Articles

Advocates say Maine's higher rural infant mortality rate tied to economic insecurity

Maine Beacon / February 24, 2020

While the overall rate of infant mortality in Maine is on the decline, infant deaths in the most rural parts of the state have recently increased, according to a recent report by a state panel that aims to prevent pregnancy-related deaths.

From 2008 to 2012, the infant mortality rate in the most isolated areas was 3.9 per 1,000 live births. During 2013 to 2017, that rate jumped to 8.7 per 1,000 live births, the report found.

Infant deaths spiked in Maine in 2013, reaching an overall rate of seven deaths per 1,000 live births. It was the only state in the last decade to see worse numbers than in the prior decade, according to reporting by the Bangor Daily News.

As of 2018, the rate had dropped to 5.5. Black women saw higher rates of infant deaths between 2003 and 2007, but that difference has since decreased, according to the state report, which was published by the Maine Center for Disease Control and Prevention.

One reason for higher infant mortality rates in rural areas is a lack of access to health care, especially in the state's remote and isolated areas. Pregnant women in rural areas often must travel an hour or more to receive reproductive care.

"Maine's rural population really struggles because of a lack of affordable housing and lack of transportation to service centers," said Destie Hohman Sprague, executive director of the Maine Women's Lobby. Maternal and infant mortality, she noted, are interrelated to economic security.

Poverty is another barrier to care. Over 50 percent of low-income women in Maine could not afford to see a doctor when they needed to, according to a 2017 report by the state's Permanent Commission on the Status of Women.

Women and children are more likely to experience poverty than men, Sprague said, and rural women, women of color and other marginalized women are disproportionately impacted.

Wage inequality exacerbates the problem. Maine women make up nearly half of the labor force but earn an average of $.79 on the dollar compared to men, according to the state's Permanent Commission on the Status of Women.

Women of color face greater wage gaps.

Maine lawmakers point to recent laws as a sign of growing support for women's and infants' health. In a statement to the Beacon, U.S. Rep. Chellie Pingree highlighted a 2018 federal law that supports states' efforts to curb maternal mortality, calling it a "great initial step."

And Maine Gov. Janet Mills signed a 2019 state law that that allows nurse practitioners, osteopathic physicians and physician assistants to provide critical reproductive health care, including abortion procedures. She and other public health advocates hope the law will expand access to care — and reduce mortality — across the state, and especially in areas with shortages of health care providers.

"Every woman in Maine should be able to access reproductive health care when and where she needs it, regardless of her ZIP code," Mills said when the bill was introduced.

Pingree said more work is needed to reduce mortality — and called for passage of federal legislation that would expand Medicaid coverage for new moms for one year after giving birth.

"Women need a health care system that is affordable, patient centered and culturally competent," she said. "Congress must confront the maternal mortality crisis head on and pass legislation that keeps pregnant women and new moms healthy."

Reproductive health care, and abortion in particular, is increasingly difficult to access across the country, and maternal and infant mortality rates are rising nationwide.

Maternal mortality rates more than doubled in the United States between 1990 and 2013, according to the World Health Organization. The Centers for Disease Control and Prevention (CDC) found that U.S. women are more likely to die from causes related to birth or pregnancy than women in any other developed nation.

"Virtually every measure of the health of pregnant women, new mothers and infants living in the United States is going in the wrong direction," Stacey Stewart, president and CEO of the March of Dimes, told lawmakers during a hearing in the U.S. House last month to address the issue.

Black women are three to four times more likely to die from pregnancy-related issues than white women, according to the CDC. And Indigenous women are more than twice as likely to die from complications than white women.

"Addressing the maternal and infant health crisis means undoing structural racism that affects every facet of American life, from health care, to housing, to education, and transportation," Rep. Frederica Wilson (D-Fla.) said in an opening statement at the hearing.

"Simply put, if we are to stop this crisis, we must all work together and address the complex issues in maternal and infant health," she said.

Maine began addressing infant and maternal mortality in 2005 when it established the Maternal, Fetal, Infant Mortality Review Panel, which aims to identify the factors associated with pregnancy-related deaths and expand the state's capacity to direct prevention efforts.

"We are one of a handful of states who review all three death categories as one panel," said Maryann Harakall, director of the maternal and child health program at Maine's Center for Disease Control and Prevention.

While Maine faces challenges due to the lack of birthing hospitals in remote areas of the state, its maternal mortality rate (18.9 per 100,000 live births, according to an investigation by USA Today) is too low to provide meaningful trend data, Harakall said. The national average is 29.6 maternal deaths per 100,000 births, according to federal data released by America's Health Rankings.

But Harakall is optimistic about progress, given state and national investments in curbing pregnancy-related mortality rates.

"The fact that a lot of people nationwide are paying attention to this issue gives me hope," she said.