Public Oversight Roundtable on Maternal and Infant Health: Addressing Coverage, Care, and Challenges in the District

Unity Health Care is pleased to provide written testimony for the Roundtable on Maternal and Infant Health: Addressing Coverage, Care, and Challenges in the District. This roundtable focuses on issues that are not only timely but also crucial to the well-being of our community. We appreciate the opportunity to contribute to this critical discussion and commend the Committee on Health for commencing a comprehensive exploration of the challenges surrounding maternal and infant health, recognizing that collaborative and compassionate interventions are vital to bridging existing gaps in care.

 
Unity Health Care, as the largest network of community health centers in the District, stands proudly at the forefront of championing comprehensive, equitable care for expectant mothers and infants. Our commitment is exemplified through our maternal health program, a collaborative effort involving OBGYNs, family doctors, mental health clinicians, midwives, nutritionists, insurance representatives, and social workers. Together, we guide our patients through the intricate stages of preconception, prenatal care, and postpartum support. The integration of on-site Women, Infants, and Children (WIC) offices and social workers further reinforces our dedication to providing necessary resources and holistic support throughout the maternal health journey.

In our ongoing commitment to comprehensive maternal care, our maternal health providers recently encountered a patient story that illustrates the transformative impact of proactive and personalized support. We had a teen patient who, given her history of preterm delivery due to high blood pressure, was enrolled in a home health monitoring program. Through meticulous monitoring and the introduction of aspirin to mitigate pre-eclampsia risks, we successfully identified the initial signs of pre-eclampsia at 37 weeks, allowing us to ensure her safe delivery at term. A week post-delivery, our follow-up call revealed that she had missed an in-person visit due to her older child falling ill. This phone check-in proved instrumental as we identified risk factors for postpartum depression. Swift action was taken, and she was seamlessly connected to therapy through the DC Mother Baby Wellness program. This patient's journey underscores the effectiveness of accessible, compassionate care and the importance of sustained investments in comprehensive maternal and infant care. 

While significant strides have been made since 2014, the District’s maternal mortality rate persists at almost twice the national average. The disparities are glaring, with Wards 7 and 8 bearing a disproportionate burden of delayed prenatal care, preterm births, low birth weights, and infant mortality. The closure of two labor and delivery facilities emergency rooms, despite a lack of proper equipment.
 
Exploring the interplay of social determinants such as housing, access to nutritious food, public safety, and transportation is crucial to illuminating feasible changes at a systemic level. Eviction and homelessness, severe consequences of housing instability, directly impact the health outcomes of mothers and infants. We urge the Council to consider policy interventions that include direct housing assistance for higher-risk expectant families and those with young children and explore pathways to utilize Medicaid funding to alleviate housing costs. 
 
Furthermore, food insecurity and transportation barriers to accessing care must be addressed to mitigate negative pregnancy outcomes such as prematurity and low birth weight, which can have a lasting impact on child development. While local Managed Care Organizations (MCOs) offer assistance to alleviate these barriers to care, there are often barriers to patients benefiting fully from these supportive programs. Additional risk factors such as exposure to high rates of violence also increase the risk of maternal mortality, preterm birth, and maternal mental health issues and need collaborative, systemic solutionsviii It is imperative that the Committee considers holistic approaches to these issues, recognizing the interconnectedness of social determinants of health and their impact on health outcomes. 

 Our recommendations include: 
 
1. Postpartum Coverage Expansion: The Postpartum Coverage Expansion Amendment Act of 2020, extending inpatient and outpatient benefits for at least a year after childbirth, represents a commendable step forward. However, caution must be exercised to avoid codifying detailed medical recommendations, which may inadvertently become barriers to care. Coverage should encompass all medically indicated health concerns, beyond maternity, recognizing the need for a comprehensive approach.  
 
2. Removing Barriers to Coverage: In under-resourced communities in Washington DC, pregnant mothers face significant barriers to Medicaid and Alliance coverage, exacerbated by delays in the insurance enrollment process, mandatory recertification for all Medicaid patients post-pandemic, and insufficient awareness within DC Medicaid about the pregnancy status of individuals. This lack of awareness has resulted in pregnant and postpartum patients being inadvertently dropped from coverage. Furthermore, disparities in coverage among MCOs compound the challenges faced by expectant mothers. To address these issues, it is imperative to streamline and expedite the Medicaid and Alliance enrollment process, improve communication within the system to accurately identify pregnant individuals, and ensure equitable coverage across all MCOs. Additionally, DC Alliance participants face amplified barriers to coverage due to limited literacy, language barriers, and challenges in accessing technology. It is imperative to implement tailored outreach programs that prioritize inclusivity and empower patients to navigate the complexities of healthcare coverage with confidence and understanding.   

Unity remains deeply committed to supporting initiatives that enhance the District’s maternal and infant health outcomes. We appreciate the opportunity to contribute to this vital roundtable discussion and look forward to continuing our collaboration with the DC Council and other stakeholders to implement effective strategies that will advance health equity and uplift the health and well-being of our community. 
 
If you have any questions or require further information, please do not hesitate to reach out to our policy lead, Fiona Mesfun, at fmesfun@unityhealthcare.org.  

1 Unity Health Care, Inc. Unity touches full spectrum of maternal health. 2019. Unity Touches Full Spectrum of Maternal Health | Unity Health Care
2 Our Healthy DC. Maternal and Reproductive Health. Maternal and Reproductive Health - Our Healthy DC
3 United Health Foundation. America’s Health Rankings. 2023. Explore Health Measures and Rankings in District of Columbia | AHR (americashealthrankings.org)
4 Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep 2019;68:762–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6835a3
5 American University Radio. Timeline: A Quick Guide to Veritas’ United Medical Center Contract. 2017. Timeline: A Quick Guide To Veritas’ United Medical Center Contract | WAMU
6 Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and Structural Determinants of Health Inequities in Maternal Health. J Womens Health (Larchmt). 2021.
7 Reece J. More Than Shelter: Housing for Urban Maternal and Infant Health. Int J Environ Res Public Health. 2021
8 Barbara A. Piperata and Darna L. Dufour. Food Insecurity, Nutritional Inequality, and Maternal-Child Helath: a role for biocultural scholarship in filling knowledge gaps. 2021.