Melissa Davlin 

Thanks so much for joining us this week. What does the latest report say about infant and maternal mortality rates? 

Ivy Smith 

Over the past few years, we’ve seen an alarming trend in maternal and infant health outcomes. We’re seeing an 18% jump in infant mortality rates and an 121.5% increase in maternal mortality rates. Among other troubling trends, such as low access to prenatal care for mothers in their first trimester and higher rates of low birth weight in preterm babies. 

Davlin 

What year did this report examine? 

Smith 

This year reports. This year’s report looked at 2019 to 2021. Unfortunately, with the effects of COVID on data collection, many of our sources of looking at this data are from many different years. So we tried to really look at the years we saw the most comprehensive data. 

Davlin 

With 2021, the first thing that pops into my mind, as you said, is COVID. And we know that there were documented increases in substance abuse and use, including alcohol, and documented increases in mental health crises. And then, of course, there were the direct health impacts of a COVID infection on pregnant women and fetuses and infants. 

Was there any correlation or any link that the report found between the increase in deaths and COVID in 2021? 

Smith 

Well, we weren’t able to point directly to COVID. We can make a few assumptions here and there because the main contributing factors that Idaho’s Maternal Mortality Review Committee’s latest report found was in maternal health trends, and specifically in maternal deaths. The top contributing factor was a lack of knowledge around the significance of their health event, their lack of access to care, and the financial resources they needed to receive treatment. 

Davlin 

When you say that, do you mean like symptoms of an infection or after effect of giving birth? 

Smith 

The MMRC, Maternal Mortality Review Committee, said that the top links in maternal deaths were surrounding mental health conditions, so this could be postpartum depression or other mental health conditions and infections. Yes. 

Davlin 

When we say mental health conditions, you’re also including deaths by suicide in the causes of death there. 

Smith 

Correct. This is their pregnancy-related maternal mortality ratio. 

Davlin 

How many of those deaths were preventable? 

Smith 

Unfortunately, in their latest report, they found that 88% of maternal deaths were preventable or treatable. 

Davlin 

What’s the difference between rural outcomes and the more metropolitan or urban areas of Idaho when it comes to those maternal mortality rates? 

Smith 

You know, what we’ve seen in terms of the rural areas using Medicaid as their primary form of payment during delivery, we’ve seen 30% of Idaho mothers have Medicaid at the time of delivery. And what’s really important here to explain is pregnancy is actually not a qualifying event for pregnant women. And what that means is if a woman doesn’t have health insurance when they become pregnant, they are not eligible to just go and sign up for a health insurance plan because pregnancy is not considered a qualifying event, making them have to wait for an open enrollment period. Which is why Medicaid becomes such an important piece of this conversation, because Medicaid doesn’t have open enrollment periods. Anyone who is eligible for Medicaid can sign up at any time. 

Davlin 

Is that a state policy or a federal policy? 

Smith 

For qualifying events? You know, I think it’s something that the state could explore, but I’m not sure what the federal implications would be. 

Davlin 

You’ve touched on this a little bit, but policy recommendations to address this rising maternal mortality death rate. What are some of the things that your agency, your organization would like the legislature to explore? 

Smith 

Sure. You know, we understand there are tensions rising around Medicaid. But what this boils down to is Medicaid is the public health system that low-income women and children have access to receive health care. It’s the system we have and it’s a system that we have opportunities to improve in. And truly, when we’re looking at our recommendations, what we are really thrilled to be working with the legislature on during this upcoming session is a comprehensive maternal and infant health package which includes raising income eligibility for pregnant women and children to access Medicaid and CHIP, and extending postpartum coverage to a full year, because as it stands now in Idaho, it ends at 60 days after delivery. And of course, reinstating Idaho’s Maternal Mortality Review Committee. 

Davlin 

Let’s start with the income eligibility. Why is that so important? 

Smith 

Right. So for raising income eligibility, Idaho is last in the nation in providing health coverage for pregnant women and children, meaning we have the lowest income eligibility criteria in the nation. And further, for pregnant women, it hasn’t been updated in Idaho since 1990, and for children it hasn’t been updated since 2004. So at Idaho Kids Covered, we believe it’s time for change, and if we don’t act now, these concerning trends will continue. 

Davlin 

And in that time, wages have risen. But cost of living has also risen substantially since 2004. 

Smith 

Sure. And income eligibility is set by a percentage. So in Idaho, for pregnant women, it’s 138% of the federal poverty line, which does get adjusted for inflation. But what that looks like in Idaho is for a pregnant woman, she has to make less than $34,000 a year to qualify. 

Davlin 

When we’re talking about postpartum care coverage, extending a year after birth, what does that care look like for people who haven’t had babies before? 

Smith 

So the government entity that reviews every maternal death in Idaho, the Maternal Mortality Review Committee, what they found in their latest and unfortunately last report is that about 56% of the maternal deaths happened 43 days after they gave birth. And typically in conditions such as postpartum depression, which we are above the national average currently, those effects can take hold later on than immediately after birth. They happen later on. And same thing with infections.  

And truly, when we are looking at expanding to a full year, we’re able to capture women who may need access to care later on. And if we try to boil it down for those who haven’t been pregnant before, at 60 days, you’re dealing with trying to raise your newborn baby and making sure they’re going and getting their checkups and appointments, and frankly, your needs take a backseat. And so to try to get the health care you need in those 60 days is really difficult, especially when we consider the statewide provider shortages we’re seeing in our state. 

Davlin 

Let’s touch on that a little bit, because I think a lot of the conversation in the last year and a half surrounding provider shortages has focused on Idaho’s abortion trigger law that went into effect after Roe v Wade was overturned in 2022. To be clear, this report looks at data from 2021, before that went into effect. 

Smith 

Correct. Yes. 

Davlin 

And none of your policy recommendations have anything to do with that abortion law? 

Smith 

Correct. 

Davlin 

Let’s talk a little bit about that maternal mortality review panel. After that review committee sunsetted in July, Idaho is now the only state without a review committee. The legislature was hesitant and ultimately did not renew that and the committee was disbanded. 

Is this something that the private sector and hospitals could get together and do themselves without the legislature working on it? 

Smith 

Unfortunately, I don’t see how the private sector could get involved because this information, this data is protected. It’s under the Department of Health and Welfare, they hold this data. They were able to share that with the committee due to the legislature enabling this committee to do so. So without legislature’s action to reinstate this committee, the private sector just wouldn’t be able to get involved. 

But we should all be asking ourselves going forward in looking at this report, seeing all of these alarming trends: How are we supposed to make sound policy solutions that meet the unique needs of Idahoans, if we don’t have Idaho specific data anymore? 

Davlin 

You mentioned trying to increase Medicaid coverage for pregnant women and making pregnancy a qualifying event to sign up for Medicaid. This legislature is very hesitant to do anything to expand existing Medicaid programs and is looking at reining a lot of those costs in. How do you sell this to lawmakers, considering that hesitancy? 

Smith 

Sure. I’ll say this. Every maternal and infant life in Idaho is precious and valuable. We have to do all that we can to ensure the health and safety of our mothers and children in our state. And if by raising income eligibility, by expanding postpartum coverage, we can ensure that more mothers and children have access to the lifesaving care they need when they need it. 

Davlin 

Have you started having those conversations with lawmakers already? 

Smith 

Absolutely. And we are very thrilled to be working with them during the upcoming session on what we know is a top priority for all Idahoans, the health and safety of Idaho moms and their babies. 

Davlin 

How are those conversations going? Are you optimistic? 

Smith 

I’m optimistic. We’re having really great conversations. And truly, I think we all know right now this is a top concern and we want to ensure that moms and babies get the healthy start in life that they deserve. 

Davlin 

All right. Ivy, thank you so much for joining us. 

Smith 

Thank you.