Health

A medida que se acerca el invierno, pocos en Mississippi reciben vacunas de refuerzo COVID-19

El refuerzo bivalente de COVID-19, que brinda protección tanto contra la cepa original del virus como contra la variante Omicron, ahora representa la mayoría de las dosis de vacuna administradas en todo el estado. Pero solo alrededor de 45,000 habitantes de Mississippi lo han obtenido desde que estuvo disponible en septiembre.

Las personas mayores de 12 años son elegibles para la nueva vacuna de refuerzo, siempre que hayan pasado al menos dos meses desde la última dosis. Todas las vacunas contra el COVID-19 son gratuitas.

La baja aceptación de refuerzo bivalente de Mississippi está en línea con la tendencia nacional: solo alrededor del 4% de las personas elegibles en los EE. UU. han recibido los nuevos refuerzos.

Actualmente, el estado está viendo un bajo número de casos y admisiones en hospitales y UCI, dijo el miércoles el epidemiólogo estatal, el Dr. Paul Byers, en una reunión de la junta estatal de salud. Pero es probable que el invierno traiga un aumento en los casos a medida que las personas pasan más tiempo en el interior, y los expertos en salud pública temen que miles de personas mueran innecesariamente.

Un análisis por Commonwealth Fund encontró que si las tasas de vacunación se mantienen estables durante el otoño y el invierno, podrían morir 75,000 personas que podrían haber estado protegidas por un refuerzo.

Los residentes de Mississippi pueden hacer una cita para el refuerzo bivalente en el sitio web del departamento de salud. Las citas para vacunas también están disponibles en el sitio web federal vaccines.gov.

Las personas pueden recibir el refuerzo actualizado incluso si no han recibido una vacuna de refuerzo anterior. Eso significa que si recibió dos dosis de Pfizer, Moderna o Noravax, o una dosis de Johnson & Johnson, califica para el nuevo refuerzo siempre que hayan pasado dos meses desde su última dosis. También es elegible si recibió una dosis de refuerzo hace más de dos meses.

La vacuna de refuerzo actualizada fue aprobada por la Administración de Alimentos y Medicamentos y los Centros para el Control y la Prevención de Enfermedades hace unas seis semanas. El departamento de salud del estado anunció que las citas de refuerzo bivalente estaban disponibles en los departamentos de salud del condado a partir del 13 de septiembre.

Byers explicó que a medida que el COVID-19 circula y evoluciona, surgen nuevas variantes que pueden evadir la inmunidad conferida por una vacuna o una infección previa. El nuevo refuerzo proporciona una protección más amplia que la vacuna original.

El futuro de las vacunas COVID-19 puede parecerse mucho a la vacuna contra la gripe, con nuevas versiones disponibles regularmente para proteger contra el virus evolucionado.

“Ese es el tipo de cosas que vemos con la vacuna contra la gripe todos los años”, dijo Byers. “Uno porque su inmunidad puede disminuir, pero también porque le brinda protección contra los virus actuales que circulan y causan enfermedades”.

Hasta ahora, la gran mayoría de los refuerzos bivalentes en Mississippi se han dirigido a personas mayores de 50 años, según los datos que Byers presentó en la reunión.

La tasa de consumo de refuerzo ha aumentado semana tras semana desde principios de septiembre, pero parece estar disminuyendo a mediados de octubre.

Solo el 52 % de los habitantes de Mississippi están completamente vacunados, en comparación con el 67 % de los estadounidenses, según el informe estatal de vacunación publicado el 1 de octubre.

Pero cuando se trata de la dosis de refuerzo, el país en su conjunto se parece a Mississippi: tanto en los EE. UU. como en Mississippi, solo el 48 % de las personas han recibido al menos una vacuna de refuerzo. Estados Unidos va a la zaga de países como el Reino Unido, donde más del 70 % de los adultos han recibido un refuerzo.

Una encuesta realizada por KFF, una organización sin fines de lucro dedicada a la política de atención de la salud, encontró que solo la mitad de los adultos estadounidenses dijeron haber oído hablar de las vacunas actualizadas.

Casi 1 millón de habitantes de Mississippi han sido infectados con COVID-19. El virus ha matado al menos a 13,000 personas en el estado.

Andrés Fuentes

Andrés Fuentes es periodista de FOX8-TV en Nueva Orleans y traductor de Mississippi Today. Antes de que el nativo de Nueva Orleans regresara, era periodista para WLOX-TV en Biloxi, Mississippi. […]

Health

As winter surge approaches, few Mississippians get updated COVID-19 booster

The bivalent COVID-19 booster – which provides protection against both the original strain of the virus as well as the Omicron variant – now accounts for most of the vaccine doses administered around the state. But only about 45,000 Mississippians have gotten it since it became available in September. 

People ages 12 and older are eligible for the new booster shot, as long as it has been at least two months since the last dose. All COVID-19 vaccines are free. 

Mississippi’s low bivalent booster uptake is in line with the national trend: Only about 4% of people eligible in the U.S. have received the new boosters. 

The state is currently seeing low numbers of cases and hospital and ICU admissions, state epidemiologist Dr. Paul Byers said at a meeting of the state board of health on Wednesday. But the winter is likely to bring a surge in cases as people spend more time indoors, and public health experts are worried that thousands of people will die needlessly. 

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An analysis by the Commonwealth Fund found that if vaccination rates remain flat over the fall and winter, 75,000 people could die who could have been protected by a booster. 

Mississippians can make an appointment for the bivalent booster at the health department website. Vaccine appointments are also available at the federal website vaccines.gov. 

People can get the updated booster even if they have not gotten an earlier booster shot. That means that if you got two doses of Pfizer, Moderna or Noravax, or one dose of Johnson & Johnson, you qualify for the new booster as long as two months have passed since your last dose. You are also eligible if you got a booster dose more than two months ago.

The updated booster shot was approved by the Food and Drug Administration and the Centers for Disease Control and Prevention about six weeks ago. The state health department announced bivalent booster appointments were available at county health departments starting on Sept. 13.  

Byers explained that as COVID-19 circulates and evolves, new variants arise that may evade immunity conferred by a vaccine or prior infection. The new booster provides broader protection than the original vaccine.

The future of COVID-19 vaccines may look a lot like the flu shot, with new versions available regularly to protect against the evolved virus. 

“That’s the kind of thing we see with the flu vaccine every year,” Byers said. “One because your immunity may wane but also because it gives you protection against those current viruses circulating and causing illness.”

So far, the vast majority of bivalent boosters in Mississippi have gone to people over age 50, according to data Byers presented at the meeting. 

The rate of booster uptake has increased week over week since early September but appears to be dropping off as of mid-October. 

Only 52% of Mississippians are fully vaccinated, compared to 67% of Americans, according to the state vaccination report released Oct. 1.

But when it comes to booster uptake, the country as a whole looks like Mississippi: In both the U.S. and in Mississippi, only 48% of people have gotten at least one booster shot. The U.S. lags behind countries like the United Kingdom, where more than 70% of adults have gotten a booster.  

A poll by KFF, a health care policy nonprofit, found that only half of American adults said they have heard about the updated shots. 

Nearly 1 million Mississippians have been infected with COVID-19. The virus has killed at least 13,000 people in the state. 

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California

‘Separate and Unequal’: Critics Say Newsom’s Pricey Medicaid Reforms Leave Most Patients Behind

LOS ANGELES — It wasn’t exactly an emergency, but Michael Reed, a security guard who lives in Watts, had back pain and ran out of his blood pressure medication. Unsure where else to turn, he went to his local emergency room for a refill.

Around the same time, James Woodard, a homeless man, appeared for his third visit that week. He wasn’t in medical distress. Nurses said he was likely high on meth and just looking for a place to rest.

In an overflow tent outside, Edward Green, a restaurant cook, described hearing voices and needing medication for his bipolar disorder.

The three patients were among dozens who packed the emergency room at MLK Community Hospital, a bustling health care complex in South Los Angeles reincarnated from the old hospital known as “Killer King” for its horrific patient care. The new campus serves the 1.3 million residents of Willowbrook, Compton, Watts, and other neighborhoods — a heavily Black and Latino population that suffers disproportionately high rates of devastating chronic conditions like diabetes, liver disease, and high blood pressure.

Arguably, none of the three men should have gone, on this warm April afternoon, to the emergency room, a place intended to address severe and life-threatening cases — and where care is extremely expensive.

But patients and doctors say it is nearly impossible to find a timely medical appointment or receive adequate care in the impoverished community, where fast food is easy to come by and fresh fruits and vegetables are not. Liquor stores outnumber grocery stores, and homeless encampments are overflowing. A staggering 72% of patients who receive care at the hospital rely on Medi-Cal, the state’s Medicaid program for low-income people.

“For some people, the emergency room is a last resort. But for so many people who live here, it’s literally all there is,” said Dr. Oscar Casillas, who runs the department. “Most of what I see is preventable — preventable with normal access to health care. But we don’t have that here.”

The community is short 1,400 doctors, according to Dr. Elaine Batchlor, the hospital’s CEO, who said her facility is drowning under a surge of patients who are sicker than those in surrounding communities. For instance, the death rate from diabetes is 76% higher in the community than in Los Angeles County as a whole, 77% higher for high blood pressure — an early indicator of heart disease — and 50% higher for liver disease.

But dramatic changes are afoot that could herald improvements in care — or cement the stark health disparities that persist between rich and poor communities.

Dr. Oscar Casillas directs the emergency room at MLK Community Hospital in South Los Angeles. “Since we see a patient population that is overwhelmingly on Medi-Cal and socioeconomically disadvantaged, all of the problems in health care are magnified here,” he says.(Angela Hart / KHN)

Gov. Gavin Newsom is spearheading a massive experiment in Medi-Cal, pouring nearly $9 billion into a five-year initiative that targets the sickest and costliest patients and provides them with nonmedical benefits such as home-delivered meals, money for housing move-in costs, and home repairs to make living environments safer for people with asthma.

The concept — which is being tested in California on a larger scale than anywhere else in the country — is to improve patient health by funneling money into social programs and keeping patients out of costly institutions such as emergency departments, jails, nursing homes, and mental health crisis centers.

The initiative, known as CalAIM, sounds like an antidote to some of the ills that plague MLK. Yet only a sliver of its patients will receive the new and expensive benefits.

Just 108 patients — the hospital treats about 113,000 people annually — have enrolled since January. Statewide, health insurers have signed up more than 97,200 patients out of roughly 14.7 million Californians with Medi-Cal, according to state officials. And while a growing number of Medi-Cal enrollees are expected to receive the new benefits in the coming years, most will not.

Top state health officials argue that the broader Medi-Cal population will benefit from other components of CalAIM, which is a multipronged, multiyear effort to boost patients’ overall physical and mental health. But doctors, hospital leaders, and health insurance executives are skeptical that the program will fundamentally improve the quality of care for those not enrolled — including access to doctors, one of the biggest challenges for Medi-Cal patients in South Los Angeles.

“The state is now saying it will allow Medicaid dollars to be spent on things like housing and nutritious food — and those things are really important — but they’re still not willing to pay for medical care,” Batchlor said.

Batchlor has been lobbying the Newsom administration and state lawmakers to fix basic health care for the state’s poorest residents. She believes that increasing payments for doctors and hospitals that treat Medi-Cal patients could lead to improvements in both quality and access. The state and the 25 managed-care insurance plans it pays to provide health benefits to most Medi-Cal enrollees reimburse providers so little for care that it perpetuates “racism and discrimination,” she said.

Batchlor said the hospital gets about $150, on average, to treat a Medi-Cal patient in its emergency room. But it would receive about $650 if that patient had Medicare, she said, while a patient with commercial health insurance would trigger a payment of about $2,000.

The hospital brought in $344 million in revenue in 2020 and spent roughly $330 million on operations and patient care. It loses more than $30 million a year on the emergency room alone, Batchlor said.

Medicaid is generally the lowest payer in health care, and California is among the lowest-paying states in the country, experts say.

“The rates are not high enough for providers to practice. Go to Beverly Hills and those people are overdosing on health care, but here in Compton, patients are dying 10 years earlier because they can’t get health care,” Batchlor said. “That’s why I call it separate and unequal.”

South Los Angeles is experiencing a homelessness epidemic. Some people live in recreational vehicles that line the streets. Tent encampments are regularly razed by law enforcement.(Heidi de Marco / KHN)

Newsom in September vetoed a bill that would have boosted Medi-Cal payment rates for the hospital, saying the state can’t afford it. But Batchlor isn’t giving up. Nor are other hospitals, patient advocates, Medi-Cal health insurers, and the state’s influential doctors’ lobby, which are working to persuade Newsom and state lawmakers to pony up more money for Medi-Cal.

It’ll be a tough sell. Newsom’s top health officials defend California’s rates, saying the state has boosted pay for participating providers by offering bonus and incentive payments for improvements in health care quality and equity — even as the state adds Medi-Cal recipients to the system.

“We’ve been the most aggressive state in expanding Medi-Cal, especially with the addition of undocumented immigrants,” said Dustin Corcoran, CEO of the California Medical Association, which represents doctors and is spearheading a campaign to lobby officials. “But we have done nothing to address the patient access side to health care.”

***

The hospital previously known as Martin Luther King Jr./Drew Medical Center was forced to shut down in 2007 after a Los Angeles Times investigation revealed the county-run hospital’s “long history of harming, or even killing, those it was meant to serve.” In one well-publicized case, a homeless woman was writhing in pain and vomiting blood while janitors mopped around her. She later died.

MLK Community Hospital rose from its ashes in 2015 as a private, nonprofit safety-net hospital that runs largely on public insurance and philanthropy. Its state-of-the-art facilities include a center to treat people with diabetes and prevent their limbs from being amputated — and the hospital is trying to reach homeless patients with a new street medicine team.

Still, decades after the deadly 1965 Watts riots spurred construction of the original hospital — which was supposed to bring high-quality health care to poor neighborhoods in South Los Angeles — many disparities persist.

Less than a mile from the hospital, 60-year-old Sonny Hawthorne rattled through some trash cans on the sidewalk. He was raised in Watts and has been homeless for most of his adult life, other than stints in jail for burglary.

He hustles on his bike doing odd jobs for cash, such as cleaning yards and recycling, but said he has trouble filling out job applications because he can’t read. Most of his day is spent just surviving, searching for food and shelter.

Hawthorne is one of California’s estimated 173,800 homeless residents, most of whom are enrolled in Medi-Cal or qualify for the program. He has diabetes and high blood pressure. He had been on psychotropic medicine for depression and paranoia but hasn’t taken it in months or years. He can’t remember.

“They wanted me to come back in two weeks, but I didn’t go,” he said of an emergency room visit this year for chronic foot pain associated with diabetes. “It’s too much responsibility sometimes.”

Sonny Hawthorne has been homeless in Watts, California, for most of his adult life. He can’t read and has advanced diabetes and untreated mental health conditions. Without stable housing, he says, he can’t keep on top of his health problems. He’d likely qualify for new, nontraditional Medi-Cal services, but there aren’t enough resources to serve everyone in need.(Heidi de Marco / KHN)

Hawthorne’s chronic health conditions and homelessness should qualify him for the CalAIM initiative, which would give him access to a case manager to help him find a primary care doctor, address untreated medical conditions, and navigate the new social services that may be available to him under the program.

But it’s not up to him whether he receives the new benefits.

The state has yielded tremendous power to Medi-Cal’s managed-care insurance companies to decide which social services they will offer. They also decide which of their sickest and most vulnerable enrollees get them.

One benefit all plans must offer is intensive care management, in which certain patients are assigned to case managers who help them navigate their health and social service needs, get to appointments, take their medications regularly, and eat healthy foods.

Plans can also provide benefits from among 14 broad categories of social services, such as six months of free housing for some homeless patients discharged from the hospital, beds in sobering centers that allow patients to recover and get clean outside the emergency room, and assistance with daily tasks such as grocery shopping.

L.A. Care Health Plan, the largest Medi-Cal managed-care insurer in Los Angeles County, with more than 2.5 million enrollees, is contracting with the hospital, which will provide housing and case management services under the initiative. For now, the hospital is targeting patients who are homeless and repeat emergency room visitors, said Fernando Lopez Rico, who helps homeless patients get services.

So far, the hospital has referred 78 patients to case managers and enrolled 30 other patients in housing programs. Only one has been placed in permanent housing, and about 17 have received help getting temporary shelter.

“It is very difficult to place people,” Lopez Rico said. “There’s almost nothing available, and we get a lot of hesitancy and pushback from private property owners not wanting to let these individuals or families live there.”

(Heidi de Marco / KHN)

Patrick Alvarez, 57, has diabetes and was living in a shed without running water until July, when an infection in his feet grew so bad that he had several toes amputated.

The hospital sent him to a rehabilitation and recovery center, where he is learning to walk again, receiving counseling, and looking for permanent housing.

If he finds a place he can afford, CalAIM will pay his first month’s and last month’s rent, the security deposit, and perhaps even utility hookup fees.

But the hunt for housing, even with the help of new benefits, is arduous. A one-bedroom apartment he saw in September was going for $1,600 a month and required a deposit of $1,600. “It’s horrible, I can’t afford that,” he said.

Hawthorne needs help just as badly. But he’s unlikely to get it since he doesn’t have a phone or permanent address — and wouldn’t be easy for the hospital to find. The homeless encampments where he lives are routinely cleared by law enforcement officials.

“We have so many more people who need help than are able to get it,” Lopez Rico said. “There aren’t enough resources to help everyone, so only some people get in.”

***

L.A. Care has referred about 28,400 members to CalAIM case managers, roughly 1% of its total enrollees, according to its CEO, John Baackes. It is offering housing, food, and other social services to even fewer: about 12,600 people.

CalAIM has the potential to dramatically improve the health of patients who are lucky enough to receive new benefits, Baackes said. But he isn’t convinced it will save the health care system money and believes it will leave behind millions of other patients — without greater investment in the broader Medi-Cal program.

“Access is not as good for Medi-Cal patients as it is for people with means, and that is a fundamental problem that has not changed with CalAIM,” Baackes said.

Evidence shows that basic Medi-Cal patient care is often subpar.

Year-over-year analyses published by the state Department of Health Care Services, which administers Medi-Cal, have found that, by some measures, Medi-Cal health plans are getting worse at caring for patients, not better. Among the most recent findings: The rates of breast and cervical cancer screenings for women were worse in 2020 than 2019, even when the demands that covid-19 placed on the health care system were factored into the analysis. Hospital readmissions increased, and diabetes care declined.

“The impact of covid is real — providers shut down — but we also know we need a lot of improvement in access and quality,” said State Medicaid Director Jacey Cooper. “We don’t feel we are where we should be in California.”

Cooper said her agency is cracking down on Medi-Cal insurance plans that are failing to provide adequate care and is strengthening oversight and enforcement of insurers, which are required by state law to provide timely access to care and enough network doctors to serve all their members.

The state is also requiring participating health plans to sign new contracts with stricter quality-of-care measures.

Cooper argues CalAIM will improve the quality of care for all Medi-Cal patients, describing aspects of the initiative that require health plans to hook patients up with primary care doctors, connect them with specialty care, and develop detailed plans to keep them out of expensive treatment zones like the emergency room.

Michael Reed, who is in his mid-50s, ran out of his medication for high blood pressure in April and went to MLK Community Hospital for a refill. He explained he didn’t have a primary care doctor and didn’t know where else to turn. “This is a good hospital,” Reed says.(Angela Hart / KHN)

She denied that CalAIM will leave millions of Medi-Cal patients behind and said the state has increased incentive and bonus payments so health care providers will focus on improving care while implementing the initiative.

“CalAIM targets people who are homeless and extremely high-need, but we’re also focusing on wellness and prevention,” she told KHN. “It really is a wholesale reform of the entire Medicaid system in California.”

A chorus of doctors, hospital leaders, health insurance executives, and health care advocates point to Medi-Cal reimbursement rates as the core of the problem. “The chronic condition in Medi-Cal is underfunding,” said Linnea Koopmans, CEO of the Local Health Plans of California.

Although the state has restored some previous Medi-Cal rate cuts, there’s no move to increase base payments for doctors and hospitals. Cooper said the state is using tobacco tax dollars and other state money to attract more providers to the system and to entice doctors who already participate to accept more Medi-Cal patients.

When Newsom vetoed the bill to provide higher reimbursements primarily for emergency room care at MLK, he said the state cannot afford the “tens of millions” of dollars it would cost.

MLK leaders vow to continue pushing, while other hospitals and the powerful California Medical Association plot a larger campaign to draw attention to the low payment rates.

“Californians who rely on Medi-Cal — two-thirds of whom are people of color — have a harder time finding providers who are willing to care for them,” said Jan Emerson-Shea, a spokesperson for the California Hospital Association.

For Dr. Oscar Casillas at MLK, the issue is critical. Although he’s a highly trained emergency physician, most days he practices routine primary care, addressing fevers, chronic foot and back pain, and missed medications.

“If you put yourself in the shoes of our patients, what would you do?” asked Casillas, who previously worked as an ER doctor in the affluent coastal city of Santa Monica. “There’s no reasonable access if you’re on Medi-Cal. Most of the providers are by the beach, so emergency departments like ours are left holding the bag.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Angela Hart:
ahart@kff.org,
@ahartreports

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Cancer

Reporter Follows Up on ‘Cancer Moonshot’ Progress and the Bias in Digital Health Records

KHN correspondent Darius Tahir discussed the latest developments related to the federal “Cancer Moonshot” initiative on Houston Public Media’s “Town Square With Ernie Manouse” on Oct. 4. Tahir also discussed how bias can be embedded in medical records on America’s Heroes Group’s “Roundtable” on Oct. 1.

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Abortion

Abortion Bans Skirt a Medical Reality: For Many Teens, Childbirth Is a Dangerous Undertaking

LITTLE ROCK, Ark. — Maryanna’s eyes widened as the waitress delivered dessert, a plate-sized chocolate chip cookie topped with hot fudge and ice cream.

Sitting in a booth at a Cheddar’s in Little Rock, Maryanna, 16, wasn’t sure of the last time she’d been to a sit-down restaurant. With two children — a daughter she birthed at 14 and a 4-month-old son — and sharing rent with her mother and sister for a cramped apartment with a dwindling number of working lights, Maryanna rarely got out, let alone to devour a Cheddar’s Legendary Monster Cookie.

On this muggy September evening, though, she was having dinner with her “sister friend” Zenobia Harris, who runs the Arkansas Birthing Project, an organization working to reduce the odds that Arkansas women and girls die from pregnancy and childbirth. In a highchair next to her, Maryanna’s daughter, Bry’anna, spiraled sideways and backward, her arms outstretched, flying. Her eyes would settle on her grilled cheese, and she’d swoop her small hand down to pick up the sandwich.

Maryanna suffered mightily during Bry’anna’s birth. (KHN is not using the family’s last name to protect Maryanna’s privacy.) She remembers telling her mother, “I don’t want to do none of this.” Nurses routinely checked to see how far she had dilated, a painful prodding of the cervix typically done before pain medications are administered.

“Nobody talks about that. I would not open my legs wide enough for them,” she said, cringing at the memory. “There were seven nurses up in there, and I was like, ‘No! Why ya’ll doing this?’”

Hours later, a doctor used vacuum suction to pull the baby through Maryanna’s 14-year-old vaginal canal, ripping apart the skin and muscle of her perineum.

The U.S. has one of the highest teen birth rates among developed nations, even after three decades of improvement. And Arkansas, roughly tied with Mississippi, has the highest teen birth rate in the country.

A U.S. map of teen birth rates from 2020, the latest data available, looks eerily like the results of the Joe Biden-Donald Trump match-up and, not coincidentally, a post-Roe v. Wade guide to legal and illegal abortion. Liberal-leaning states largely have the lowest teen birth rates per 1,000 females: Massachusetts (6.1), New Hampshire (6.6), Vermont (7), Connecticut (7.6), Minnesota (9.1), New Jersey (9.2), Rhode Island (9.4), New York (10), Oregon (10.1), Maine (10.6), Utah (10.8), California (11).

And conservative states largely have the highest rates: Arkansas (27.8), Mississippi (27.9), Louisiana (25.7), Oklahoma (25), Alabama (24.8), Kentucky (23.8), Tennessee (23.3), West Virginia (22.5), Texas (22.4), New Mexico (21.9).

Teenagers in Arkansas do not have significantly more sex than teens elsewhere, according to a 2019 risk behavior survey by the Centers for Disease Control and Prevention, but they are far less likely to use birth control. Sex education is not required in Arkansas schools and, by law, any school-based curriculum must stress abstinence.

In 2017, Gov. Asa Hutchinson, a Republican, successfully jettisoned Planned Parenthood clinics from the state’s Medicaid program. Since then, girls and women who receive medical care at the organization’s clinics cannot use Medicaid coverage to obtain contraception.

Arkansas’ trigger ban outlawing abortion went into effect the day the Dobbs v. Jackson Women’s Health Organization decision came down in June. A woman can receive an abortion only if her death is imminent. For teenagers seeking medical care to end a pregnancy, the nearest clinic where abortion is accessible is in Illinois, 400 miles northeast of Little Rock, a six-hour drive.

“If you’re from a small town in Arkansas, the idea of going to Chicago or Colorado, it may as well be on the moon,” said Gordon Low, a nurse practitioner at Planned Parenthood in Little Rock. Faced with finding a car and gas money, or dealing with a school absence, teenagers “may throw their hands up and continue with the pregnancy, even if they don’t want to.”

For Maryanna, abortion did not really seem an option even before the Dobbs decision. Like many adolescent girls in Arkansas, her extended family is filled with moms who gave birth as teens and whose children grew up to do the same. It’s the life she knows, and, at least at first, the notion of having a baby seemed a respite from the chaos of her family life.

Bry’anna’s father, who Maryanna believes is 19, is not in the picture. She was in eighth grade when her mother, battling her own stresses, took off — temporarily, it turned out — and left Maryanna and her siblings with her “brother’s baby mother’s family.” Into that stew of terrifying uncertainty, the texts from an older boy felt comforting.

They’d been texting each other for a month, with the boy “acting like he could relate to me,” she said. “He was, like, ‘Your momma gone, so you might as well do this or that.’ I just fell for it.” She remembers thinking, “Yeah, she is gone. She told me to save my virginity, but who listens to her anymore? I was just upset.”

Girls’ menstrual cycles can take years to settle into a predictable routine, and Maryanna initially made nothing of the fact that it had been months since she last bled. By then, her mother had returned and the family was living, periodically, in a motel. She considered adding water to her pee to outsmart the pregnancy test, but, she said, “Something was telling me, ‘No, you want to know the truth.’”

A few months after Bry’anna’s birth, Maryanna had sex with an older teenager who only pretended to put a condom on, she said. She gave birth to her son, Tai’lyn, in April.

The young man’s name is listed on Tai’lyn’s birth certificate, but like Bry’anna’s father, he has never paid child support.

***

Traditionally, teen motherhood is viewed as a symptom of poverty, invoking puzzled head-shaking by wizened adults and calls from many conservative lawmakers for young, unmarried people to stop having sex. But it is also a dangerous undertaking for a teen mother and baby.

Infant mortality rates in Arkansas are highest for babies born to women younger than 20, and the large number of teen births fuels the state’s third-highest infant mortality rate in the country. Arkansas women have the highest rate of pregnancy-related deaths in the U.S., according to CDC data, about double the national average.

Hajime White (right) with her daughter Gwen and Gwen’s daughter, Quen, at the family compound in Warren, Arkansas. Gwen had her first baby, a son, at 16, and, defying the odds for teen moms, went on to finish high school and earn a degree in pharmacy tech. “She never stopped because she had the support of me, her dad, her sisters,” Hajime says. (Sarah Varney / KHN)

For young women who continue their pregnancies, the emotional and physical challenges can be daunting. The age at which girls in the U.S. begin menstruating has dropped in recent decades, in part due to widespread obesity, but the physiological changes necessary to birth and feed a newborn require additional years of development.

“When she has her first menstruation, she is capable of becoming pregnant, but that doesn’t mean she is capable of having a child,” said Dr. Dilys Walker, director of global health research for the Bixby Center for Global Reproductive Health at the University of California-San Francisco.

Walker explained that during adolescent development, the beginning of menarche signals the start of a growth spurt that can take up to four years to complete. During that time, a girl’s uterus and bony structures, including her pelvis, remain narrow, developing slowly as she ages.

It’s a precarious moment to give birth. It’s not uncommon for girls to face obstructed labor “because their pelvis is not developed enough to accommodate a vaginal delivery,” said Dr. Sarah Prager, an obstetrics and gynecology professor at the University of Washington School of Medicine.

Going through with a vaginal birth could cause lasting damage to a teen’s pelvic area and rectum. So, teenage childbirth often ends in cesarean section, causing uterine scarring that almost guarantees she will need to give birth via cesarean section if she has more children.

“Adolescents are at increased risk for low-birth-weight babies, high blood pressure in pregnancy, preeclampsia, higher complications from sexually transmitted diseases, and increased rate of infant death,” said Dr. Anne Waldrop, a maternal-fetal medicine fellow at Stanford University.

Abortion opponents have argued in recent months that girls are duty-bound to give birth no matter how old they are. In the high-profile case of a 10-year-old rape victim from Ohio who traveled to Indiana for an abortion, James Bopp, chief counsel for the National Right to Life Committee, said, “She would have had the baby, and as many women who have had babies as a result of rape, we would hope that she would understand the reason and ultimately the benefit of having the child.”

A judge in Florida recently ruled that a 16-year-old girl “had not established by clear and convincing evidence that she was sufficiently mature to decide whether to terminate her pregnancy.”

The elevated risks of teen childbirth were not weighed.

***

Hajime White saw what preeclampsia can do to a young woman close-up, when it nearly killed her daughter.

Hajime lives in Warren, a lumber town 90 miles south of Little Rock, where she helps run the Precious Jewels Birthing Project, an offshoot of Zenobia’s Arkansas Birthing Project that offers support for pregnant women and girls and new moms. Hajime was in 11th grade when she got pregnant the first time; the fetus grew without a brain and died inside her. Full of grief, she married her boyfriend. They went on to have six girls, ages 17 to 30, and recently celebrated their 30th wedding anniversary.

On a recent Sunday, after playing piano for the liturgy at St. John African Methodist Episcopal Church, she met her cousin, Monique Davis, at a Mexican restaurant in downtown Warren to assess the needs of the week. Women reach out in need of diapers, breast pumps, formula, and, quite frankly, said Hajime, money.

The “sister friends” counsel their “jewels” to take prenatal vitamins and see a doctor. Self-denigration is a common response Hajime will not let stand. “They’ll say, ‘I’ll just be like my mama. I’m not going to amount to nothing.’ And I was like, ‘No! You got a life ahead of you.’”

That was the message she gave her own daughter Gwen, who became pregnant at 16. Hajime remembered how, when she was a pregnant teen, her grandmother pronounced her life ruined. “She said, ‘Everything you ever did is over with.’”

Gwen White nestles her second child, Quen, in a studio shed outside her mother’s home in Warren, Arkansas. Quen was delivered by cesarean section after Gwen developed preeclampsia, a pregnancy complication that almost killed her.(Sarah Varney / KHN)

About a third of the girls who drop out of high school cite pregnancy or parenthood, and Hajime was determined to keep Gwen in school. “She never stopped because she had the support of me, her dad, her sisters,” Hajime said. Two of her daughters are in college, another just graduated from high school, and Gwen earned a degree in pharmacy tech. Her oldest daughter, Majestic, is a certified nursing assistant.

It was a surprise, then, when Gwen, pregnant with her second child at 21, felt piercing pain in her pelvis last spring. Her doctor advised standard pregnancy fare: a pillow between her legs, light stretching. By eight months, Gwen’s petite legs were swollen, stretching tight her ankle bracelets. The doctor blamed too much salt. In July, she was willing herself to enjoy her baby shower when pain ricocheted inside. She could barely breathe on the drive to the hospital.

Gwen went in and out of consciousness as the swelling moved into her chest and her face turned dark. “We would try to wake her back up, her eyes would look at us, she was there, but she wasn’t there,” said Hajime. With protein levels in her urine dangerously high, symptoms that had once been dismissed — water retention, seizures — were now full-fledged preeclampsia, a potentially fatal syndrome marked by rising blood pressure. With the baby in distress, doctors performed a C-section.

Two months later, itty-bitty Quen slept on Gwen’s lap inside an air-conditioned studio shed on her mother’s property. Gwen is still recovering. Breastfeeding after surgery has been painful, and she is advised against lifting anything.

Back in Little Rock, in between spoonfuls of Cheddar’s Legendary Monster Cookie, Maryanna said she is dead set on staying un-pregnant. “I can’t mess up again,” she told Zenobia. “I’m kinda scared of sex now. I’m paranoid. Everybody trying to trap you.”

One of Maryanna’s brothers, she confided, recently found out his girlfriend was pregnant. The couple already have an infant. “She can’t afford another baby right now,” Maryanna said. Would she make the journey to Illinois? “I don’t think she has a way out of state.”

Sarah Varney:
svarney@kff.org,
@SarahVarney4

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