Pregnancy, no insurance don't mix, midwives say

May 4 2005

Being uninsured and pregnant in this country should be recognized as a risk factor for the health of the mother and baby, said the American College of Nurse-Midwives (ACNM) as the organization marked Cover The Uninsured Week (May 1-8, 2005). ACNM is troubled by how this condition – uninsured and pregnant – is severely impacting the financial well-being of taxpayer-financed health care programs, while solutions such as broader access to midwifery care are left unexplored.

According to a published report in the New England Journal of Medicine, uninsured pregnant women are 60% more likely to delay prenatal care, 3 times more likely to experience an adverse outcome following pregnancy, and 30% more likely to give birth to infants who die, require a prolonged hospital stay, or must be transferred to another institution for care. Research has also demonstrated that for every dollar spent on prenatal care, as much as $3.00 can be saved in complications after birth. And considering the long-term cost implications of potential physical and developmental disabilities, the savings could be dramatic and have a profound impact on the ability of health care systems to expand access to care.

“Uninsured pregnant women begin their prenatal care later, and that care is more sporadic, than women with private health insurance or Medicaid,” said Katherine Camacho Carr, CNM, PhD, president of the ACNM. “The result of that late start is that a potentially healthy baby could be at risk of being born prematurely, resulting in expensive technological interventions. There are extraordinary costs to that care, and society pays in the end, through increased up-front prices for services or higher insurance premiums.”

“It certainly goes without saying that this issue demands considerable attention by lawmakers on the federal and state level,” Carr continued. “The overwhelming financial burden associated with caring for the uninsured is threatening our existing taxpayer-financed systems of care. Policymakers need to explore ways to broaden access to midwifery care, which has been shown to reduce overall costs while improving health outcomes. By closing the gap in insurance coverage for pregnant women in this country, we can improve the health of mothers and newborns, while reducing costs for taxpayers overall.”

ACNM notes that the United States was ranked 27th in the world in infant mortality rates in 2000 – just one rank better than Cuba. In 2000, the United States infant mortality rate was 6.9 per 1000 live births. The United States infant mortality rate was more than 2 times higher than the infant mortality rate in Singapore (2.5 per 1,000 live births), the country with the lowest reported rate in 2000.

For more information about how midwifery care could help improve outcomes for mothers and newborns, visit www.midwife.org