‘A fragile state:’ Where Louisiana ranks for women’s health | Louisiana Health

Women in Louisiana have decent access to preventative care and still face some of the worst health outcomes in the United States, according to a new analysis from the Commonwealth Fund.

The group, a nonprofit focused on health issues, released its first state-by-state analysis of women’s health and reproductive care on Thursday. The rankings came from 32 measures of health care availability and outcomes among 50 states plus Washington, D.C.

The scorecards were compiled from 2022 data, a time when women’s reproductive care underwent a massive restructuring with the fall of Roe v. Wade and the loss of abortion access in many states, including Louisiana.

“Women’s health is in a very fragile state,” said Joseph Betancourt, president of the Commonwealth Fund, pointing out that where a person lives very much influences their health, with clear disparities among states.

37th among states

The analysis ranked Louisiana 37th among all states for women’s health care, a significant bump up from where Louisiana typically falls for health care measures. United Health Rankings, for example, put Louisiana dead last in a 2023 report. 

The higher ranking is due to strides in insurance coverage for women. Louisiana expanded Medicaid in 2016, which has increased the number of people covered by about 75%, or 720,000.

More people are getting breast and cervical cancer screenings in Louisiana than in most places. But the state still had among the highest rates of breast and cervical cancer deaths.

Insurance ‘not sufficient’

While increases in health care coverage are good, that doesn’t automatically translate to longer, healthier lives, according to the authors of the report. Women face earlier deaths in Louisiana than in most places. The state ranked 46th for deaths of any cause among women ages 15 to 44.

“Insurance coverage is necessary, but it’s not sufficient,” said Sarah Collins, lead study author. “You have to have other things in place.”

Collins said women in Louisiana could be underinsured, meaning they have high insurance deductibles that keep them from seeking care that will be expensive. Insurance is also complicated.

“The complexity of our health insurance system has increased,” said Collins. “It’s made it more difficult for people to use their care, (there are) more pre-authorization phone calls when you’re trying to access care, and it’s confusing to many people.”

A number of other factors can also influence whether coverage availability leads to better health, said Dr. Veronica Gillispie-Bell, an Ochsner Health OB-GYN who was not part of the study.

Patients often have problems with transportation or getting child care while they go to appointments for themselves, Gillispie-Bell pointed out. For those patients, she tries to offer alternatives.

“If we know transportation is going to be a problem, I offer a virtual visit,” said Gillispie-Bell, who also leads the Louisiana Department of Health’s review committee of maternal deaths and morbidity. “We’ve found other ways to bring care to the patient.”

In pregnancy, patients are given a blood pressure cuff and scale through Ochsner’s Connected Mom program. Patients can strap on the cuff at home and have the results delivered instantly to their physician.

Over the course of her 15-year practice, Gillispie-Bell said she has seen an increase in dangerous hypertensive disorders in pregnant women, one of the leading causes of death.

“There is not a week I’m in the hospital we don’t have somebody admitted for preeclampsia,” said Gillispie-Bell, referring to a condition of sudden high blood pressure in pregnant women that can be fatal to the mother or fetus.

The causes for the increase are unclear, but may be related to pollution and environmental exposures, which can cause serious health risks in newborns. Women are also having children later in life, when the chances of complications increase. 

State plan to improve

The Louisiana Department of Health released a state health improvement plan this week, listing maternal health as one of four areas of focus for improvement.

In the next four years, LDH aims to lower preterm births by 1.5%, reduce the number of babies dying by 0.8%, and increase breastfeeding by eight percentage points.

The most ambitious goal is lowering the maternal mortality rate from 39.4 deaths per 1,000 births to 19.3, bringing Louisiana below the national average for deaths among pregnant and recently pregnant women.