News and Tribune

November 11, 2013

HAYDEN: The government’s role in healthy babies

Indiana would be wise to follow Texas’ lead

By MAUREEN HAYDEN
CNHI Statehouse Bureau

INDIANAPOLIS — Indiana Gov. Mike Pence opened the state’s Infant Mortality Summit last week by sharing a personal story: He and his wife had struggled with infertility issues early in their marriage, so the eventual arrival of their three children was met with deep gratitude and appreciation.

“Anybody who knows me, knows I have Ph.D. in ‘Dad,’” he said.

Pence went on to promise his audience of public health officials that a key goal of his administration will be to reduce the number of babies in Indiana dying before their first birthday.

It’s an ambitious goal. Over the last decade, Indiana’s has dropped from 32nd to 45th in the nation in infant mortality rates. A ranking that Pence called “deplorable.” There are multiple causes for the state’s high rate of 7.7 deaths for every 1,000 live births, with many linked to the state’s poor overall health and the lack of access to health care.

A majority of babies less than 1 year old die due to complications related to birth defects, premature births or a mother’s weight, age or illness. More Hoosier women smoke while pregnant — almost 17 percent in Indiana versus 9 percent nationally — and they’re more likely to obese.

Indiana mothers are also less likely to breast feed; more likely to sleep in the same bed with their infants, putting babies at risk for suffocation; and increasingly likely to have doctors who are electing, for convenience rather than medical need, to deliver babies before they reach full term. Also: more than one-third of pregnant women in Indiana don’t get any prenatal care during the critical first trimester.

“Indiana is consistently one of the worst in the U.S.,” said Indiana Health Commissioner William VanNess. “It’s not that a lot of good people haven’t worked on this, but we haven’t been able to stop the heartbreak.”

VanNess’ efforts to elevate the issue are critical, since it will take an infusion of resources to make an impact. So far, both Pence and the Indiana General Assembly have been averse to expanding health care coverage to the uninsured, and have worked to prevent Medicaid dollars from going to women’s health clinics like Planned Parenthood because they also provide abortions.

Some advice for how to handle the politics of infant mortality was offered by another summit speaker: Texas health commissioner and Indiana native Dr. David Lakey, who told the audience: “We have a moral obligation to confront this issue.”

To do so in his state, he had to convince conservative lawmakers to restore the funding for primary health care for low-income women that was slashed as part of a bitter battle to remove abortion-affiliated providers, namely Planned Parenthood, from the state’s health program.

Earlier this year, the Texas legislature agreed to do so, by offsetting the impact of those cuts with the largest financial package for women’s health services in state history, increasing spending by more than $100 million. The state plans to spend 60 percent of its primary care expansion dollars on family planning services, and provide wraparound benefits, including prenatal and dental care for pregnant women, which are not covered by other public programs.

Lakey said Texas legislators were persuaded to restore the funding in part by an economic argument: Nearly 60 percent of all births in Texas are paid for by the state’s Medicaid dollars, and the average cost to the state Medicaid program for a prematurely born baby is $71,000.

What also worked: Lakey convinced Texas legislators that reducing infant mortality was a noble cause that would appeal to voters back home.  

“I don’t think there is a cause that can line folks up better than to talk about increasing the chances that every baby born in your state will have a healthy, happy first birthday,” Lakey said. “Who can argue that’s not a role government should play?”

— Maureen Hayden covers the Statehouse for the CNHI newspapers in Indiana. She can be reached at maureen.hayden@indianamediagroup.com