Despite having ample access to preventive health care, Louisiana women continue to have the worst health outcomes in the nation, according to a new analysis from the Commonwealth Fund.
The health-focused nonprofit group released its first state-by-state analysis of women’s health and reproductive health care on Thursday. The rankings evaluate health care availability and outcomes across 32 measures in the 50 states and Washington, D.C.
The scorecard was compiled from data from 2022, a time when women’s reproductive health care underwent a major restructuring with the lapse of Roe v. Wade and the loss of access to abortion in many states, including Louisiana.
“Women’s health is extremely vulnerable,” said Joseph Betancourt, president of the Commonwealth Fund, noting that where people live has a major impact on their health, with stark disparities across states.
37th by state
The analysis ranked Louisiana 37th among all states when it comes to women’s health care, which is a significant increase from where Louisiana typically sits when it comes to health care metrics. UnitedHealth Rankings, for example, ranked Louisiana dead last in its 2023 report.
The rise in the rankings is due to progress in health coverage for women: Louisiana expanded Medicaid in 2016, which increased the number of insured people by about 75%, or 720,000 people.
More people in Louisiana are screened for breast and cervical cancer than almost any other state, yet the state’s breast and cervical cancer death rates remain among the highest.
Insurance is “insufficient”
While greater health insurance coverage is a good thing, it doesn’t necessarily translate to longer or healthier lives, the report’s authors say. Louisiana has a lower death rate for women than most other states; the state ranks 46th in all-cause death rates for women ages 15 to 44.
“Insurance is necessary, but it’s not enough,” said Sarah Collins, the study’s lead author. “Other measures must also be taken.”
Collins said Louisiana women may be underinsured, meaning they have high out-of-pocket costs and may not be able to afford expensive medical care. Insurance is also complicated.
“The health insurance system is getting more complicated,” Collins said. “It’s making it harder to get care, and it’s confusing for a lot of people with the increased number of pre-authorization calls when trying to get care.”
Many other factors may also influence whether insurance coverage translates to better health outcomes, said Dr. Veronica Gillispie Bell, an Ochsner Health obstetrician-gynecologist who was not involved in the study.
Gillispie Bell said patients often have problems figuring out transportation or child care while they make their own appointments, so she tries to offer them alternatives.
“If we know transportation is going to be an issue, we offer virtual visits,” said Gillispie Bell, who also chairs the state’s Maternal Mortality and Morbidity Review Committee. “We’ve also found other ways to provide care to patients.”
During pregnancy, patients are given a blood pressure monitor and blood pressure monitor through Ochsner’s Connected Mom program, which they can wear at home and get the results immediately to their doctor.
Dr Gillispie Bell said that during her 15 years as a doctor she had seen an increase in dangerous high blood pressure disorders, which are one of the leading causes of death among pregnant women.
“Not a week goes by when I’m in the hospital that someone isn’t admitted with preeclampsia,” said Dr. Gillispie Bell, a condition that causes sudden high blood pressure in pregnant women that can be fatal to the mother and fetus.
The causes of the increase are unclear but may be related to pollution and environmental exposures that can pose serious health risks to newborns, as well as women being able to have children later in life, increasing the chance of complications.
State Plans for Improvement
The Louisiana Department of Health released the state’s health improvement plan this week, naming maternal health as one of four focus areas for improvement.
Over the next four years, the LDH aims to reduce premature births by 1.5%, reduce infant deaths by 0.8% and increase breastfeeding by 8%.
The most ambitious goal is to reduce the maternal mortality rate from 39.4 to 19.3 deaths per 1,000 births, bringing the mortality rate for pregnant and recently pregnant women in Louisiana down to below the national average.
