Industry leaders discussed initiatives aiming to improve maternal health outcomes at the 2024 Arizona State of Reform Health Policy Conference.
Rachael Salley, maternal child health/early and periodic screening, diagnostic and treatment manager at the Arizona Health Care Cost Containment System (AHCCCS), said the U.S. has higher maternal mortality rates than other countries, which she finds inexcusable due to the resources and financing available here. To assist with addressing the maternal mortality crisis, AHCCCS is reviewing policies regarding syphilis testing.
“In general, syphilis is another huge issue right now. According to ADHS [Arizona Department of Health Services], 213 Arizona babies were born with congenital syphilis in 2023, and 21 of them were either stillborn or died during infancy,” Salley said.
Syphilis-related deaths are preventable with testing and treatment, Salley said. AHCCCS is working to increase syphilis testing for non-pregnant people, as they already have a requirement in place to test pregnant people at their first prenatal appointment, during the third trimester and during delivery.
AHCCCS is also working on implementing an addition to prenatal care that is similar to CenteringPregnancy, which is an evidence-based holistic approach to prenatal care, and will offer group-based education and support.
“What we’re hoping to do is add another layer for our members to have more choice in their prenatal care, and hopefully make another dent in some of those birth outcomes,” Salley said.
Salley said mental health is the most common intervening factor for maternal deaths, and that screening for depression and anxiety needs to occur at least once during pregnancy as well as postpartum.
Individuals eligible for AHCCCS based solely on pregnancy status have been able to maintain coverage for up to one year postpartum since April 2023. Prior to that, they were able to maintain AHCCCS coverage for 60 days postpartum. Salley believes the COVID-19 pandemic was a driving factor for the Centers for Medicare and Medicaid Services to allow states the option to expand coverage for a full 12 months.
“Any covered service is available during this time. One of the reasons this is important is because when we see complications that don’t always happen during pregnancy … This is something that gives our most vulnerable people an extended period of time that they can have access to the physical or behavioral healthcare they need,” Salley said.
Shadie Tofigh, director of maternal and infant health initiatives at March of Dimes, said pregnancy-associated deaths doubled from 2017 to 2019, and 90 percent of those are preventable. Leading causes of these deaths include cardiovascular conditions, hypertension disorders, and hemorrhaging.
“We know infant mortality is also on the rise,” Tofigh said.
The original mission of March of Dimes was to eradicate polio, but it is now based on the needs of both mothers and infants, Tofigh said. To reduce preventable maternal health risks and deaths, the health equity gap must be closed, Tofigh said.