Q&A: Harvard public health dean talks Medicaid expansion and heartbreaking mortality rates of Delta mothers

by Kate Royals, Mississippi Today
March 19, 2023

Michelle Williams, a renowned epidemiologist and dean of the Harvard T.H. Chan School of Public Health, caught up with health editor Kate Royals following the state Legislature’s decision to expand postpartum Medicaid coverage.

Harvard University’s School of Public Health has an active program focused on the maternal mortality rate in the Mississippi Delta. Williams has also paid close attention to Mississippi’s debate over Medicaid expansion.

While Williams says she is heartened by Gov. Tate Reeves’ decision to extend postpartum coverage, the esteemed public health expert says the new law doesn’t go far enough.

Kate Royals: Tell me about the school’s work in the Mississippi Delta.

Michelle Williams: We have a long history of collaborating on research and education in the Delta, in partnership with state officials, community health centers and local colleges, including Mississippi State and the University of Mississippi.

When you talk about health in Mississippi, the focus is often on the dire statistics, such as sky-high infant and maternal mortality. But it’s important to know that the state has a history of truly important innovation. For instance, the first community health centers sprang up in Mississippi — an outgrowth of the civil rights movement. Our collaborations aim to build on and nurture those innovations.

We gather regularly with our partners to discuss and develop health care programs. We work together on research grants, too. As one example, we would love to secure funding to enable state health officials to make regular home visits to new moms in the Mississippi Delta; we would then evaluate the impact of the program and widely disseminate lessons learned.

Finally, we organize academic exchanges so students in Mississippi spend time at Harvard and vice versa, with opportunities to get involved in research and community projects. I recently talked to one of our (master’s of Public Health) students who is in Clarksdale for her fieldwork practicum, working with a program called “Baby University” that teaches new parents about early childhood development and gives them tips for supporting their babies’ growth.

Royals: You have cited some pretty startling statistics about outcomes for mothers – particularly Black mothers – in Mississippi compared to other countries. What were those?

Williams: I’m glad you asked, because I think these are statistics that every policy maker – and every citizen – should know.

For Black women in Mississippi, the mortality rate is 65.1 deaths per 100,000 live births, according to the state Department of Health.

That’s a horrifying number. To put it in context, Black women in Mississippi are nearly 20 times more likely to die from complications of pregnancy or childbirth than women in Greece, Poland, or Slovenia. They’re nearly 8 times more likely to die than women in Turkey.

The mortality rate for white women in Mississippi is lower, at 16.2 deaths per 100,0000 live births, but that is still far above the U.S. average. They are at least three times more likely to die from complications of pregnancy or childbirth than women in the UK or Canada.

Each of those deaths is a tragedy with long-lasting effects: Too many young, promising lives cut short; too many children who grow up without the love and support of their mothers; too many families who struggle with grief for the rest of their lives.

It is heartbreaking but it is also, quite frankly, infuriating. We know why maternal mortality rates are so high among Black women. They are high because of the devastating impacts of structural racism and individual bias, including lack of access to appropriate care. That we allow this to continue to happen, in the wealthiest country in the world, is unforgivable.

Royals: What do you believe, from your research and experience, will be the benefits of extending the health care coverage of mothers on Medicaid for women and babies in Mississippi?

Williams: We know from state data that 42.5% of pregnancy-related maternal deaths in Mississippi occur between 60 days and a year after childbirth. That’s the precise period that would be covered by the Medicaid expansion bill now on the governor’s desk.

I am certain that having access to care in this period will save lives. Remaining on Medicaid will give new mothers … access to mental health care, which is critically important for not only a mother’s health but also the health of her children. It will also allow women to get care for chronic conditions such as high blood pressure, diabetes and obesity. That’s important because cardiovascular conditions are the most common cause of pregnancy-related maternal deaths in the state.

There are many other benefits as well. Extending Medicaid coverage should help more young mothers get … screened for cancer. This is crucial because Mississippi has among the highest mortality rates in the nation for breast, cervical and colorectal cancer, all of which can often be treated successfully if detected early.

The bill should also help new mothers get access to contraception to help them control the spacing of future pregnancies. Given that abortion is now banned in Mississippi, with very limited exceptions, access to effective birth control is critical.

Finally, I want to emphasize what I mentioned earlier: Extending Medicaid will improve the odds not only for the mom, but for the newborn – and for any other children in the family. This generational effect is particularly important in Mississippi, which has long had the highest infant mortality rate in the U.S.

As every parent knows, the first year of a child’s life is wondrous, but it can also be tiring, isolating, and stressful. Parents are better equipped to navigate those stresses and support their children through this crucial phase of development if they have access to the care they need to keep themselves healthy.

Royals: I understand you applaud Mississippi for passing extended postpartum coverage but maintain there’s much more to be done. Can you say more about that, and how Medicaid expansion factors in?

Williams: Absolutely. That’s a great question.

The extension is critical for all the reasons I mentioned above. But the state could – and should – enact the full Medicaid expansion allowed under the Affordable Care Act. So far, I believe 39 states plus D.C. have taken advantage of this provision to extend Medicaid to nearly all adults with income up to a certain level, typically about $20,000 a year for a single person. That would cover not just new mothers, but all adults who meet the income guidelines.

One particular group that would benefit is young women who are not yet pregnant but might conceive in the near future. It would give them access to the care they needed to get chronic diseases like hypertension and diabetes under control. That could be a game changer in reducing maternal mortality.

And of course, Medicaid is not the only way to protect public health.

I firmly believe that Mississippi must restore physicians’ freedom to deliver the full range of health care for every resident, including gender-affirming care and abortion. State policy makers must also address the environmental factors that threaten health and well-being. That includes the unconscionable water crisis in Jackson, air pollution in Pascagoula, and the lack of access to fresh fruits and vegetables in “food deserts” across the state.

Williams cited the following articles in her responses:

Health Status : Maternal and infant mortality

Mississippi State Plan for Comprehensive Cancer Control 2018-2022

A Mississippi community is ‘grateful’ for more air testing, but skeptical of what comes next | WWNO

Food Deserts in Mississippi

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.