CT must safeguard its maternal and infant safety net
The One Big Beautiful Bill Act will cause a major disruption of Connecticut’s public health and social welfare infrastructure.
Comptroller Sean Scanlon estimates somewhere between 103,000 to 171,000 people could lose their Medicaid coverage due to $13 billion in cuts over the next decade, and the state could pay as much as $173 million a year just to maintain current SNAP services.
Access Health CT, the Affordable Care Act program, also estimates a loss of up to 50,000 enrollees by 2034 due to higher costs, and the loss of the federal enhanced subsidies for the Covered CT program could cost the state of Connecticut $32 million a year.
This threatens a maternal and infant health safety net that Connecticut legislators and public health agencies have been working on for years, marked most recently by legislation tackling issues ranging from birthing centers to maternal mental health.
And for us this situation heightens concern that the rate of infant deaths may rise, reversing an overall decline in Connecticut infant mortality rates since 2015, even though racial disparities persist – Black infant mortality rates are three times higher than white – and Medicaid coverage for Black, Hispanic, and American Indian/Alaska native peoples is also three times higher.
The threats from this increase would be both health-related and societal.
If women become uninsured, their access to prenatal care is reduced, putting them at higher risk for preterm birth and low birthweight babies. And this risk cascades: preterm birth and low birthweight babies are also at greater risk for Sudden Unexpected Infant Death (SUID), a sleep-related cause that includes Sudden Infant Death Syndrome (SIDS), unknown causes, and Accidental Suffocation and Strangulation in Bed. It is the number one cause of death for U.S. infants in their first year of life.
The societal threat is that greater stress will be put on daily life under social determinants of health and the families who navigate it. Economics, systemic racism, limited access to resources, and other factors are the backdrop against which decisions regarding infant sleep are made.
The Office of Child Advocate names unsafe sleep-related death as number one in preventable infant deaths in Connecticut, with no decline in ten years. The American Academy of Pediatrics safe sleep guidelines have babies sleeping on their backs alone, on a firm, flat surface with no bedding or loose materials to reduce the likelihood of unsafe sleep-related death. However, parents or caregivers exhausted from work and childcare may instead place their crying infant in bed with them, either out of lack of knowledge, or desperation.
Connecticut lawmakers are “getting it” that maternal and infant health depends on an integrated safety net to counter the health and societal pressures, but many enacted programs are still in development stages. And now hospitals face declining Medicaid reimbursement and reduced provider taxes. The new federal law will offer some rural health provider funding, termed “modest” by Scanlon.
Nonetheless, Connecticut must do whatever it can to safeguard its maternal and infant health infrastructure. This includes applying for the $50 billion five-year Rural Health Transformation Program, and meeting in legislative special session this month to assess shortfalls and how the Rainy Day fund and general fund surplus can help offset them. SNAP changes hit in late 2026 and Medicaid in 2027, effectively around the corner.
This may also be the time to change Connecticut’s infant safe sleep public health messaging.
In 2015 Connecticut legislated that hospital maternity facilities provide written safe sleep guidelines based on American Academy of Pediatrics standards. But a 2020 study found that while there was no significant change in SUID or SIDS rates post-legislation, more infants died from positional asphyxia than before. Study authors suggested that the effectiveness of this legislation should be re-examined.
Our organization has been teaching AAP safe sleep to health care professionals since being a part of the National Institute of Child Health and Human Development-led Back to Sleep campaign in the 1990s, which cut national SIDS rates by 50%. Rates have since largely levelled off, while racial disparities have grown.
These facts have made us re-evaluate our effectiveness and make changes to reduce rates of unsafe sleep-related death. Today we take a community-based approach to meet with families where they work and live, in partnership with trusted community members – doulas, social workers, lactation consultants – as well as peers. The sessions are regular, informal, non-judgmental yet purposeful in talking about safe sleep, breastfeeding, and family challenges and needs. We also collaborate with hospitals to meet in NICUs.
The qualitative research feedback on our programs indicates positive changes in awareness and behavior around caregiver decisions as to how and where an infant sleeps, indicating a community-based approach could be an effective addition to the public health messaging to bolster Connecticut’s maternal and infant safety net.
Alison Jacobson is the CEO and Executive Director of Connecticut-based First Candle, a national 501(c)3 which is committed to the elimination of SIDS and other sleep-related infant deaths. She is also a member of the Connecticut Child Fatality Review Panel and the Connecticut Perinatal Quality Collaborative.
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