Health Policy Fellows - Kristin B Ashford

US maternal morbidity and mortality rates are on the rise. Maternal mortality is one of the key indicators of the health of a nation, and the US currently places at the bottom of all developed nations. According to the CDC, maternal mortality is defined as a death from a pregnancy-related caused within one year of delivery. Further up to 60% of these deaths are preventable. Improving access and extending health coverage can reduce maternal death and improve health, especially among racially and ethnically diverse women and women in low resource communities, where rates of maternal mortality are disproportionately high. State Medicaid programs pay for nearly half (42%) of all US births. Low income women below or up to 138% above the poverty level are currently eligible for healthcare through 60 days postpartum. Significant medical and behavioral complications that persist beyond this time contribute to increased maternal morbidity and mortality. Roadblocks and difficulty transitioning to alternative providers after the 60-day coverage period makes women less likely to seek health services for ongoing problems. Moreover, the COVID pandemic has further contributed to adverse maternal health conditions, primarily worsening mental health, increasing the urgency for extension of coverage. The postpartum period is also one of the most opportune times in a woman’s life to adopt health behavior changes. Leading national organizations, including the Association for Women’s Health and Neonatal Nursing (AWHONN) and the American College of Obstetrics and Gynecology (ACOG) define this period for as up to one year following birth, recognizing the need for continued medical and mental health support and treatment. Over the past decade, federal funding for maternal health has increased, though primarily focused on demonstration projects and bundles/grants (HHS, NIH). State and national projects and studies focused on providing services up to one year are cost effective and have resulted improved maternal outcomes. Despite increased funding, these types of approaches continue to be fragmented and slow to impact the most underserved. Further, women may not benefit from these projects based on their zip code. A bold, broad and meaningful approach to improve maternal medical and psychosocial well-being among the most disparate populations will reduce US maternal deaths and improve health of mothers, children and families. Legislation to extend Medicaid coverage from 60 days to one-year post birth will save lives and reduce healthcare expenditures. Coverage extension warrants being a national priority. This Robert Wood Johnson Fellowship will afford me the opportunity to be trained as a health policy expert and impact maternal child health equity.