Kentucky obstetricians have warned that even with exceptions when a mother’s life is in danger, the abortion ban “could force physicians to wait for a patient’s condition to deteriorate so severely that significant bodily harm or even death could occur.” (John Fedele/Getty Images)

Motherhood can certainly be a blessing. But Kentucky’s near-total abortion ban also has made it a risky obligation in a state with one of the highest maternal death rates.

“Pregnancy in Kentucky is too often a death sentence,” said Rep. Lisa Wilner, chair of the House Democratic Women’s Caucus, which has focused on maternal-health issues including addiction, mental health and racial equity. The challenges are huge:

• With 37.7 women for every 100,000 live births dying during or within 42 days after childbirth, Kentucky has one of the highest maternal mortality rates, according to the Centers for Disease Control. Nationally, deaths of new mothers have been rising sharply even before the pandemic. climbing to 32.9 per 100,000 in 2021,
• Black Kentuckians, 8% of the population, have a maternal mortality rate more than double that of whites.
• Substance abuse is the known cause of 53% of all maternal deaths, according to the state’s Maternal Mortality Review Committee.
• 34% of Kentucky births in 2020 resulted in Caesarean sections, associated with maternal mortality and severe medical consequences.
• In 2021, 14.2% of mothers received inadequate prenatal care, according to the March of Dimes, which gave Kentucky an F on its annual report card.?Almost half of the state’s 120 counties have little access to maternity care, according to the report.

“If you’re 25 years old and pregnant today, you have a higher chance of dying from your pregnancy than your mother did when she was pregnant with you 25 years ago,” Dr. Jeffrey M. Goldberg of the Kentucky chapter of the American College of Obstetricians and Gynecologists told a Senate committee in February. “That’s completely unacceptable.”

It’s also unacceptable that lawmakers prioritized reproduction over voters’ support of abortion rights and then ignored the need for a comprehensive strategy to improve the health of mothers.

Already, women in states with restrictive abortion laws are nearly three times more likely to die during pregnancy, childbirth or soon after giving birth, according to a research study from the Gender Equity Policy Institute. An analysis by the Commonwealth Fund shows death rates of women of reproductive age (15 to 44) is 34% higher than in states with abortion access.

“Abortion access is health care,” said Jackie McGranahan, senior policy strategist?for ACLU-Kentucky who is active with groups focused on Black maternal health. “The less access to health care, the more we will have poor outcomes If you want safe, healthier births, offer the full range of reproductive care.”

State obstetricians have already warned that even with exceptions when a mother’s life is in danger, the abortion ban “could force physicians to wait for a patient’s condition to deteriorate so severely that significant bodily harm or even death could occur.”

Meanwhile, doctors are avoiding residency programs in states with the most stringent abortion restrictions, a recent report?from the Association of American Medical Colleges found.

Unlike other states with strict abortion bans, Kentucky expanded Medicaid to more citizens in 2014. In 2022, Kentucky expanded coverage to new mothers from two months after birth to a full year. The state also used federal pandemic funds to expand a home-visitation program that advises families from pregnancy until the child is age 2.

Advocates for improving maternal care are pushing for more midwives and doulas – nonclinical aides for before, during and after childbirth – and to license birthing centers for the 700-800 babies?born every year outside of hospitals.

These services, which would especially benefit rural areas with few doctors, should be paid by insurance, especially Medicaid, said McGranahan. Right now, she said, “those who need them most can’t afford them.”

Lawmakers passed a law in 2019 to certify more midwives and doulas, after the hospital association and medical society dropped their long opposition. Yet, while some hospitals have added their own midwife services, the number of ?midwives has only increased by 12, to 131 providers, according to a February Kentucky Lantern report. One obstacle is a $1,000 fee for license renewal. That compares to a $110 fee in Tennessee.

State medical organizations have not embraced birthing centers, where midwives work with clients to create the kind of birthing options they want. The March of Dimes says birthing centers, now operating in 37 states and the District of Columbia, help decrease the rates of C-sections. Kentucky last had a freestanding center in the 1980s.

A major obstacle is the state’s “certificate of need” process, that sets various administrative and financial requirements for medical facilities. Bipartisan bills to exempt birthing centers from that requirement did win support in House and Senate committees this year.

That encouraged Rep, Jason Nemes, R-Louisville, who has championed birthing centers for years. “Families deserve the right to welcome their children into the world in a way that best suits them,” he said.

Helping mothers and families should be the top priority of the next General Assembly after years of preoccupation with right-wing causes that often limit people’s rights.

Lawmakers named the abortion ban, “The Human Life Protection Act.” Mothers are human. Protect them.