There has been more stress on Washington reproductive and maternal care facilities—and providers—since the US Supreme Court (SCOTUS) decision that overturned Roe v. Wade in June 2022. Those impacted by the decision discussed the challenges they—and those seeking services—face during the 2024 Washington State of Reform Health Policy Conference.
Lee Che Leong, senior policy advocate at Northwest Health Law Advocates, said 14 states have enforced total abortion bans since then, while seven states have set restrictions on them that would’ve been found unconstitutional prior to the SCOTUS decision.
“The landscape has changed dramatically in the US since (then),” Leong said. “We’re very fortunate in Washington to be one of 22 states, and the District of Columbia, that have enacted 129 measures to protect abortion access, as of the middle of last December.”
The lack of available services in states that have implemented bans has made it necessary for those in need of services to travel to other states. Interstate travel for abortion has doubled since the SCOTUS decision, and nearly one out of every five people who obtained an abortion crossed state lines to do so, Leong said.
“Meanwhile, abortion has actually increased in the US since the overturn of Roe,” she said. “In Washington, there were over 20,000 abortions in 2022. That’s 3,800 more than there were in 2021. And we are a very important provider for some neighboring states.”
Washington is one of only six states with a shield law in place, Leong said, which means healthcare services like abortion and gender-affirming care are protected in the state.
“Providers and patients from out of state are shielded from out-of-state prosecution, and it restricts Washington businesses, courts, and law enforcement from complying with prosecutions from other states,” she said. “Last June, Planned Parenthood of Greater Washington and North Idaho shared that at their 11 clinics, the out-of-state patients increased by 36 percent. Patients from Idaho, specifically, increased by 56 percent.”
The changing reproductive care landscape has also led to a greater need for maternity services in the state. Last June, Washington’s Apple Health (Medicaid) program expanded postpartum coverage to provide one full year of coverage following a pregnancy no matter how that pregnancy ends, Leong said.
“This coverage is available to all Washingtonians up to 193 percent of the federal poverty level. Citizenship is not required.”
— Leong
Molly Firth, clinical instructor of health systems and population health at the University of Washington, said more than two people die per day from causes related to childbirth.
“And that is not what we’d like to see in a country like ours,” Firth said. “Washington is doing better, but we’re by no means perfect. We have some work to do. We have disparities.”
Jazmin Williams, founding member of the Doulas 4 All Coalition, said the coalition formed in order to address maternal health disparities, specifically those impacting Black and Brown people.
“It started from speaking on behalf of Black and Brown people, which we know are going to be the most impacted in using Medicaid to connect to doula support,” Williams said.
The coalition helped gain support that led to the passage of House Bill 1881 in 2022, which established a pathway to certification for birth doulas and Medicaid reimbursement for services. The bill is crucial for historically marginalized communities as well as members of the LGBTQ community.
“We worked really hard to make sure we had queer, trans, (and) BIPOC doulas at the forefront (to) speak on behalf of ourselves (and) our community. We wanted to make sure we had a model that was going to be equitable for BIPOC communities, and to build up our workforce. For a lot of medical providers, especially midwives and doulas, we don’t get past the fifth or sixth years in practice. We burn out and go into other professions. So we needed to look at what was going to be sustainable for us and keep us in practice.”
— Williams
The bill has provided different pathways for doulas to come into practice, Williams said.
“Having a voluntary, competency-based model has also made it so any organization that says they have a doula training now needs to meet certain competencies that show they can support the BIPOC, queer, and trans community,” she said. “Not just them coming in and setting the standard for what a doula needs to be. In terms of our reimbursement model, we looked at other states, primarily in terms of what they did wrong. A lot of them did not have doulas at the forefront to be able to say, ‘What is our market rate?’”
Dr. Demetria Malloy, chief medical officer and health officer at Community Health Plan of Washington, discussed ways to mitigate negative maternal health outcomes. One solution is to ensure that provider/care teams are expanded so members can follow up with the birthing person and their family to answer questions in between clinic visits and encourage a follow-up clinic visit. It is also important to screen for postpartum depression and anxiety, she said.
“There’s a lot of maternal morbidity following (childbirth),” Malloy said. “There are a lot of support members on the team that can still follow-up after the main event. There’s still a lot to deal with; breastfeeding, coaching and support, lowering incidences of sudden infant death syndrome, which is higher in Black and Brown communities. There’s a lot of support that can be built in to help the birthing person directly.”