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Born in a Pandemic, Part I: States Respond to Decline in Maternal Well-Being

By Jennifer Palmer and Khanh Nguyen  |  May 25, 2022

Priyanka Premo anticipated facing a lot of unknowns as a first-time parent. That’s why, before her son Rami’s arrival in June 2020, the Minnesota Senate Counsel staffer prepared as much as possible.

“I had planned everything out,” she says. “I had done all my research. I had secured a spot at an amazing day care a year in advance. I thought I was on top of it.”

Despite her planning, Premo’s entry into parenthood has been nothing like she expected.

“Risk mitigation, anxiety and isolation … those are the themes of my experience of motherhood so far,” she says.

Fears of contracting COVID-19 and losing employment, housing or child care have caused stress, anxiety, loneliness and depression to skyrocket among parents. Low-income families who struggle to afford basic needs report the highest levels of emotional distress.

Since the onset of the pandemic, federal and state lawmakers have passed historic funding and policy measures with direct implications for families who welcomed a child during these strange and stressful times.

Trends in state legislation affecting parents and their “pandemic babies” are summarized in this two-part State Legislatures News series. Here in part one, we explore legislation that supports maternal health.

What to Expect When You’re Expecting During a Pandemic

The coronavirus upended nearly every step of the birthing process for new parents. Lockdowns led to disruptions and cancelations in pre- and postnatal care. Partners could not attend ultrasounds or pediatric appointments. In locations with severe outbreaks, mothers gave birth without a partner present, and if they tested positive for COVID-19, they sometimes were separated from their newborns.

All of this uncertainty weighed heavily on expecting parents. Research shows maternal depression and anxiety rose significantly among expecting mothers in the last two years. Maternal depression is linked to numerous adverse health outcomes for mothers and infants alike and can negatively impact bonding. Early research shows babies born during the pandemic are at increased risk for developmental delays and lower motor, social and cognitive development.

Such adverse outcomes can be mitigated by strong social connections. For many parents with “pandemic babies,” social support was hard to come by. Lacy Ramirez, reading clerk for the Oregon Legislature, became mom to Rosalia in May 2020. At the time, she was concerned about exposure to COVID-19 for herself, her child or her parents. Now she considers herself lucky to have had the support of a colleague, Mandi McGowan, who was also pregnant at that time.

Though McGowan’s twins, Evelyn and Connor, will soon be turning 2, they have only recently begun to meet friends and extended family.

“For the first year, no one really met our kids, which was really sad,” McGowan says. “I do feel robbed … I wanted to shout it from the rooftops, ‘We did it! We made it! Here they are!’ It was not the experience I imagined or was hoping for.”

In recent years, over 20 states have enacted legislation to raise awareness of maternal mental health issues; require screening and treatment in various settings; expand access to and coverage for care; and create task forces and committees to improve maternal mental health services.

Maternal Mortality Rates Spike

Data from the Centers for Disease Control and Prevention shows pregnancy-related deaths increased by almost 20% in 2020. While the CDC’s figures do not link the rise in maternal deaths to COVID-19, they continue a disturbing three-year trend of rising maternal mortality rates. The 2020 data also reveals persistent disparities for Black women, who have a maternal mortality rate roughly three times that of white and Hispanic mothers.

To explain the disparities, researchers point to inequitable access to health care and preexisting health conditions, including cardiovascular issues, which are more likely to affect Black women. Since 2020, at least 32 states have enacted over 110 bills to address rising rates of maternal mortality and related disparities. For example, Delaware, Michigan and Tennessee passed resolutions to raise awareness and call for action on maternal health. The Tennessee resolution specifically recognized doulas and community health workers and acknowledged their contribution to ending maternal health disparities.

Doulas are professional labor assistants who provide physical and emotional support during pregnancy, childbirth and the postpartum period. Arizona, Florida, Nevada and Rhode Island joined at least seven other states and the District of Columbia in approving, if not yet implementing, Medicaid doula coverage. Additional states have launched pilot programs or special programs outside the legislative process.

States also examined maternity care workforce and access issues, such as modifying scope of practice, training and education, and insurance coverage for midwives. Arkansas, California and Louisiana are among the states that expanded access to midwifery care. For example, Arkansas granted certified nurse-midwives full practice authority, and Louisiana required health insurance companies to pay for midwifery care.

More than 23 states have extended postpartum Medicaid coverage beyond the first 60 days of postpartum recovery, recognizing that the program pays for more births among populations with higher rates of maternal mortality. These bills ensure coverage up to a year following birth and recognize the postpartum period as an essential time for early identification and management of common pregnancy-related complications.

‘Not Much Has Changed’

With mask mandates and other pandemic precautions on the decline, life is returning to something close to normal for many. Not so for parents of pandemic-born babies, who are too young to be vaccinated.

For Premo, who is expecting her second son in June 2022, the anxiety hasn’t gone away. “I still have to navigate life with a little bit of uncertainty and a lot of caution,” she says. “In some ways, I feel that not much has changed.”

Indeed, many challenges made worse by the pandemic persist for parents of young children today. High-quality child care for infants and toddlers is exceedingly difficult to find or afford. Closure of child care facilities due to staffing shortages or COVID-19 exposures continue to negatively affect parents’ ability to work and add to their stress. In addition, the rising cost of diapers, shortages of infant formula and increasing prices for groceries are contributing to higher levels of food insecurity for families.

Jennifer Palmer is a senior policy specialist in NCSL’s Children and Families Program and Khanh Nguyen is a project manager in the Health Program.

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