April 13, 2023

About 25% of pregnant people did not get prenatal doctor’s appointments in the first trimester. People of color were less likely to see a doctor in the first three months.

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About a quarter of Colorado pregnant women on Medicaid insurance do not go to a doctor’s appointment during the first trimester, a statistic that likely contributes to the state’s rising maternal death rate.

That’s according to the latest “maternal health equity report” from the Colorado Department of Health Care Policy and Financing, which matched health records with 2020 birth certificates across the state. The Medicaid program, called Health First Colorado, covers 40% of all births in the state, or nearly 26,000 births in 2020.

The maternal death rate examines the time period of a pregnancy through one year following the birth. A previous report from Colorado’s Maternal Mortality Committee found the leading cause of maternal death was suicide, followed by accidental overdose.

A recently released national report from the Centers for Disease Control and Prevention found that the maternal death rate increased by nearly 40% from 2020 to 2021 and was 2.6 times higher for Black women compared with white women. The increase was attributed in part to the effects of the COVID pandemic, including isolation.

“We are equivalent to a Third World nation in terms of our maternal health,” said Lily Griego, regional director for the U.S. Department of Health and Human Services, who spoke Wednesday to Colorado Medicaid officials and nonprofit advocates who want more equitable maternal health care. “Most folks are in shock about this.”

Colorado’s report from the state Medicaid division had other grim news, too.

The number of Colorado babies born chemically dependent on opioids and other drugs rose by 31% in one year, keeping with a national trend that has seen the rate of “neonatal abstinence syndrome” climb in the past decade. About 3.8% of newborns in 2020 whose mothers were on the government insurance program for Coloradans with low income were born with chemical dependency. That was up from 2.9% in 2019.

Nationally, the number of addicted newborns jumped 82% from 2010 to 2017.

Colorado is working with the federal Medicaid department on a five-year, $4.6 million program to provide better services for pregnant women who are addicted to opioids. The program sites are Denver Health, River Valley Family Health Centers in Montrose and Southern Colorado Harm Reduction Association in Pueblo.

Also, only 8.2% of pregnant people received a prenatal screening for depression, according to 2020 Medicaid data. That’s an undercount, however, because many patients likely received a screening for depression but it was not captured in the system because doctors’ offices often don’t bill for that as a separate service, Medicaid officials said.

An analysis of claims data found that in 4,405 births, about 17% of patients, there was at least one behavioral health visit.

The number of Medicaid patients who received screening for substance abuse or addiction treatment was also low. Statewide, just 49 pregnant people had such a screen, but Medicaid officials believe that’s also an undercount since doctors don’t often submit claims for a separate, 15-minute substance abuse screening.

Colorado now allows all pregnant people to continue their Medicaid coverage for 12 months after giving birth, regardless of whether they meet the income eligibility requirements. Medicaid officials said the new policy is key to lowering the maternal death rate, including by making sure new parents have access to mental health treatment. Prior to the change, people maintained coverage for just 60 days after giving birth.

Additional reforms include Medicaid coverage for doulas beginning next year. State officials also are considering eliminating coverage restrictions at birthing centers, which are operated by midwives. More women are seeking to give birth in a birthing center instead of a hospital, an alternative that grew more popular during the coronavirus pandemic. The number of people who chose to give birth in a birth center rose almost 19% from 2019 to 2020.

Prenatal care visits remained stable from 2019 to 2020, with 76% of pregnant women receiving care in the first three months of pregnancy. Black patients were less likely to receive care, at 70%. And Native Hawaiian and other Pacific Islander people were the least likely to see a doctor in the first trimester, at 58%.

Previous research has found that Native American women in Colorado are almost five times more likely than other women to die in pregnancy or in the year following a birth.

Pia Long, with the reproductive justice organization Elephant Circle, said that eliminating racial inequity in maternal health care will require a system in which people can choose how and where to give birth.

“That’s what equity looks like, is birth choice and reproductive choice,” she said.

Colorado’s Maternal Mortality Review Committee has not yet released data from 2020, but health officials suspect that the maternal death rate worsened during the early days of the COVID pandemic the same way it did nationwide. The increase was due to COVID infection, as well as delays in seeking health care, and mental health and substance abuse issues brought on by social isolation.

Press Coverage

Colorado’s maternal death rate is rising. A new report says the answer is prenatal care, mental health screens.