By Darryl McGrath
Tuesday, January 29, 2002
An ongoing fiscal crisis in Massachusetts threatens the future of Healthy Start, which provides prenatal care to low-income women. The state's governor, who recently had a high-risk pregnancy herself, hasn't persuaded the House to vote on the issue.
(WOMENSENEWS)--A prenatal care program in Massachusetts credited with having helped lower a shockingly high infant mortality rate is in jeopardy, caught between a budget crisis and political wrangling.
A Massachusetts state court judge issued an injunction two weeks ago to force the state health department to continue enrolling low-income women in the Healthy Start program and to continue providing services to women already enrolled.
The Massachusetts Law Reform Institute, a legal services advisory group that represents low-income residents, obtained the injunction after suing the Commonwealth of Massachusetts to prevent threatened cutbacks in Healthy Start enrollment. The cutbacks could have affected an estimated 1,000 women.
But even with the injunction, the future of the program is not assured. The latest effort by the Massachusetts legislature to restore Healthy Start funds that were cut in the state's ongoing fiscal crisis has stalled in the state's House of Representatives. Those monitoring the impasse are not optimistic.
"This will be an incredible struggle to comply with the court order, given the fiscal realities the state is facing," said Roseanne Pawelec, a spokeswoman for the Massachusetts Department of Public Health.
Massachusetts founded its Healthy Start program in 1985 after the state's infant mortality rate of 9.1 deaths for every 1,000 births drew comparisons to Third World countries. Similar programs also using the Healthy Start name exist in many other states. In Massachusetts, enrollment in Healthy Start gives low-income women prenatal care, prescriptions for medications related to pregnancy and access to outreach and advocacy services.
Healthy Start is credited with helping reduce the Massachusetts infant mortality rate to 5.2 deaths per 1,000 births.
After birth, infants whose mothers are enrolled in Healthy Start are covered by one of two state healthcare programs for children. Their mothers get six weeks of postpartum care through Healthy Start. About 4,000 women are enrolled, many of them part of the state's growing immigrant population of South and Central Americans.
"It's multiple things that will reduce your infant mortality rate, but this is a critical component of it," said Sally Fogerty, an assistant commissioner at the Massachusetts health department's Bureau of Family and Community Health. "One thing we do know is women without prenatal care have a much higher infant mortality rate. And so the goal of the program is to get women into the program and prenatal care as early as possible and provide them with ongoing prenatal care."
Healthy Start has done that, providing care to more than 100,000 pregnant women since its inception.
Advocates of the program have watched the political bickering between the House and Gov. Jane Swift's office with growing frustration.
State Rep. Kathleen Teahan, a Democratic member of the legislature's Health Care Committee and an aggressive advocate of Healthy Start, filed an amendment to put the $2 million in threatened cuts to Health Start back into the House version of the supplemental budget, to no avail.
Teahan points out that by trying to save the $2 million in the short run, the state could eventually end up paying more than the entire $7 million annual budget for Healthy Start, in emergency medical services to premature or underweight newborns.
Teahan, a Democrat who opposes abortion, sees another advantage to Healthy Start. An uninsured woman, faced with a pregnancy and little or no income, can feel isolated and desperate. Healthy Start "gives a woman another alternative to abortion, when she finds herself pregnant and overwhelmed," Teahan said.
Massachusetts didn't pass a state budget for the current fiscal year until December, five months past the July 1 deadline. Swift, a Republican, then submitted a supplemental budget to restore cuts in certain social services and bring other services up to funding levels that could cover anticipated increases in enrollment.
Included in the governor's supplemental budget was an additional $2 million to cover the estimated 1,000 additional women who had either just begun the paperwork to qualify for Healthy Start or recently had enrolled. The state Senate supported restoring the funds. The Massachusetts House, controlled by Democrats, however, has yet to vote on the measure, even though its Ways and Means Committee has recommended approval.
As of Jan. 25, no date had been set for a House vote on the supplemental budget that could restore the Healthy Start funds.
As the politics play out, women receiving Healthy Start services say the program has made a tremendous difference in their lives. Among them is Ronisha Austin, 27, of the Dorchester section of Boston, who started her maternity leave unexpectedly early after an emergency trip to the hospital for a diabetic episode in December. Her baby is due March 1.
A bookkeeper at a financial services company, Austin supports herself and her 9-year-old daughter on a $32,000 salary. She cannot afford the $230 monthly cost for health insurance.
"A nurse at the clinic I visit gave me information and told me it would probably be a good idea for me to enroll, because I didn't have insurance," Austin said. "I was a high-risk pregnancy. They were really great. They've been helpful in preparing me."
Critics have called on Swift to push more aggressively for restoration of the Healthy Start funds, noting that the governor--who gave birth to twins last May--should be more sympathetic to women facing difficult pregnancies.
"It's particularly galling that the governor, who had a high-risk pregnancy herself, would deny services to 1,000 women," said Allison Staton, manager of statewide issues at Health Care for All, an advocacy group that has protested the planned cuts to Healthy Start. Staton argues that even though it's the Democratic House stalling, the governor should exercise more pressure to get the bill passed.
Dominick Ianno, spokesman for the governor's budget office, said the governor has pushed as much as she can as governor.
Teahan, the Health Committee member, hopes the state can scrape the necessary funds out of other budget lines, such as ice and snow removal in what has been a mild winter. Despite the state's bleak fiscal outlook, she plans to continue supporting Healthy Start.
Darryl McGrath is a journalist in Albany, N.Y., who has written extensively on child welfare issues and social services systems.
Health Care For All:
Massachusetts Department of Public Health:
Entering the words "Healthy Start prenatal care pregnant income"
on the search link of the home page will pull
up numerous articles on prenatal care from the department's archives.
Maternal and Child Health Bureau: