Missouri has some of the worst rates for maternal and infant mortality in the country. This isn’t old news. Nor are the solutions that lawmakers like state Rep. LaKeySha Bosley, a St. Louis Democrat, continue to propose in the hopes of finally getting more people to pay attention.
The numbers should raise alarms for Missourians in every corner of the state, Bosley said.
“I can only imagine how fearful I’d be to have a child in this state knowing what I know statistically. And I know that is very true for other women who are not just in the urban areas but are in rural communities that don’t have access to a hospital within 20-plus miles, or even an urgent care, or anything,” Bosley said. “And that right there is where we should be putting a lot of our focus.”
Bosley, who is entering her eighth and final legislative session in the Missouri House, said she hopes to finally push through legislation that better addresses the state’s birth outcomes. She is among the only lawmakers so far to pre-file multiple legislative fixes to better study and prevent infant and maternal deaths.
“We are a state that claims to love our children and want to put our children in the best outcomes to succeed in life,” Bosley said. “And the only way that I know how to do that is to start at the beginning.”
On average, 70 women die each year in Missouri during childbirth or in the first year postpartum. Of those deaths, 80% are deemed preventable. Cardiovascular disease and mental health conditions were among the main causes of pregnancy-related deaths in the state.
Missouri’s Pregnancy-Associated Mortality Review board dissects the causes of death in each case, aiming to identify preventable situations.
Bosley is hoping to pass legislation that would establish a similar board to track and study infant deaths in the state, as well as fund grief counseling for family members who lost a child during childbirth or shortly after. The same bill would also expand the maternal mortality board to also study and address the socioeconomic and environmental outcomes, including global warming, on pregnancy outcomes.
While the state’s infant mortality rate improved slightly from 2022 to the latest 2023 data, 441 babies still died before they turned 1 year old in Missouri in 2023, putting the state 33rd in the nation for infant deaths. Black infants are dying at twice the rate of white infants. The leading causes of death for infants in Missouri were birth defects, preterm birth, sudden unexpected infant death and accidents, according to a recent report from the March of Dimes.
“The problem here is not only is this a lack of access issue, this is also a social economic issue,” Bosley said. “Most women who live in very poor communities in rural Missouri and also women of color typically have greater health risk and lower health outcomes. That goes back to systemic bias at how the health care system came to be.”
State Sen. Barbara Washington, a Democrat from Kansas City, who is also pushing for the expansion of doula services, is hoping to further expand the state’s maternal mortality review board to include more diverse statewide representation. Her legislation would also add data on prenatal and postnatal health care access to the data collected by the board.
“We gotta do something,” Washington said. “ … People that English isn’t their first language and women of color, and women who are poor, especially Medicaid recipients, they’re not treated with the same level of respect. I’m not sure if any woman is, to be honest.”
Not long ago in Missouri, women on Medicaid were seven times more likely to die within a year of pregnancy than women on private insurance, according to a report by the state’s Pregnancy-Associated Mortality Review studying deaths from 2017 to 2021. Black mothers in that time frame were 2.5 times more likely to die within a year of pregnancy than white mothers.
These outcomes prompted lawmakers to expand Medicaid coverage for new mothers from 60 days to one year postpartum.
One of Bosley’s bills seeks to include coverage for doula services for up to one year through the state’s Medicaid program, called MO HealthNet.
Doulas — who offer support for families during pregnancy, delivery and postpartum, but do not deliver babies — have been lifted up as one solution to improving maternal and infant health outcomes, especially among low-income families and families of color.
Last year, in an effort to address this, the state issued an emergency rule allowing doulas to be reimbursed through Medicaid. That rule has since expired.
Bosley also reintroduced a bill seeking to create the “Missouri Dignity in Pregnancy and Childbirth Act,” which would establish an evidence-based implicit bias program for perinatal health providers at all Missouri hospitals.
“I don’t think we’ll ever get rid of bias, unfortunately, but we can at least have a conversation so people can start to be conscious about certain thoughts,” she said.
She made note of a recent case in Indiana where a Black woman in active labor was turned away from a hospital and gave birth a short time later in a truck. She also noted the recent charges against a Virginia nurse accused of intentionally injuring at least one baby in the NICU.
“This is not something in the 1800s when we didn’t have technology that we have now,” Bosley said. “These are real-life stories that are happening in the 21st century.”
Another bill would make childbirth classes free for expectant mothers enrolled in the state’s Medicaid program.
Rose Anderson-Rice, CEO of Generate Health, a St. Louis nonprofit that works to create more equitable maternal and infant health outcomes, particularly for families of color, said legislative fixes such as expanding Medicaid eligibility can be really impactful.
She hopes to see lawmakers and community leaders focus on growing and diversifying the perinatal workforce, invest in addressing social determinants of health, fund community-based organizations that work with moms and babies, and improve access to maternal health care for families who are both underserved and under-represented.
Anderson-Rice pays particular attention to the state’s infant mortality rates, thinking of the classrooms full of children lost, whose futures — perhaps as doctors, athletes, parents — will never be realized.
“Public health professionals often liken infant mortality to the canary in the coal mine- it’s an indicator on the health of the community,” she said. “This is not about politics; it’s about responsibility. If we want a healthy Missouri, we need to fix this now.”
