Kentucky has one of the highest mortality rates for pregnant people in the nation and advocates are calling on state lawmakers to help address the problem.
During a meeting of the Kentucky Senate Health Services Committee on Wednesday, experts said mental health disorders and substance abuse are growing factors that lead to maternal deaths in the state.
Dr. Jeffrey Goldberg, state legislative chair for the American College of Obstetricians and Gynecologists, said the new factors are adding on to typical causes for pregnancy-related deaths like preeclampsia or infection.
“Maternal mental health is playing a major role in maternal deaths, particularly suicides,” he said.
According to a report from the Kentucky Maternal Mortality Review Committee, a state panel that reviews pregnancy-related deaths, 91% of maternal deaths in 2018 were "potentially preventable."
The report found that 8.4% of maternal deaths are suicides and 128 "accidental" deaths weren’t clearly attributed to physical health complications.
The number one reason for hospital readmissions among Medicaid patients within three months of giving birth is suicidal ideation.
Kentucky has strict criteria for what qualifies as a suicide, Goldberg said, and it’s very likely accidental deaths had a component of self-harm.
The report also found that substance use disorder was a contributing factor in two-thirds of maternal deaths.
This isn’t new
Kentucky’s maternal death rate is double the nationwide rate, with nearly 40 deaths per 100,000 live births, according to data from the Centers for Disease Control and Prevention.
In 2017, 46% of maternal deaths in the state were related to substance use disorder.
Goldberg called on the legislature to mandate improved quality and safety in healthcare institutions, and participate in Alliance For Mental Health programs to focus on improving maternal mental health outcomes.
He also said there needed to be more interventions during prenatal and postpartum periods.
But the discussion didn't include access to abortion, which is outlawed in Kentucky except in medical emergencies. Those emergencies don't include mental health emergencies.
Sen. Shelley Funke Frommeyer, a Republican from Louisville, said freestanding birthing centers could be considered part of the solutions to reduce maternal deaths.
“We have wonderful hospital opportunities but we could also see those outcomes in birthing centers,” she said.
Rep. Jason Nemes, a Republican from Louisville, filed House Bill 129 to remove the certificate-of-need requirement for birthing centers. Frommeyer filed a companion bill in the Senate.
Sen. Donald Douglas, a Republican from Nicholasville, said deaths that result from substance use disorders shouldn’t be considered a mental health issue.
“We can’t make excuses for people who make poor decisions. I know this won’t play very well, but that’s not why I got elected. I don’t want us to miss the boat, and I want to hold healthcare providers and mental health institutions accountable.” he said.
Lawmakers also discussed the Minority Health Status Report, an effort by the state health cabinet that studies social determinants that impact access to health care like income, language, immigration status and zip code.
Vivian Lasley-Bibbs, director of the state’s Office of Health Equity, said lack of transportation is a major barrier to accessing transportation.
“We saw that the most when the pandemic hit. Trying to get access to vaccination sites, access to a doctor – transportation was a major barrier there. That’s what tore the Band-Aid off on where we needed to focus our efforts, especially in Appalachia and western Kentucky,” she said.
