in January, but no hearing was ever scheduled. House leadership didn’t assign it to a committee until the session was almost over.

Missouri House Speaker Todd Richardson didn’t respond to an email seeking comment on the bill.

Unsicker said it was one of many bills introduced by Democrats that the House’s Republican majority pushed to the bottom of the stack. She said she would look for Republican co-sponsors heading into next year because the state’s maternal death rate is an issue that crosses partisan lines.

Missouri already has a Pregnancy Associated Mortality Review Board within the Department of Health and Senior Services that collects data and issues summary reports on maternal deaths in the state.

But Unsicker’s bill would have gone further. It would have established a 14-member committee comprised mostly of maternal health specialists to do a comprehensive review of maternal deaths every year, identify what factors caused them and make recommendations to the legislature for improving the health care system.

Unsicker said putting it in law would also make the committee more permanent and more likely to get federal grants.

Missouri ranks 42nd nationally with 32.6 pregnancy-related deaths per 100,000 live births, according to data published in March by the UnitedHealth Foundation, the nonprofit arm of the insurance company UnitedHealthcare.

That’s the same ranking as in 2016, but the rate is up from 28.5 deaths per 100,000 live births. The national average is 20.7, and Kansas ranks 22nd in the country at 17.7.

Randall Williams, the director of the Missouri Health Department and an obstetrician/gynecologist, said in a statement that more information about what kind of care the state’s expecting mothers are getting would be valuable.

“Along with heightened surveillance of maternal care and deaths in the state, increasing access to prenatal care and education for Missourians is a top priority of the department as another prevention method,” Williams said.

Tobacco use is one of many factors contributing to Missouri’s ranking. The state has one of the nation’s highest rates of pregnant smokers.

Large disparities in maternal mortality between white and black women exist nationwide, but the gulf is particularly wide in Missouri.

In an analysis released in March, Ravi Johar, the chief medical officer for UnitedHealthcare Community Plan of Missouri, found that black women face a maternal mortality rate of 65 deaths per 100,000 live births in Missouri, while it’s only 28 deaths per 100,000 births for white women.

Johar said many factors play into that disparity, including access to health care and educational and economic opportunities.

“Additionally, inequities in the level of medical care and gaps in patient safety for expectant black mothers play a role,” Johar wrote.

Infant mortality rates in the Kansas City metro area are also significantly higher for black and Latino children, according to a recent report from the Mother Child Health Coalition.

Unsicker said she was aware of the stark racial disparities but chose not to emphasize them in pushing for the maternal mortality review committee.

“I tried not to make that as much of an issue in the debate just because I didn’t want to alienate anyone,” Unsicker said. “I didn’t want to make anyone think, ‘Oh, well, it’s not a problem that happens in my community.’”

Under Unsicker’s original bill, the committee would have also studied severe health complications caused by pregnancy and childbirth. But she said she would drop that from future versions to lower costs.

By focusing solely on maternal deaths, she said, she believed the committee’s costs would be no more than $100,000 a year, out of a state budget of about $27 billion.

Unsicker, a mother of two, said that’s a worthwhile investment.

“I remember how difficult childbirth can be,” she said, “and knowing that women die from that is just terrible. I want to do something to help women.”