Uninsured pregnant women need support to confront coronavirus | Expert Opinion

The COVID-19 crisis shines a light on one of the painful failures of America’s health care system: the inability to provide equitable care for poor women during childbirth. Too many mothers and infants die in the United States, in large part because of barriers to prenatal care. COVID-19 has made that lack of access clearer than before. In fact, just as thousands of routine health visits have gone online this month, those who do not have computers and data plans are left out. The digital divide became very real.

Pregnant women fear COVID-19 not only for themselves, but also for their unborn. They are beset with questions: Can I transmit the virus to my baby if I am infected, can I have a normal delivery, can my support people be present for my delivery, can I be with my baby when he or she is born, can I breast feed? The evidence based on small numbers is reassuring and demonstrates the lack of viral transmission from mom to baby. But all the other questions, from support at delivery to breast-feeding, vary in response depending on hospital policies for pregnant women during the COVID-19 pandemic.

Against this background, in Philadelphia, we are confronted with a significant number of undocumented and uninsured pregnant women who do not qualify for medical assistance. Under federal law, hospitals have to accept women in labor and there is reimbursement for that delivery, but not for prenatal care. In Pennsylvania, Medicaid provides limited coverage for prenatal care.

For these reasons, three years ago we decided to open a special free clinic to care for these women subsidized by the health system and philanthropy. (This Jefferson-supported clinic builds on a free clinic founded by Dr. Ludmir 15 years ago). We decided that not only was it morally and ethically the right thing to do, but by providing prenatal care and identifying high-risk conditions, we could prevent pregnancy complications and prematurity with consequences for the baby, as well as the associated costs. Services are provided by volunteers and patient navigators that have established significant trust in the community and are available for these vulnerable individuals 24 hours a day, helping to coordinate outpatient and inpatient care. In the three years, we have provided more than 5,000 visits and delivered 300 women, a significant number of them considered high risk with great outcomes for moms and babies and at reduced cost.

The argument for this free clinic is clear: Preventive care during pregnancy saves lives and saves money when the patient ends up in an emergency department in crisis.

» READ MORE: Pregnant women need doctors, but want to avoid coronavirus. Penn is using robots to keep them home more.

However, this pandemic crisis brings the challenges to a higher level. Based on national and our own departmental guidelines we are limiting the number of prenatal visits face-to-face and replacing them with telehealth. Unfortunately, most of our undocumented and uninsured patients do not have access to this technology because of low English proficiency, limited access to computers and smart phones, and no ability to pay for a high-level data plan.

Many of these women represent some of the most vulnerable individuals during this crisis. They now have no source of income, live in crowded conditions, have no school for children. They are food-deprived and lack transportation. But they of course still want a healthy pregnancy and healthy child. For these reasons, we continue to provide prenatal services, following guidelines for those suspicious for COVID-19. Our team of volunteers has risen to the occasion even providing home visits where needed. We have received donations for blood pressure cuffs, so women can check their blood pressure at home, a key component of prenatal care, without having to go out and increase the risk of exposure.

» READ MORE: Distancing while due: The coronavirus is rapidly changing pregnancy

This crisis is bringing not only the tragedy of human suffering, despair and death, but also the best of humanity by showing caring, dedication and sacrifice. As we look ahead to building a better healthcare delivery system after the COVID-19 crisis, a few things are clear:

Internet access must be seen by government as a utility. It is just as critical to the public good as electricity, clean water, and plumbing. For some time, our social workers have been counseling cancer patients to obtain a cheap data plan to download their own treatment protocols and health data. Now that mandate is true for all patients.

We must find ways to fund clinics for uninsured or under-insured women during childbirth. A major core of deep poverty in Philadelphia consists of single-parent households. We believe that if society can solve poverty for mothers, we solve a host of issues for everyone. There is no more effective step a city can take.

We have the ability to come out of COVID-19 with an equitable and sustainable model for healthcare delivery. But only if we agree, across many sectors of a community, to do exactly that. This is a challenge to all of us.

Jack Ludmir, MD, is Executive Vice President for Equity, Executive Director of Philadelphia Collaborative for Health Equity, and Professor of Obstetrics & Gynecology at Thomas Jefferson University and Jefferson Health. Stephen K. Klasko, MD, MBA, is President of Thomas Jefferson University and CEO of Jefferson Health.