Prenatal and Postpartum Care
Ensuring that Ohioans have access to the services they need during pregnancy and delivery is critical to the state of choice in Ohio. The accessibility of adequate prenatal care for all Ohio women is a crucial part of having real reproductive health options. Between 2009 and 2011 an average of 83.7% of Ohio women who were pregnant started prenatal care within the first trimester of their pregnancy (Ohio Department of Health, 2014). Amnesty International reported that in 2010, 12.2% of all women and 19.3% of women of color in Ohio who were pregnant did not receive prenatal care or their prenatal care was delayed, demonstrating a racial disparity in access to care (Amnesty International, 2010). These numbers indicate that there are barriers to accessing necessary care during pregnancy in Ohio. Between 2009 and 2011, an average of 52% of pregnant women were covered through their employment, an average of 44% were covered through Medicaid, and 3.3% were uninsured (Ohio Department of Health, 2014). In Ohio becoming pregnant does not qualify as a life event that would make an individual eligible to obtain new insurance outside of the open enrollment period. This policy leaves vulnerable women without the coverage they need to have a healthy pregnancy.
The majority of prenatal care providers discuss a range of issues related to healthy pregnancies, including the effects of alcohol and smoking on the fetus, breastfeeding, depression during and after pregnancies, symptoms of preterm labor, and HIV testing. Unfortunately, a shockingly low number of prenatal care programs in Ohio discussed or provided resources that address physical abuse and domestic violence. Data show that from 2006 to 2011 (the latest available data) less than half of the providers discussed these forms of violence (Ohio Department of Health, 2014). An average of 5.2% of women who became pregnant between 2009 and 2011 reported being abused by their partner during the pregnancy (Ohio Department of Health, 2014).
Postpartum care is essential to a healthy pregnancy because it is impacts women’s safety and wellbeing when recovering from pregnancy and childbirth. From 2009 through 2011, on average around 91% of women who gave birth received at least one postpartum check-up (Ohio Department of Health, 2014). In the same time period, an average of 12.4% of women who gave birth experienced symptoms of postpartum depression (Ohio Department of Health, 2014).
Unintended Pregnancy Rates
In 2010, the unintended pregnancy rate in Ohio was 49, representing the number of women who had an unintended pregnancy out of 1,000 women aged 15-44 (Guttmacher Institute, 2014). More than half, 55%, of total pregnancies in Ohio in 2010 were unintended (Guttmacher Institute 2014). Clearly, the high rate of unintended pregnancy points to a need for better sexual education and improved contraception access. Unfortunately the 2010 statistics are the most recent data on the question of unintended pregnancy in Ohio, which creates a gap in understanding the current state of choice. Furthermore this statistic is from before the Affordable Care Act’s mandate for contraception coverage without co-pays was instituted, which most likely decreased the unintended pregnancy rate. It is difficult to evaluate abortion rates without having an accurate and recent picture of the rate of unintended pregnancy.
Low-birth weight / Preterm births
Low-birth weight and preterm births illustrate potential problems in Ohio’s state of pregnancy and delivery. In 2013, 12% of total births in Ohio were preterm births, defined as babies born with gestational age of less than 37 weeks (National Kids Count, 2015). The percentage of preterm births remained consistently around 12% from 2009 to 2013, the most recent year for which data is available. Nationally, 11.4% of the total births in 2013 were classified as preterm (National Kids Count, 2015). From 2009 to 2013 about 8.6% of the total births in Ohio were categorized as low birth weight, defined as live births weighing less than 5.5 lbs (National Kids Count, 2015). Nationally, 8% of births in 2013 were classified as low birth weight (National Kids Count, 2015). From 2009 to 2013, about 1.7% of total births in Ohio were reported as very low birth weights or live births weighing less than 3.4 lbs (National Kids Count, 2015). Nationally, from 2009 to 2013 about 1.4% of total births were reported as very low birth weights (National Kids Count, 2015).
Race and ethnicity are the most carefully tracked demographic information regarding preterm and low birth weight data. From 2009 through 2013, the percent of low birth weights for Black babies was almost twice as much as the percent for white, Hispanic, and Asian or Pacific Islander babies (National Kids Count, 2015). The percent of low birth weights were higher among American Indian babies than other racial demographics, but still consistently lower than that of Black babies.
Maternal Morbidity and Mortality
There are many complications and health risks associated with pregnancy and childbirth. Maternal morbidity and mortality levels are essential considerations when deciding whether to become pregnant or continue a pregnancy, because they directly impact the wellbeing and safety of women during the reproductive process. In 2010 the maternal mortality rate, defined as number of deaths per 100,000 births, was 8.4 (Amnesty International 2010). In 2010 Amnesty International ranked Ohio 18th nationally in maternal mortality (Amnesty International, 2010). The Ohio Pregnancy-Associated Mortality Review (PAMR) reports on pregnancy-associated deaths which are defined as, “death during pregnancy or within one year of the end of pregnancy, regardless of cause,” as well as pregnancy-related deaths, which refer to “death during or within one year of pregnancy that is related to pregnancy” (Ohio Department of Health, 2015). The rate of both pregnancy-associated and pregnancy-related deaths spiked in 2009 to 50.5 (associated) and 20.1 (related) deaths per 100,000 live births (Ohio Department of Health, 2015). Both rates have decreased since 2009. In 2012 the pregnancy-associated death rate was 39.1 and the pregnancy-related death rate was 15.2 (Ohio Department of Health, 2015).
There are many different causes of maternal mortality. Hemorrhaging, sepsis or infection, hypertensive disorders, prolonged or obstructed labor, and indirect causes, such as pre-existing medical conditions that increase the risk of maternal death, are the leading causes of maternal mortality nationally (Columbia University Mailman School of Public Health). Maternal mortality is difficult to accurately track, given that a death directly caused from childbirth can take place much later than the delivery, at a different hospital or geographic location than the childbirth. Therefore the actual mortality rate could be higher than these statistics show.
Along with maternal mortality, it is important to look at pregnancy complications and maternal morbidities. The World Health Organization’s Maternal Morbidity Working Group defines maternal morbidity as “any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman’s wellbeing” (World Health Organization, 2013). The Ohio Department of Health tracks maternal morbidity through its Pregnancy Risk Assessment Monitoring System (PRAMS) program. From 2009 through 2011, the most common morbidity causes were as follows: kidney or bladder infection (20.8%), preterm labor (21.1%), vaginal bleeding (19.4%), high blood pressure (14.3%), gestational diabetes (10%), and premature ruptured membranes (5%) (Ohio Department of Health, 2014).
The Ohio teen pregnancy rate, referring to the number of pregnancies per 1,000 women, for the 10 to 14, 15 to 17, and 18 to 19 aged groups decreased from 2006 to 2010 (Ohio Department of Health, 2012). The Ohio teen birth rate, referring to the number of births per 1,000 women for teens age 10 to 19, also decreased dramatically from 2006 through 2013. The 18 to 19 aged group has the highest birth rate compared to the younger teenage groups (Ohio Department of Health, 2012). These numbers indicate a decrease in the number of teenagers who become pregnant in Ohio. Ohio teen birth rates are similar to national teen birth rates, which have also decreased (National Kids Data Center, 2014). While teen pregnancy and birthrates have decreased, the Ohio Department of Health found that “from 2003 to 2013 there was no significant change in the percentage of [high school] students who have currently had sexual intercourse” (Ohio Department of Health, 2013). The steady level of teenage sexual activity suggests that the decrease in teen pregnancy and birthrates is due to other factors, such as increased use of contraception and better sexual education.
Analysis of demographic information in regards to teen pregnancy is important for best evaluating where resources such as comprehensive sexual education, subsidized sexual health services, and access to contraception, are falling short or lacking. Unfortunately, statistical information about socio-economic class or income correlated with teen pregnancy or birth rates is virtually non-existent. Race and ethnicity are the most fully reported demographic information for teen pregnancy and births. The teen birth rates in Ohio from 2009 through 2013 were lowest for Asian and Pacific Islander teens and highest for Black and Hispanic teens (National Kids Count, 2016). White and American Indian teens had roughly similar teen birth rates from 2009 through 2013; their birth rates were about half those of Black and Hispanic teens (National Kids Count, 2016). For all racial and ethnic groups the teen birth rates decreased each year between 2009 and 2013 (National Kids Count, 2016).
Ohio is known for its high infant mortality rate, which has remained higher than the national average for the past seven years (Ohio Department of Health, 2015, Xu, 2016). Infant mortality refers to the death of an infant before its first birthday. The infant mortality rate in Ohio has not improved much over the past decade. Maternal age and racial/ethnic demographics impact infant mortality numbers. The teenaged groups, ages 15 to 17 and 18 to 19, have the highest risk for infant mortality at 10.3 deaths per 1,000 births in 2010, while the 30-34 aged group has the lowest risk at six deaths per 1,000 births in 2010 (Ohio Department of Health, 2015). The Ohio Department of Health statistics reveal that the infant mortality rate for Black women has consistently been twice as high as any other racial or ethnic group in Ohio (2015). Neonatal death rates, cases in which the infant dies within the first 28 days of life, reflect the same racial difference, with Black women’s rates being twice as high as white women’s. The racial disparity in infant mortality is a clear illustration that Black women face obstacles that do not exist for white women. Lack of access to reproductive health care, higher unintended pregnancy rates, and systematic structural racism all play a role in increasing the infant mortality rate for Black babies.
As of 2013, the biggest causes of neonatal deaths and infant mortality were: prematurity (47%), sleep issues (15%), and birth defects (13.8%), with other causes making up the remaining 24.6% (Ohio Department of Health, 2015).
Crisis Pregnancy Centers or Fake Clinics
Crisis pregnancy centers or CPCs are unregulated anti-choice facilities that are promoted as providing assistance to pregnant women and girls, when in reality their primary purpose is to counsel women away from abortion. CPCs often represent themselves as medical clinics, although they are not licensed and often do not have any medically trained staff. These fake clinics purport to provide impartial counseling, information, and free ultra-sounds while they consistently strive to dissuade pregnant women and girls from having abortions. Moreover, CPCs present women with misleading, incomplete and factually incorrect information about pregnancy and abortions, such as stating that abortion causes breast cancer and increases the risk of suicide. Through these actions, CPCs pose a threat to reproductive choice and to the wellbeing and safety of women and girls in Ohio (NARAL Pro-Choice Ohio Foundation, 2013).
While there are only nine abortion clinics across Ohio, there are hundreds of crisis pregnancy centers. Some of these crisis pregnancy centers receive public subsidies through state funding. The Ohio Parenting and Pregnancy Program subsidizes crisis pregnancy centers and any other non-profit organization whose primary purpose is “to promote childbirth, rather than abortion, through counseling and other services” (LAWriter ORC, 2013). The Ohio Parenting and Pregnancy Program is a grant program created by the Ohio legislature to funnel money into these anti-choice organizations that seek to curtail women’s ability to exercise full control over their own bodies and reproductive lives. This program is funded with Temporary Assistance to Needy Families (TANF). TANF is a federal grant program that is supposed to provide financial assistance to families in need. However, since 2013 Ohio has reallocated some of this money to directly subsidize crisis pregnancy centers through the Parenting and Pregnancy Support Program. In the 2016-2017 State Budget, the Parenting and Pregnancy Support Program funds Elizabeth’s New Life Center, Heartbeat of Toledo, Oasis of Hope, and Family and Youth Initiatives (Ohio Right to Life, 2015).
The Ohio “Choose Life” fund is another way the state funnels money to CPCs. Fees from the purchase of “Choose Life” license plates from the Department of Motor Vehicles are paid into the fund. Both the license plates and the fund were instituted in 2005, and the legislation governing the fund was amended in 2015 (LAWriter, 2015). For the state’s fiscal year 2012 (July 1, 2011- June 30, 2012), recipients of the “Choose Life” public funds included the following: Community Pregnancy Center, Hannah’s Home, Pregnancy Resource Center of Clark County, and Pregnancy Decision Health Centers. Pregnancy Decision Health Centers have six facilities: Franklinton Caring Center, Campus Caring Center, Lancaster Caring Center, Linden Caring Center, North Caring Center and West Caring Center (Ohio Choose Life Inc. 2012).
Numerous other public funds, such as federal grants for abstinence-only education, also subsidize CPCs. The following programs received public funding through these other funding programs: Oasis of Hope PPSC: Pregnancy Care Center; Elizabeth’s New Life Centers, which include six centers located in Dayton, East Dayton, Kettering, Lebanon, Sharonville, and Sidney; Heartbeat of Toledo, which has two centers in Toledo; and Family & Youth Initiatives, which has three locations in Fairborn, New Carlisle, and Springfield. Family & Youth Initiatives is also known as the Women’s Care Network (Ohio Right to Life, 2015).