Wishing for the stork to bring some common sense

Having recently returned to work following maternity leave, I’ve been reflecting on my experience with pregnancy, childbirth and clumsily learning how to care for my now five-month-old baby. Humans aren’t delivered by storks and we don’t spring from our parents’ heads as fully formed adults capable of caring for ourselves, but the attitudes shaping this country’s policies surrounding pregnancy, childbirth and newborn care often seem to be based on ancient mythology and silly stories parents tell their kids to avoid awkward conversations about sex.

Sadly, these misguided notions have been invoked as justification to repeal the Affordable Care Act (ACA), as the law’s critics have asserted that men can’t get pregnant and pregnancy is not a disease (although before the ACA’s enactment, insurance companies could consider pregnancy a pre-existing condition warranting higher premium charges and deductibles if not outright denial of coverage).

Despite not experiencing any of the scary complications that can occur during the nondisease of pregnancy, I’m befuddled by a prevailing mindset that discourages prenatal coverage as a standard element of health insurance and paid leave time for new mothers and fathers. This attitude certainly isn’t conducive to good health for children, parents or families.

Some have suggested that the ACA’s requirement that insurance policies sold on the healthcare exchange cover obstetric care constitutes special coverage unfairly given to women at men’s expense. However, every single one of us, regardless of sex, exists because someone with a uterus carried us for months and then gave birth through a usually long, painful and sometimes traumatic process (which, in the United States, is shamefully often threatening to health and life). That some of the insurance premiums paid by people who will never become pregnant ultimately cover expenses associated with pregnancy, childbirth and postnatal care isn’t an injustice, it’s just paying it forward.

In waiting until age 37 to have a child, I’ve heard countless lectures about how selfish it is to be childless by choice and that we all have a duty to procreate for various reasons (all of them ironically selfish). But when it comes time to pay for it, human reproduction is suddenly viewed as an extraordinary burden to employers, other insurance subscribers and society at large rather than the natural process by which every one of us comes into this world.

Yes, healthcare for pregnant people, fetuses and newborns is expensive (as is healthcare for all other humans in the United States), and accommodating absences for new parents presents challenges to employers and coworkers. But it doesn’t look like nature will be changing the way our species perpetuates itself anytime soon–there’s no reason to single out pregnancy and childbirth from other naturally occurring health conditions, so we might as well learn to deal with them in ways that don’t cause further losses to society.

Family LeaveToday, my daughter is healthy and happy, largely because we have insurance that covered most of the costs, my employer provides paid parental leave and is accommodating of my family’s needs, and we could afford for my husband to take an extended unpaid leave along with me. But many American families aren’t so fortunate.

Families with low incomes, families of color and single parents have the least access to so many of the supports that save lives and strengthen families and are then cruelly stereotyped as inferior, while white, middle-class, married couples who are more likely to have robust insurance coverage, access to high-quality health providers and paid leave benefits are admonished to have more children so as to maintain an adequate population of “people like us”.

Historically, the stork has been revered as a sign of good fortune, even enjoying special protection in some cultures. Why don’t we show such regard for the actual human bearers and nurturers of children? A society that claims to value children’s lives must also value their parents’ lives, especially during the early years when so much crucial development takes place, and reflect this value in its policies related to health and family.

— Julie Cassidy

All babies deserve to thrive

How we treat and care for mothers and babies is a good measure of our priorities. Thinking about my own experience as a mother, the amount of support that I received from family and friends, especially when my daughter was little, is amazing. Every mother deserves to be supported and have access to the things that she needs to ensure her good health and the health of her baby: having someone to ask questions during pregnancy, connecting with caring healthcare providers, having access to affordable, quality child care when returning to work—and paid maternity leave. These are some of the ways we know help ensure that all babies thrive and do well.

Unfortunately, not all moms and babies in Michigan receive the support and care that they need. The most recent Kids Count in Michigan Right Start maternal and infant health report, Infant death rates decline in Michigan, other trends raise concerns, shows us that while some overall trends are improving, there are still disparities by race, place and income. This year’s report focuses on the infant mortality rate, which is improving in our state. However, the rates of babies who die before their first birthdays are particularly disturbing among African-Americans and Latinos. Comparing 2010 to 2015, infant death rates are rising in smaller, rural counties and income level continues to be highly related to the risk of infant deaths.

All of us can probably remember a time that we cared for or held an infant—or even helped a loved one welcome a new baby to their family. We can all also recall how delicate and fragile newborn babies are! As a new parent, I did not feel as prepared as I thought I would even after reading all of the books and reports that I could get my hands on. I could hardly figure out the car seat to get my baby home from the hospital—a first of many challenges!

im-home-visitBut, thankfully I had access to support and care. All families with little ones should too. This is why home visitation programs are extremely important in our strategy to reduce disparities in infant mortality and improve overall maternal and child health outcomes for everyone. Not only have home visiting programs demonstrated remarkable results, but they are geared toward helping those who need the most support.

Home visiting programs equip families with the tools they need to overcome any barriers or challenges they are facing during pregnancy or the first years of their child’s life. Trained professionals, sometimes nurses or social workers, make home visits with families who have voluntarily enrolled to have one-on-one conversations about any concerns that expectant or new parents might have. For example, if an expectant mom is having difficulty getting to her doctor for prenatal care, the home visitor will work with community partners to help her get to the appointments. Participants in these evidence-based programs experience improved access to prenatal care, reduced preterm births and more, which are critical to reducing infant mortality rates. Just listen to some of the experiences Michigan families have had.

While over 35,000 families are served in state-funded programs, there are many more families in need of services than are currently served. Home visiting programs have been rigorously evaluated and do improve health, increase financial security and reduce child maltreatment. State policymakers should consider expanding the reach of these programs with additional funding. Plus, the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program will expire at the end of September. Congress must reauthorize the program, but also increase its funding to reach more families.

If we are to ensure that all babies thrive well beyond their first birthdays, policies should be targeted to serve those most in need. With rising rates of infant deaths for Latinos and African-American babies being more than twice as likely to die before their first birthday as White babies, reducing racial disparities is a critical component in reducing infant mortalities. Home visiting is a part of this solution.

When I look at my daughter today as she darts all over the soccer field, I think about all the support I had and how she’s the strong kid she is today because of it. All Michigan kids deserve to have a foundation like hers.

— Alicia Guevara Warren