The current medical environment, which includes many policies enacted by government entities, insurance providers, and organizations, poses challenges for nurses and patients. These two parties are frequently trapped between the repercussions of budget limits and access to appropriate quality healthcare. As nurses engage with their clients, they are often the first professionals to notice healthcare system failures and how these glitches affect care delivery (Edmonson et al., 2017). Daily, nurses observe the influence of health policies on patients and the demand for more fundamental reforms in laws that address a wide range of health-related concerns.
When nurses assume the role of regulatory advocates to fix the process, they are known to leave the comfort zones of their practicing arena to enter unfamiliar territory. Policies and rules affecting care delivery are established in these positions, and hurdles for limited resources are bargained. Accepting this duty, as complex and time-demanding as it might be, provides nurses with a remarkable opportunity to create a difference and experience the gratification of playing an essential role in making a better healthcare system. Advocacy provides a layer to their clinical practice that rewards them with more significant influence over patient care.
Bill: The Maternal Health Quality Improvement Act of 2021
Bill Number: H.R. 4387
Sponsor: Rep. Kelly Robin of Illinois
Co-sponsors: Mr. Bucshon, Ms. Adams, Mr. Burgess, Mrs. Hayes, Mr. Latta
The Maternal Health Quality Improvement Act (MHQIA) of 2021 seeks to improve maternal health access to mothers in rural areas, reducing healthcare inequality in the United States. Nurses and other healthcare professionals are set to benefit from this bill in many ways. First, the bill sets aside funds to facilitate maternal health innovations to increase the adoption of evidence-based practices in clinics. With improved early diagnosis and prompt access to medical care, innovation can assist optimize care quality for mother and fetus by reducing newborn and maternal mortalities and lowering medical costs throughout the client’s entire medical journey.
Nurses usually first are the first patient advocates in healthcare facilities. Most are caught by emotional trauma or psychological drain when they fail to deliver the best care for their patients. However, the MHQIA seeks to prevent this problem by increasing healthcare efficiency through innovation. This strategy will lead to increased access to healthcare through the development of cheaper treatment procedures.
This bill also seeks to prevent implicit bias and racism in maternal healthcare. Implicit bias is commonly thought to significantly impact how healthcare practitioners interact with and handle African American women, leading to inequities in maternal health (Green et al., 2021). As a result, policymakers have advocated for adopting unconscious bias education in prenatal care settings. The MHQIA intends to increase funding to nursing colleges and healthcare facilities to train professional nurses and nursing students about implicit bias and its effects on quality care.
Reducing Maternal Health Inequalities in Rural Areas
In the United States, around 700 maternal fatalities occur yearly, with an extra 50,000 cases of severe maternal morbidities (Kozhimannil et al., 2019). Severe maternal morbidities refer to potentially fatal complications or the necessity for life-saving surgery during or shortly after delivery. Cardiac arrest, cerebrovascular disease, thrombosis, or an urgent hysterectomy resulting from childbirth are all cases of severe maternal morbidity. Interestingly, there are contrasting patterns in rural and urban populations, with rural inhabitants experiencing higher death rates.
Kozhimannil et al. (2018) conducted a retrospective cohort study to investigate the link between the reduction of hospital-based maternal services, delivery location, and neonatal outcomes in rural regions. An annually discontinuous time-series data technique was used in this retrospective cohort research, which used county-level predictive models. Births in remote U.S. counties from 2004 to 2014 were located using birth records. In 2004, 4,941,387 deliveries in all 1086 remote counties had hospital-based obstetrics. They discovered that more remote counties (179) in the United States lost access to maternal obstetric services than urban counties. The decline in in-patient obstetrics in remote counties was related to a rise in out-patient births, deliveries in a facility without antenatal services, and premature births. These factors led to a rise in poor prenatal care utilization over the research period.
In a second study, Kozhimannil et al. (2019) conducted a cross-sectional study to investigate in-patient maternal health disparities between rural and urban populations using government in-patient data between 2007 and 2015. During the research, they discovered that maternal and neonatal morbidities and mortalities rose among rural and urban populations, rising from 109 per 10,000 postpartum admissions in 2007 to 152 for every 10,000 in 2015. When they accounted for sociodemographic and clinical variables, they discovered that rural inhabitants had a 9% higher likelihood of severe maternal morbidity and death than urban populations—paying attention to remote patients and medical care institutions’ challenges is critical to implementing initiatives to minimize maternal morbidities and deaths in remote regions. Clinical variables like understaffing and the opioid crisis are among the obstacles, as are socioeconomic factors that influence health, like transport, shelter, and unemployment.
Cyr et al. (2019) conducted a systematic review to compare health access disparities between rural and urban populations. They systematically reviewed the literature published between 2013 and 2018 in databases like CINAHL and ProQuest. Search criteria focused on peer-reviewed scholarly articles relevant to access to urban or rural specialized U.S. health care. They discovered that most problems were associated with both urban and rural populations. However, rural healthcare facilities were prone to a lack of accommodation and insurance policies, which endangered maternal healthcare.
Nidey et al. (2019) conducted a cross-sectional study to investigate the risk differences in perinatal depression among women living in remote and urban areas of the United States. They evaluated the relationship between rural-urban positions and the risk of developing depression during the postpartum period using the national health records database. The overall analytical sample comprised 17,229 women from 14 different states. The risk of prenatal depression was assessed using logistic regression after controlling for ethnicity, maternal age, and county of residency. The findings point to a rural-urban disparity in prenatal levels of depressive symptoms. Addressing this discrepancy may necessitate enhancing socioeconomic situations and lowering potential risks among rural women.
Wendling et al. (2021) conducted a cross-sectional study to investigate the quality of maternal care in remote Michigan counties. The findings were confirmed using Internet research and phone conversations. Medicaid reimbursement records were used to establish the services delivered. Elevated-risk regions were classified as those where mothers had to commute more than 30 miles for parental treatment. They observed that most remote Michigan women have inadequate access to prenatal care. The outcomes could be used to focus on particular measures to increase these women’s access to medical care.
The American Hospitals Association (AHA) published a memorandum on behalf of its 5,000 member hospitals, 270,000 affiliate doctors, and over 2 million nurses to express their support for H.R. 4387. They argued that maternal health issues are a top priority for their members due to the country’s increased maternal morbidity and mortality rates. The bill would assist hospitals and healthcare systems in improving maternal health by financing programs that: develop and propagate clinical practices to improve maternal outcomes. The bill would also educate healthcare professionals in maternal care settings, improving health outcomes and reducing disparities.
York City speaker Adrienne E. Adams and the city’s council members applauded the signing into law of the maternal health legislation bill, which tackles significant inequities in maternal care like mortality and morbidity. According to Adams, maternal care is a social justice problem critical for several pregnant women in the state and country, particularly in Black neighborhoods. This traditionally diversified and female-majority council emphasized tackling this problem to lessen the enormous disparities in accessing fair treatment that African American, Hispanic, and native people suffer (New York City Council, 2022). The horrible encounters that have threatened many lives were recognized via tangible regulatory changes, and the passage of this legislation represents a significant step for the state.
Summary
The contemporary medical environment, which includes a slew of laws issued by government agencies, insurance providers, and organizations, presents difficulties for nurses and patients. These two parties are frequently caught between the repercussions of budget constraints and access to appropriate quality treatment. As nurses interact with their patients, they are typically the first experts to recognize the healthcare system’s flaws and how they influence care delivery. The Maternal Health Quality Improvement Act of 2021 aims to increase maternal health access for mothers living in rural regions, eliminating healthcare disparity in the United States. Policy advocacy positions provide nurses with a unique opportunity to make a difference and enjoy the satisfaction of contributing to a better healthcare system.
References
Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019). Access to specialty healthcare in urban versus rural U.S. populations: a systematic literature review. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4815-5
Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., & Marshall, J. (2017). Emerging Global Health Issues: A Nurse’s Role. Online Journal of Issues in Nursing, 22(1), 2. https://doi.org/10.3912/OJIN.Vol22No01Man02
Green, T. L., Zapata, J. Y., Brown, H. W., & Hagiwara, N. (2021). Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals. Obstetrics & Gynecology, 137(5), 935–940. https://doi.org/10.1097/AOG.0000000000004363
Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States. JAMA, 319(12), 1239. https://doi.org/10.1001/jama.2018.1830
Kozhimannil, K. B., Interrante, J. D., Henning-Smith, C., & Admon, L. K. (2019). Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The U.S., 2007–15. Health Affairs, 38(12), 2077–2085. https://doi.org/10.1377/hlthaff.2019.00805
New York City Council. (2022, September 6). Speaker Adrienne Adams, First Women-Majority New York City Council Celebrate Signing of Maternal Health Bills into Law. Press. https://council.nyc.gov/press/2022/09/06/2248/
Nidey, N., Tabb, K. M., Carter, K. D., Bao, W., Strathearn, L., Rohlman, D. S., Wehby, G., & Ryckman, K. (2019). Rurality and Risk of Perinatal Depression Among Women in the United States. The Journal of Rural Health. https://doi.org/10.1111/jrh.12401
Wendling, A., Taglione, V., Rezmer, R., Lwin, P., Frost, J., Terhune, J., & Kerver, J. (2021). Access to maternity and prenatal care services in rural Michigan. Birth. https://doi.org/10.1111/birt.12563
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