Want healthier moms? Expand Medicaid

As a state, Oklahoma cares a lot about children and families, but we sometimes forget that a mother’s health is a critical piece of family health. When women are healthy, they have healthier pregnancies, healthier babies, and healthier families. But too many Oklahoma women die of child-birth related causes, and too many Oklahoma babies don’t live to see their first birthday.

Fortunately, most infant and maternal mortality is preventable. Medicaid expansion in Oklahoma would provide reliable health care coverage to thousands of Oklahomans, and provide women with better access to care at all stages of their lives. Consistent health care means more women will have healthier babies, better physical and mental health, and less likely to die of preventable, birth-related causes. 

Healthy women have healthier pregnancies and healthier babies

Oklahoma ranked 47th for its infant mortality, and 34th for its maternal mortality last year. There are a few reasons why Oklahoma women and babies are at greater risk of dying from preventable, birth-related causes. Oklahoma has a high uninsured rate, including a high uninsured rate for women of childbearing age, and offers limited coverage to pregnant women and new moms through SoonerCare, the State’s Medicaid program. SoonerCare coverage of pregnant women and new moms is limited, based on income level requirements and in order to qualify, women must provide proof of pregnancy, then wait for an approval. This current structure also leaves many of the same women without health care when they’re not pregnant, which is a majority of their adult lives. 

Without consistent health care coverage before pregnancy, many women cannot regularly see a doctor or treat ongoing illnesses. Because of this, women begin their pregnancies in poorer health, increasing the risk of complications for mom and baby. Giving birth to a child is physically and mentally demanding for the mother and the infant, so it’s important that women be healthy before pregnancy to have the best chance for a healthy pregnancy and birth. Expanding Medicaid enables more women to have continuous health care coverage so they can see a doctor more regularly, making for healthier pregnancies, healthier births, and healthier children who are also more likely to have insurance

Women in Medicaid Expansion states are healthier before, during, and after pregnancy

Infant and maternal mortality decreased in Medicaid expansion states, where more women have coverage before and during pregnancy. A leading cause of infant mortality in Oklahoma is complications related to low birth weight and prematurity. Regular doctor visits allow moms to address health concerns throughout the pregnancy, increasing the likelihood the baby will be born full term at a healthy weight. While most pregnant women in Oklahoma can access health care coverage, Medicaid expansion ensures more women who aren’t currently pregnant can go to the doctor regularly, maintaining better health. Women who begin their pregnancies in good health are less likely to experience these birth complications, making access to health care before pregnancy a critical piece of women’s and children’s health care.

Access to good prenatal care is also crucial. Regular doctor visits during pregnancy increase the likelihood the baby will be born full term, allowing the baby additional time to gain weight. Weight gain is an important part of physical and cognitive development. It not only lessens the likelihood that the infant will need emergency care once born, but also increases the chances the infant will survive its first year. 

Expanding Medicaid can help after birth as well. Currently in Oklahoma, postpartum coverage for women who have SoonerCare ends two short months after birth. Some of the leading causes of maternal mortality can occur days or weeks after birth, potentially leaving a new mother too sick to care for her new baby, and unable to see a doctor because she doesn’t have health care coverage. This also has consequences for maternal mental health, as postpartum depression or other mental health disorders, can present up to a year after giving birth. Continued coverage for women after birth can help ensure both the infant and mother stay physically and mentally healthy.

Mental health care before and after birth saves lives

Maternal mental health is vital to the health and well-being of the mother and child during and after pregnancy. Anxiety and depression during pregnancy can affect the baby’s brain development. Mental health disorders after birth like postpartum depression and anxiety can impact the baby’s safe sleep environment, attachment, and growth. Maternal mental health disorders also increase the likelihood the mother could experience self-harm or die by suicide.

In an effort to address this, the Oklahoma Legislature passed SB 419 in 2019, requiring all health care providers, including OBGYNs and pediatricians, to “invite” mothers to complete a depression screening while pregnant and before the baby’s first birthday. However, without Medicaid expansion, there’s no way to ensure that Oklahoma women with postpartum mental health disorders can access health care coverage for treatment.

Requiring screenings for mental health disorders is a good first step, but simply identifying and diagnosing these illnesses is not enough. Mothers need a way to access medical care to address these and other issues that may arise for longer than the limited time provided by current SoonerCare policies. By expanding Medicaid, Oklahomans can ensure better outcomes for mothers and babies across the state.


Margaret (Maggie) den Harder obtained a Bachelor of Arts in Christian Theology from Seattle Pacific University and a Master of Public Administration from the University of Oklahoma. Originally from the Pacific Northwest area of Washington state, Maggie has called Tulsa home for the past 8 years. Since living in Tulsa, Maggie has worked in the legal field, higher education administration, and the nonprofit sector as well as actively volunteering in the community. Maggie also recently spent time at the City of Tulsa as a consultant and wrote the content for Resilient Tulsa, an action-oriented strategy designed to better equity in Tulsa. Through her work, community involvement, and personal experiences, Maggie is interested in the intersection of the law and mental health and addiction treatment issues, preventative and diversion programs, and maternal mental health, particularly post-partum depression and post-partum psychosis. While working at Oklahoma Policy Institute as a research intern, Maggie further developed an interest in family dynamics and stability, economic security-related stress, and intergenerational trauma.

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