About one out of four of the 4.25 million women who gave birth in the last twelve months live below the poverty level, according to the U.S. Census. This is the first in a series of posts exploring the contrasts between being pregnant when you are one of those women-and when you are not.
It’s a ten-minute drive from my house in the Park Hill section of Denver to the Inner City Health Clinic in the low-income neighborhood of Curtis Park. The clinic is in a low slung brick building across the street from an Economart Liquor store on one side and on another some dilapidated Victorians that in my neighborhood, renovated with granite kitchen counters and a jet tub in the bathroom would easily fetch a half a million dollars.
Like many of the women who walk through the doors of the clinic, I am pregnant, 24 weeks pregnant on this day, to be exact. Unlike the great majority of them, however, I have generous health insurance coverage through my husband, a federal employee, which covers the cost of my expensive care at Obstetrix, a high risk ob/gyn practice some miles away.The pregnant women who come here typically find out about the clinic from a friend or family member who has been there or knows somebody who has, says Ann Fairbairn, the prenatal health care coordinator. Most of them are in the country illegally and speak Spanish. Ironically, she says, many of them work at one of the massive commercial laundries that provide clean sheets for hospitals-for people who enjoy the health care coverage that they lack.
Fairbairn herself is the mother of four and the young grandmother of one (she is nearing 50), not one of whom, she says has inherited her long, curly red hair. She works from a small office whose walls are decorated by kids’ paintings, a poster showing fetal development. On the battered book case are folders, a copy of “What to Expect in the First Year,” and a box of condoms.
Right now about 84 patients are coming to the clinic for prenatal care. If they are anything like the crop of patients who have given birth over the past year, they will benefit greatly. Among these 134 women, there were only two premature births and the average birth weight was an impressive 7.21 pounds. Prenatal care is most effective when women start receiving it in the first trimester of their pregnancies, and most of the women who come to Inner City Health do.
The patients who are in the country illegally and lack health insurance-which is most of them-are encouraged to apply for emergency Medicaid, which will cover the cost of their hospital deliveries. Medicaid will also cover costs associated with their new babies, since these babies will be U.S. citizens.
The clinic does a financial assessment to see how much they will pay. Most end up paying 35 percent of the cost of their care-the visits over the nine months of pregnancy including blood tests and ultrasounds-which amounts to about $350. That might not sound like much, but that’s more than a full week’s worth of work at the rate of the new minimum wage just approved by Colorado voters of $6.85 per hour, a large expense for most of these women. While the women who come to the clinic benefit greatly, there are many women who don’t come at all, fearing that they can’t cover costs or that they may be punished for their illegal status.
I ask Fairbairn what happens to the patients who, like me, are considered “high risk.” I’m high risk largely because of my age-42-but also because of my history of previous miscarriages. I’ve had testing that shows I carry a relatively common genetic mutation that is sometimes associated with blood clotting, which can cause miscarriage. Because of this, I’m on a blood thinner, which is monitored by frequent blood tests. I also get extra ultrasounds. The clinic tries to refer high risk patients to specialists, she says-but there are very few spots open for uninsured patients.
“So what happens to them?” I ask.
“They have a baby with problems,” says Fairbairn, “or they lose the baby. That’s the reality.”
To paraphrase George Orwell, some pregnant women in this country are more equal than others. And the difference can be a matter of life and death.
[crossposted at Muckraking Mom]