HJNO Sep/Oct 2024

Dimes found Louisiana’s infant mortality rate to be 8.1 infant deaths per 1,000 live births: significantly higher than the na- tional infant mortality rate of 5.6 deaths per 1,000 live births. Rates of severe ma- ternal morbidities, often with life-altering consequences, are also much higher for Black/African American women living in Louisiana. Additionally, there are sig- nificant ethnic and racial disparities in the state’s preterm birth rates. At 16.6%, Black/ African American Louisianans have a pre- term birth rate that is 55% higher than that among all other women, according to March of Dimes. White and Hispanic Loui- sianans hold the state’s lowest preterm birth rates — 10.8% and 10.2%, respectively. March of Dimes Social Vulnerability In- dex (SVI) — a number between 0 and 1 — is given to determine where a pregnant per- son is more likely to experience poor ma- ternal or infant health outcomes. The fac- tors that determine a given parish’s SVI are grouped into four categories: socioeco- nomic status; household composition and disability; minority status and language; and housing type and transportation. Vir- tually every parish in Louisiana has the highest possible SVI score (0.6-1.0), indi- cating that poor health outcomes are high- ly likely for most pregnant Louisianans. A contributing factor to poor perinatal outcomes for Louisiana residents is the increasing struggle with complex chronic physical and mental health comorbidi- ties of the state’s residents. In 2019, Loui- siana ranked 49 out of 50 states based on a composite score of metrics aimed at capturing the whole health of the state. 7 Over 95% of the state qualifies as medi- cally underserved. Greater than 95% of the state is classified as rural, with 35 of 64 parishes being rural and 25% of the population residing in rural areas. Two million residents reside in health professional shortage areas (HPSAs). 8 Health professional shortage areas (HPSAs) designate either geographic ar- eas or population subgroups as lacking healthcare professionals in the fields of primary care, mental health, or dentistry. Twenty-three percent of Louisianans live in poverty (compared to 15% nationally), and Black/African American citizens are almost three times as likely as White citi- zens to be poor. One-third (33%) of Loui- siana children under age 19 live in pov- erty, compared to 1 in 5 nonelderly adults (20%) and 16% of adults aged 65 and older. 8 Thirty-two percent of the state’s residents are covered by Medicaid/CHIP. Sixty-one percent of births in Louisiana are covered by Medicaid. Thirty-eight percent of the state population is low- Michelle Collins, PhD, CNM, dean at Loyola New Orleans University College of Nursing and Health is a certified nurse- midwife active in clinical practice, teaching, research, and administration. In addition to her current administrative position, Collins works as a CNM at Ochsner Baptist in New Orleans. She represents the American College of Nurse- Midwives on several national committees and initiatives and is a nationally recognized expert on the use of nitrous oxide in labor and birth. Collins also writes an invited blog for the British show Call the Midwife , which appears on the PBS website. She is a fellow of the American College of Nurse-Midwives, the American Academy of Nursing, and the National Academies of Practice. Michelle Collins, PhD, CNM, RNC-EFM, FACNM, FAAN, FNAP Dean of Loyola New Orleans University College of Nursing and Health income (<200% Federal Poverty Level). What is even more striking about the U.S. maternal mortality rate is that the ma- jority of these deaths (approximately 80%) are deemed as preventable. Moreover, the maternal mortality rate is disproportional- ly distributed. Non-Hispanic Black women had a death rate of 69.9 deaths per 100,000 live births in 2021, which was 2.6 times the rate for non-Hispanic White women. 9 The U.S.’s very high cesarean section rate (32.1% in 2022) contributes to the over- all maternal death rate in that the risk for maternal death is greater after a cesarean than a vaginal delivery via hemorrhage, cardiac arrest, injury occurring during the cesarean delivery, thrombus/thromboem- bolism, complications as a result of anes- thesia. 10,11 The World Health Organization has stated that no industrialized country’s rate should be over 10-15%. 12 Lack of ac- cess to quality prenatal care is another important variable contributing to the ma- ternal health crisis in the U.S. A significant number of women cannot access prenatal care for a variety of reasons — top among them that they lack insurance access. Yet, there are other factors that play into the issue of maternal mortality being a greater burden, particularly for women of color. Centuries of mistreatment by the medical establishment, which HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2024 9