In 2012, the Affordable Care Act policy went into effect requiring commercial and Medicaid expansion programs to cover lactation support beginning during pregnancy. 11 years passed and nothing happened. Keep the change, please. We have yet to see any health program held accountable, despite the White House announcing last year that HHS would begin enforcing the policy.
As a third mom currently feeding a 12 week old girl, I respectfully call on CMS to implement the legislation and policies enacted in 2012. As outlined in the Kaiser Family Foundation report on Medicaid coverage of pregnancy-related services, many states are not currently eligible under the ACA.
Currently, the United States lags significantly behind our peers in all aspects of maternal health. Our maternal mortality rate is worse than our parents’ generation, women’s and maternal health is under-researched and invested, and women’s suffering during pregnancy and postpartum has been neglected.
The failure of the American healthcare system to support women is extremely short-sighted. Economists Henry Paulson and Timothy Geithner have published a report on economic uncertainty in the United States, and one of their main recommendations is that the country needs population growth, including new births. Some members of Congress have even called on American women to focus on thriving families, but they do not support investing in the health of mothers and babies.
Today, most states do not allow lactation support providers to register as Medicaid providers, severely limiting access. In some cases, this is because there is no provider type designation for lactation consultants. States may require certifications such as MD, NP, PA, or RN in addition to the International Board Certified Lactation Consultant (IBCLC) certification. Many states include lactation support services in the global cost of maternity care rather than being reimbursed separately, which is detrimental to care delivery and is time-bound, while many parents require support beyond postpartum care visits. Already too little is spent on universal maternal health care, leaving little room for breastfeeding and infant feeding support as a clinical specialty. However, like many issues in the field of women’s health, despite their enormous health benefits, these specialties are overlooked and overlooked.
Infant feeding is closely related to the mother’s experience of health, including the mother’s physical and mental health and the health of the baby. The first hours, days and months are critical to a baby’s health.
We know that breastfeeding support helps improve breastfeeding rates for those who choose to breastfeed (it’s their choice!). Despite the clear public health benefits of breastfeeding, society does not support those who want to breastfeed. Families in maternal health deserts lack access to supportive services, research shows, and this is especially true for Black women.
Lactation support that begins during pregnancy reaches patients before the baby is born to help with other issues that plague maternal health. Early mental health screening can detect risk for postpartum depression and anxiety. Postpartum lactation support appointments are also a great way to remind patients to attend their six-week postpartum visit – historically only 60% of patients attend. The six-week postpartum appointment is critical to check on the mother’s health, including checking blood pressure to prevent preeclampsia, and checking for diabetes or anemia problems.
The ACA’s coverage for CMS Medicaid lactation services must be followed. Women have been waiting 11 years.
Andrea Ippolito is a health technologist and founder of SimpliFed, a maternal healthcare company that provides breastfeeding and infant feeding support.
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