The cost of doing nothing: Preventable premature births for at-risk women
Abstract
Background: The effects of poverty in the United States are growing, and the impacts are most severe for the already vulnerable populations. This analysis looks at the cost of doing nothing for at-risk pregnant women in one county in NE Ohio. Most of these women are living at or below the poverty level, lack safe, affordable, and stable housing, and often do not receive the recommended levels of prenatal care. This examination uses data from Mahoning County, Ohio, where one program has provided wrap-around support for any at-risk pregnant mother since 2016. Objective: Examine the cost/savings of providing wrap-around support services to at-risk pregnant women. Methods: Data was provided by the Mahoning County Pathway HUB (MCPH) regarding all births since its 2016 inception. Data was extracted from the Ohio Department of Health, the CDC, and other sources regarding the cost of births, specifically premature births. These sources of data were analyzed using causal-comparative methods, in order to understand the frequency of premature births, with, and without the support services provided by the MCPH. Conclusion: The results of these causal-comparative analyses suggest that the cost of doing nothing for at-risk pregnant women is substantial for all stakeholders. The results demonstrate a savings of 2.45 million dollars for the five years included in the analysis. Because most of the services provided by the MCPH are billable to public health insurance, this model of supporting pregnant mothers who are at risk is important. The cost of doing nothing can lead to a lifetime of avoidable suffering and financial hardship for women and infants who are born premature. The results from the MCPH suggest that this model of support and service delivery is making a difference, based on the lower-than-expected pre-term births over their tenure of operation.
References
[1] Adane, A. A., Bailey, H. D., Morgan, V. A., et al. (2021). The impact of maternal prenatal mental health disorders on stillbirth and infant mortality: a systematic review and meta-analysis. Archives of Women’s Mental Health, 24(4), 543–555. https://doi.org/10.1007/s00737-020-01099-9
[2] Braake, T. (2023). Broke and Broken: The financial toll of raising a disabled child. Available online: https://www.linkedin.com/pulse/broke-broken-financial-toll-raising-disabled-child-tracey-te-braake-lizee/ (accessed on 8 January 2024).
[3] CDC. (2018). CDC: Ohio’s infant mortality rate remains one of the highest in US. Available online: http://www.ideastream.org/news/cdc-ohios-infant-mortality-rate-remains-one-of-the-highest-in-us (accessed on 8 January 2024).
[4] CDC. (2024). Healthy People 2030. Available online: https://health.gov/healthypeople (accessed on 8 January 2024).
[5] Cygan-Rehm, K., & Karbownik, K. (2022). The effects of incentivizing early prenatal care on infant health. Journal of Health Economics, 83, 102612. https://doi.org/10.1016/j.jhealeco.2022.102612
[6] Fishman, S. H., Hummer, R. A., Sierra, G., et al. (2021). Race/ethnicity, maternal educational attainment, and infant mortality in the United States. Biodemography and Social Biology, 66(1), 1–26. https://doi.org/10.1080/19485565.2020.1793659
[7] Gleason, J., & Jones, M. M. (2019). Exploring the roles of community health workers and patient navigators to improve birth outcomes: A literature review.
[8] Green, E. K. (2023). The Changing Relationships Between Local Socioeconomic Conditions and Racial Disparities in Infant Mortality. The University of Arizona ProQuest Dissertations Publishing.
[9] Gupta, S., Adhisivam, B., Bhat, B. V., et al. (2020). Short Term Outcome and Predictors of Mortality Among Very Low Birth Weight Infants – A Descriptive Study. Indian Journal of Pediatrics, 88(4), 351–357. https://doi.org/10.1007/s12098-020-03456-z
[10] Kanda, T., Murai-Takeda, A., Kawabe, H., et al. (2020). Low birth weight trends: possible impacts on the prevalences of hypertension and chronic kidney disease. Hypertension Research, 43(9), 859–868. https://doi.org/10.1038/s41440-020-0451-z
[11] Lain, K. Y. (2002). Contemporary Concepts of the Pathogenesis and Management of Preeclampsia. JAMA, 287(24), 3183. https://doi.org/10.1001/jama.287.24.3183
[12] Larwin, K. H., & Larwin, D. A. (2023). Maternal and Infant Pathways HUB in NE Ohio: Influence on Birth Outcomes. Maternal and Child Health Journal, 28(1), 83–92. https://doi.org/10.1007/s10995-023-03799-x
[13] Larwin, K. H., Budnik, A., & Horne, S. E. (2023). Ohio community pathway HUB: The cost benefit of supporting minority mothers. Journal of Contemporary Research in Social Sciences, 5(2), 27–37. https://doi.org/10.55214/26410249.v5i2.328
[14] Leyenaar, J. K., Schaefer, A. P., Wasserman, J. R., et al. (2021). Infant Mortality Associated With Prenatal Opioid Exposure. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2020.6364
[15] MacDorman, M. F., Mathews, T. J., Mohangoo, A. D., et al. (2014). International comparisons of infant mortality and related factors: United States and Europe, 2010. National Vital Statistics Reports, 63(5), 1.
[16] Mathews, T. J., MacDorman, M. F., & Thomas, M. E. (2015). Infant mortality statistics from the 2013 period linked birth/infant death data set. National Vital Statistics Reports, 64(9).
[17] Meinhofer, A., Witman, A., Maclean, J. C., et al. (2022). Prenatal substance use policies and newborn health. Health Economics, 31(7), 1452–1467. https://doi.org/10.1002/hec.4518
[18] Nash, D. B., Fabius, R. J., Skoufalos, A., et al. (2017). Population health: Creating a culture of wellness. Burlington, MA: Jones & Bartlett Learning.
[19] OCMH. (2024). Ohio Commission on Minority Health Available online: https://mih.ohio.gov/about/ (accessed on 8 January 2024).
[20] ODM. (2024). Ohio Department of Medicaid: Mahoning County Maternal and Infant Health Dashboard. Available online: https://medicaid.ohio.gov/static/Stakeholders%2C+Partners/ReportsandResearch/Medicaid+Quarterly+Dashboards/2021/Q4/Mahoning.pdf (accessed on 8 January 2024).
[21] Ohio Department of Health. (2019). Ohio Infant Mortality Report 2019. Available online: https://odh.ohio.gov/wps/wcm/connect/gov/e30e2521-b6ae-4d75-a5fa-09c4241feb42/Infant+Mortality+Report+2019.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-e30e2521-b6ae-4d75-a5fa-09c4241feb42-nq6i5Cy#:~:text=Ohio%20infant%20mortality%20across%20all,to%20die%20than%20white%20infants (accessed on 8 January 2024).
[22] Ohio Infant Vitality. (2024). Available online: https://odh.ohio.gov/know-our-programs/infant-vitality (accessed on 8 January 2024).
[23] Opondo, C., Jayaweera, H., Hollowell, J., et al. (2019). Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: An analysis of linked national data from 2006 to 2012. J Epidemiol Community Health, 74(4), 336–345. https://doi.org/10.1136/jech2019-213093
[24] Prather, C., Fuller, T. R., Marshall, K. J., et al. (2016). The Impact of Racism on the Sexual and Reproductive Health of African American Women. Journal of Women’s Health, 25(7), 664–671. https://doi.org/10.1089/jwh.2015.5637
[25] Redding, S., & Redding, M. (2019). Pathways Community HUB Model: A Whole Person Approach to Improving Health Outcomes. Presentation to the Ohio Department of Health. Available online: https://odh.ohio.gov/know-our-programs/patient-centered-medical-homes/annual-conference/pathways-community-hub-model-redding (accessed on 8 January 2024).
[26] Redding, S., Conrey, E., Porter, K., et al. (2015). Pathways community care coordination in low birth weight prevention. Maternal and Child Health Journal, 19(3), 643–650. https://doi.org/10.1007/s10995-014-1554-4
[27] Rose, P. R. (2018). Health disparities, diversity, and inclusion: Context, controversies, and solutions, 1st ed. Burlington, MA: Jones & Bartlett Learning.
[28] VSCP. (2024). Natality Records 2016–2022. Available online: http://wonder.cdc.gov/natality-expanded-current.html (accessed on 8 January 2024).
[29] Waitzman, N. J., Jalali, A., & Grosse, S. D. (2021). Preterm birth lifetime costs in the United States in 2016: An update. Seminars in Perinatology, 45(3), 151390. https://doi.org/10.1016/j.semperi.2021.151390
[30] Wang, L., Zhang, X., Chen, T., et al. (2021). Association of Gestational Weight Gain with Infant Morbidity and Mortality in the United States. JAMA Network Open, 4(12), e2141498. https://doi.org/10.1001/jamanetworkopen.2021.41498
Copyright (c) 2024 Karen H. Larwin, Susan E. Horne
This work is licensed under a Creative Commons Attribution 4.0 International License.
