The Florida Department of Health is getting out of prenatal care. That begs the question: Is there a safety net for poor pregnant women in Florida?
Florida is one of only three states where county health departments employ obstetricians for pregnant women. It’s a legacy of the 1990s when Florida’s infant mortality rate was one of the worst in the nation. All this week, 90.7 News is kicking off a series: Pregnant and Poor, the decline of prenatal care in Florida. Check here to see the full series.
90.7 Health Reporter Abe Aboraya spoke with Morning Edition Host Renata Sago:
RENATA: How many health departments still offer care for pregnant women?
ABE: Only 28 of Florida’s 67 counties offer prenatal care in the health department. So Florida’s health departments have been getting out of prenatal care, and, frankly, direct patient care overall.
RENATA: How long has this been going on, and what caused it?
ABE: This has been going on for years, and there’s a number of reasons. One is budget. The Florida Department of Health’s budget was cut by $155.8 million dollars last year. Staff is down by 2,700 employees as well since 2011. The state has told some counties to get out of prenatal care, other counties simply decided they couldn’t afford it. So that’s one pressure. Another factor is that Florida shifted to Medicaid managed care. Now that’s a whole other conversation, and it’s complicated, but let’s just say some health departments have had their reimbursement rates cut as a result. And finally, there’s a shift in Florida Department of Health priorities as well.
RENATA: How do you mean, Abe?
ABE: Well the thinking is the health departments really should only be providing care if there is absolutely no one else doing. Rather, the health departments should be focused on population health, things like flu vaccines and preventing STDs. And the thinking there is that if something major like Ebola were to come to Florida, you want the health departments ready to handle that.
RENATA: If someone is listening to this thinking, OK, so what? I’m not pregnant and I have insurance, this doesn’t affect me, what would you say?
ABE: Prenatal care has a huge impact on a child throughout life. I spoke with Linda Sutherland, the director of Orange County’s Healthy Start coalition. She has a map in her office that shows where there are pockets of low birth weight and where there are low performing schools are. Those maps overlap.
“There’s a direct correlation between being born low birth weight or not as healthy as your potential and low performing schools," Sutherland said. "Because really what happens in those zip codes is you start out behind.”
RENATA: Can private doctors offer prenatal care better than health departments?
ABE: The Florida Department of Health says the majority of women who were getting care in county health departments are being seen by private doctors since the state privatized Medicaid. But there are caveats. In Orange County, for example, only about a third of doctors in private practice are willing to see Medicaid patients, and even then, they only see a few per week.
RENATA: Abe Aboraya, let’s look at Central Florida: which county health departments offer prenatal care?
ABE: Brevard, Orange and Osceola counties still have it, while Seminole and Volusia counties have recently gotten out of prenatal care.
RENATA: What’s been the impact of health departments getting out of prenatal care?
ABE: I looked at 10 different healthcare stats across Florida. And what I found is when a county drops prenatal care, you have more of those statistics getting worse.
RENATA: What are some examples?
ABE: Women getting in to see a doctor in the first trimester is getting worse in 11 of the 12 counties that stopped offering prenatal care in the last two years. In one rural county, when the county health department stopped offering prenatal care, the rate of women giving birth never seeing a doctor more than doubled to the worst rate in Florida. As one source put it, things are getting worse quicker in these areas. And there’s a worry that we may start seeing things like infant mortality rates go up, although those statistics are a little touchier to track.
RENATA: What does the health department say about all this?
ABE: I spoke with Swannie Jett of the Florida Department of Health in Seminole County Health Department. He says health departments really should only have doctors who see patients when there are no options.
“Once the community begins to stand up and provide some of those services, the health department can begin retracting their services,” Jett said.
RENATA: You’ve spent a few months on this project, so what can we expect from your reporting this week?
ABE: So tomorrow we’re going to meet a pregnant drug addict in Volusia County and her detoxing newborn. Later we go to the west coast and the Sarasota-Charlotte area where the state wants them to get out of prenatal care. We’re going to the area between Gainesville and Tallahassee for a story on rural access to care. And we end back here in Central Florida.
Check here to see the full Pregnant and Poor series from WMFE.
