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Fleming outlines plan for improving maternal health in rural Indiana

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INDIANAPOLIS- Today, State Representative Rita Fleming (D-Jeffersonville), a former registered nurse, nurse practitioner and obstetric practitioner, released a statement calling on the legislature to enact policy to improve health outcomes for Hoosier mothers and infants in the 2022 legislative session.

“I commend the Indiana Maternal Mortality Committee for their hard work and collaboration in unearthing and organizing data that provides vital information on what Hoosier mothers are dying from. Currently, Indiana ranks as the 3rd worst state in the country for maternal mortality and 7th worst for infant mortality. As the General Assembly returns to session, I call on my colleagues in the legislature to renew their dedication to address our state's dismal ratings in maternal and infant health,” Fleming said.

“A recent IndyStar investigation shed light on the disproportionate effect inadequate access to care has on rural and minority women. “Recent data shows the maternal mortality rate for Indiana rural mothers is almost four times higher than the national average. The issues rural mothers face provide a lens to the larger issue our state experiences in addressing health outcomes. Innovative policies are needed to address this growing crisis, solutions should address: 

Hospital Shortages

“Rural areas face a disproportionate shortage of not only providers, but facilities that are equipped to care for pregnant women and their infants. Currently, 33 Indiana counties are designated as OB deserts because they lack a hospital or the hospital does not provide OB services. Even with Hoosiers paying more than ever in health care costs and hospitals seeing increased revenues, facilities continue to close across the state. We should take a closer look at the reasons profitable hospitals are choosing to close their doors to Hoosier women. Steps should also be taken to ensure nonprofit hospitals are utilizing profits to expand care, not just line their pocketbooks.”

Alternative Practitioners

“As more hospital OB units close, the crisis must be addressed with innovative solutions. In my own district, successful expansion of access to care has been achieved through partnerships with alternative practitioners like nurse practitioners and midwives. Doulas also serve as an important addition to these skilled providers by providing vital patient education, emotional support and improving patient outcomes. The legislature should investigate all options to support this vital workforce and encourage utilization to provide access to women in access shortage areas.”

Student Incentives

“Successful partnerships with universities have exposed medical and nursing students to the benefits of working in small, rural hospitals like increased hands-on experience and the freedom to practice in an entrepreneurial environment that is often lost in larger hospitals. We know that students who participate in these programs are more likely to plant roots and remain in these communities after graduation. Increasing incentives for students to work in access shortage areas through loan forgiveness, housing support or additional measures would create a multi-faceted solution that decreases student loan debt, trains a skilled workforce and provides rural communities with long-term solutions.”

Maternal Mortality Review Committee

“I applaud the work of the Indiana Maternal Mortality Review Committee (MMRC) in taking steps to identify maternal mortality trends in an effort to provide solutions. I encourage the MMRC to include near-death experiences, also known as 'maternal morbidity,’ as part of the review process in the future. Maternal morbidity is more common among rural women and can lead to serious long-term consequences like infertility, stroke or mental health conditions. This data can create a greater understanding of where problems in the healthcare system exist, opening a discussion to comprehensive solutions.”

Equitable Access to Birth Control

“For years, I have championed increasing access to birth control, especially for postpartum mothers. According to the MMRC, most deaths in pregnant women occur in the year after birth with the leading cause related to substance misuse disorder, followed by mental health conditions. An unintended pregnancy can contribute to increased stress and anxiety, exacerbating these issues. With over half of all pregnancies being unintended, birth control can prove to be a vital resource in preventing unintended pregnancies, decreasing abortion rates and saving Hoosier lives. I intend to present legislation this session to ensure access to this life-saving medication is equitable and accessible for all Hoosier women.”

“The Indiana General Assembly made huge strides in improving maternal outcomes in the 2021 session by expanding Medicaid coverage for 1 year postpartum in the budget. If the state truly wants to see the long-term human and economic benefits of this expansion, the legislature should make this a permanent policy. I look forward to ongoing discussions that will improve health systems, lower the fiscal impact of poor outcomes and save Hoosier lives.”

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