Maternal mortality has long been a top-of-mind issue for Rep. Rita Fleming, a retired obstetrician first elected to the Indiana General Assembly in 2018. But when the Jeffersonville Democrat read “Joy in Jeopardy,” the IndyStar series on maternal mortality that published earlier this month, she grew even more certain that the legislature needs to act – soon.
“I just think it’s more urgent than ever,” she said.
This legislative session Fleming plans to propose a bill along the lines of one passed four years ago in Ohio. That law requires hospitals to ensure that women who have just given birth are offered the option of long-term contraception before they leave the hospital.
Studies have shown that women who become pregnant again within a year after delivering a child have a higher risk of a poor outcome, said Fleming, who has proposed similar legislation in past years but the bill has never received a committee hearing. Bills proposed by a Democrat without a Republican co-sponsor are rarely passed and signed into law in Indiana because Republicans have a supermajority and control the legislative process.
This year, a short session, she’s focusing her energy on this proposal as, she said, she feels it could save lives and reduce abortions by preventing unintended pregnancies.
“We have not done a good job of addressing access to contraception for women and they particularly need it post-partum,” she said. “It’s very easy to put an implant in a woman before she leaves the hospital.”
For many women the most dangerous period comes not during labor and delivery but in the months following the arrival of a baby, according to the Maternal Mortality Review Committee, a panel of experts convened by the state to delve into the data around maternal mortality. Indiana has a higher maternal mortality rate than many other states and the actual toll may be even higher than thought, the IndyStar investigation found.
Most women who died in the year following childbirth do so six weeks or more after the birth, Fleming said. In many cases this happens because women develop conditions, such as diabetes or hypertension, during pregnancy that persist long after and do not receive much needed follow-up care.
About 40% of women do not return for any post-partum care, Fleming said. Childcare, work or transportation concerns may all prevent them from seeing a doctor in the weeks and months following the birth. And, in many cases they may not have health insurance in the long-term.
Previously Medicaid coverage for women who gave birth ended 60 days after the birth, Fleming said. Starting this April in Indiana, women who give birth will have coverage for up to a year post-partum, under the American Rescue Plan that President Joe Biden signed into law in March of 2021.
Behavioral and mental health issues can also prove deadly for new mothers, the data shows. In Indiana, substance use played a role in just under half of all the pregnancy-associated deaths in 2018 and 2019, according to the Maternal Mortality Review Committee’s 2021 report.
A few years ago Fleming had proposed legislation that would require drug treatment centers to offer women in treatment birth control, a measure that did not pass but that she said would ensure women who wanted contraception received it.
The key thing, said Fleming, who in her years in practice delivered more than 7,000 babies, is that the care women receive does not end when they walk out the hospital door with their new baby.
“I have a pretty good understanding of what their needs are and what we can do to meet their needs and have moms stay healthier and babies stay healthier,” she said. “Every woman has unique needs.”
In an effort to serve all pregnant people, Fleming said that in the future, she’s hoping to propose legislation that would prohibit hospitals from keeping imprisoned women who are delivering in shackles.
During her 31 years in practice, Fleming lost two mothers. One died by suicide after delivering her child and the other suffered an amniotic fluid embolism, a rare and often fatal condition that occurs when amniotic fluid enters a woman’s bloodstream. The day that happened was one of the worst of Fleming’s life, she said.
“That doesn’t happen often. When you’re an OB-GYN usually there’s happy outcomes and happy parents,” she said, “so when it does happen, it’s a tragedy.”