Navajo County seeks to help women and infants thrive

The US has the highest maternal and infant death rate in the industrialized world – more than twice as high as in other advanced economies. The rate more than doubled between 1987 and 2017. The high death rate stems in large measure from a lack of prenatal care, a lack of medical insurance, high child poverty rates and other preventable causes, including low breastfeeding rates.

Apache County has the highest rate of severe maternal illness in the state, and Navajo County ranks No. 3.

The non-reservation portions of Navajo and Apache counties also have some of the highest rates of premature births, low-birthweight babies and lack of prenatal care in the state.

A team of Navajo County nurses and health educators work doggedly every day to reduce those grim tallies by ensuring women get the care they need before, during and after giving birth, WIC director Ivy McCullough reported to the board of supervisors at their last meeting.

The program this year provided monthly services to 1,000 children younger than five, 330 pregnant women and 330 infants – a big jump from the 1,570 served in 2022. The program relies mostly on state and federal grants, administered by the county.

“We thank you for the current staffing levels,” McCullough told the supervisors.

The WIC team constantly tries to connect with pregnant women, as well as the families of infants and young children. But it’s a struggle, given the high rates of child poverty, low rates of prenatal care and lack of support for children.

“Some 12% of these households experience food insecurity,” McCullough said. “A lot of times, we’re changing the eating patterns of the whole family. The studies show that you avert $2.48 in medical costs for every $1 spent on WIC.”

The program hopes to offer some innovative new approaches in the coming year.

For starters, they’re handing out to families in the program $30 coupons they can use to buy fresh fruits and vegetables at farmers markets in Show Low, Snowflake, Taylor and Winslow.

Moreover, they’re going to start holding baby showers for expectant mothers. This provides an opportunity to work with families and offer vital gifts, such as breast pumps.

Supervisor Jason Whiting loved those ideas. “I really like the farmer’s market idea, and the interactive learning that’s going to take place at the baby shower. I certainly hope we can partner with groups in the community to make sure people are aware of it. It really does surprise me how little people understand about health. So I really appreciate what you’re doing.”

Partial care, inconsistent coverage a problem

Part of the problem stems from the fragmented, inconsistent medical care system, which forces many of the people who need care the most to scramble to find coverage or qualify for programs that can help.

Some 40% of families with children in the White Mountains have incomes below 130% of the poverty line, according to the 2020 First Things First report on the status of women, infants and young children. The median income for families with children in Navajo County is about $46,000, compared to $63,000 statewide and $71,000 nationally.

But that figure obscures the real victims of poverty and the resulting lack of medical care – families headed by single mothers. They have a median family income of just $14,400 and account for 20% of households. Grandparents caring for kids account for 14% of families and single fathers another 10%. Only 70% are now composed of two-parent families, which includes stepparents.

As a result of poverty, a fragmented medical system and a lack of public education, many mothers and infants don’t get even the most critical, cost-effective care, such as prenatal care.

One study concluded that providing prenatal care for teenagers saves about $3,000 per person simply in the medical cost of caring for low-birthweight babies, according to the study in the Journal of the American Board of Family Medicine.

Another study found that women who did not get prenatal care were three times more likely to have a low-birthweight baby. The analysis involved 7,000 births in Texas and compared outcomes with and without prenatal care, after controlling for other factors. Providing prenatal care saved $1,000 per woman in hospital charges alone.

Low-birthweight babies are 40 times more likely to die, and even if they survive, they face a big risk of other medical problems.

And yet, a shocking percentage of mothers receive little or no prenatal care.

The annual report for 2020 on child health issued by First Things First gathered the dismaying statistics on prenatal care, maternal health and child health in the Navajo-Apache region. This includes most of the non-reservation portions of Apache and Navajo counties, although Winslow was put into a different region for the purposes of the report.

Studies on the Navajo and Hopi reservation suggest that maternal death, low-birthweight babies, food insecurity, child poverty and other risk factors are far higher on the reservation than in the non-reservation areas of the county.

The figures show that in the White Mountains region, 35% of the 859 mothers who gave birth in 2017 had late or infrequent prenatal care.

Partially as a result of that lack, 9% of the babies were low birthweight and 8% were born prematurely. About 10% ended up hospitalized in intensive-care nurseries. About 2% of the mothers were younger than 18, and 7% were younger than 20.

The mortality rate for infants within the first year in Navajo County was almost double the statewide average.

About 57% of the births in the White Mountains were paid for by the Arizona Health Care Cost Containment (AHCCCS) system, due to low family income. The Indian Health Service paid for 1%, people paid out of pocket in 6% of cases. The rest were covered by private healthcare plans.

The US remains the only industrialized country without universal health insurance, which contributes to the problem. In the White Mountains, 13% of people lack health insurance, including 8% of children younger than five.

The problem continues long after birth.

For instance, breastfeeding results in a multitude of benefits for infants. Doctors say women should rely entirely on breastfeeding for at least the first six months of an infant’s life, whenever possible. Breastfeeding is not only cheaper, but it also significantly reduces the risk of asthma, obesity, type 1 diabetes and sudden infant death syndrome. Breastfed babies are also less likely to have ear infections and stomach bugs, according to the federal Centers for Disease Control. Moreover, breastfeeding reduces the mother’s risk of breast and ovarian cancer, type 2 diabetes and high blood pressure.

But in the White Mountains, only 8% of women breastfeed for six months. About 83% breastfeed at all.

The National Institutes of Health estimates that if 90% of mothers breastfed for six months, it would avert $3.7 billion in direct and indirect child medical costs and $10 billion in medical costs related to child deaths. It would also save $4 billion annually spent on infant formula.

In fact, the savings on breastfeeding could provide full, universal, paid maternity leave and still produce a net medical savings of about $9 billion, according to the National Institutes of Health.