In a world where women do not often have a place to turn for additional support, Pregnancy Resource Centers (PRCs) do a phenomenal job of providing both a safe harbor and wings to fly for pregnant women. That being recognized, a question lingers. While PRCs are offering key services like pregnancy testing and ultrasounds, are women who are undecided about continuing their pregnancy truly being holistically supported beyond that initial screening? This especially applies in the case of disadvantaged women, who are likely not getting their most basic needs met daily.
While the good currently being done by PRCs cannot be overemphasized, when and why should they explore the opportunity to champion women throughout their pregnancy by offering medical services, thus achieving their goal of affirming life more impactfully as a result? This piece will explore the unique opportunity presented to PRCs in transitioning to a medical model. Shifting to a medical clinic would not only allow them to sustain their mission to affirm life but also allows them to meet the needs of women in a more tangible and holistic way through medical services. This model also offers PRCs the added benefit of stabilizing a revenue stream to help combat the unpredictability of donor funding, and shift toward the steadier revenue stream offered by insurance, which will also assist in covering the clinic’s operating cost.
Our Present
Pregnancy resource centers are typically local, nonprofit organizations that provide support and information to women and men faced with making decisions about an unexpected or unintended pregnancy. The history of the modern pregnancy resource center movement began in the late 1960s, as several states began to remove legal restrictions on abortion1. The first PRC was opened in Hawaii in 1969 and evolved into a network of volunteer-run “Pregnancy Problem Centers” across the nation. These centers offered free pregnancy testing, counseling, and some emergency and financial help for women considering abortion. In the decades to follow, ultrasound technology became widely available as a critical tool of PRCs. Today about half of PRCs in America offer ultrasound services to the women they serve at little or no cost1.
While countless women have received unmeasurable support at what is often a high period of need, the resources provided are typically only a portion of what is needed throughout the duration of pregnancy and motherhood. With the overturning of Roe v. Wade, there is also intense scrutiny on PRCs as being “fake clinics”. Paired with concerns related to U.S. maternal mortality and morbidity as well as maternity deserts, 2023 represents a tipping point by which PRCs should consider how they might reconsider the services provided to women and support their mission in a more effective way.
Life-Affirming Care Should Be Comprehensive Care
We are all complex and multi-dimensional, and the women who seek support from a PRC are no different. Many of these women often come from underserved communities, with a wide range of medical, psychological, spiritual, and social support needs that are not being met. PRCs have long served as a beacon of hope for women in need. With a heart for service, they have consistently provided for the basic needs of pregnant women at times in an effort to encourage them to consider not undergoing an abortion. However, despite best efforts, the limited range of services that PRCs offer often fall short of providing a woman the support she needs through a pregnancy.
By adopting a full medical model, the core mission and services of a PRC can be maintained while the expansion of clinical services meet a wider spectrum of physical and psychosocial needs for its patients. By adding prenatal and postnatal care, vulnerable women are seen regularly by healthcare professionals who are trained to recognize danger signs during or after pregnancy. Regular visits with licensed professionals means quality and non-judgmental healthcare will be provided. Furthermore, utilizing a clinic nurse as a care navigator means that the diverse care needs of the women can be referred outwards from the clinic. Having well-developed referral sources to support other healthcare needs such as diabetes management, nutritional needs, and mental health needs – in addition to material goods, food, or shelter security – means that pregnancy outcomes can be optimized.
Comprehensive Care is Not Just Physical Care
Mental health needs are an example of how clinics can coordinate needed care. Healthcare providers are trained to conduct mental health screenings and provide referrals to much needed assistance. Statistics show that 1 in 5 women will experience a mental health condition during pregnancy or in the year following the birth2. Among women with perinatal (while pregnant) mental health conditions, 20% will experience suicidal thoughts or undertake acts of self-harm.3 Therefore, ignoring perinatal mental health issues not only risks women’s overall health and well-being but also impacts infants’ physical and emotional development.3
As a result, screening for specific types of trauma and mental health issues during a pregnancy are either required or recommended by multiple organizations including (but not limited to) the National Academy of Medicine (formerly the Institute of Medicine) and the American Medical Association.4 Further underscoring the need to require mental health assessments, the American College of Obstetricians and Gynecologists recommend screening pregnant women for circumstances of intimate partner violence5, sexual assault6, and childhood sexual abuse7 within their guidance.4 When a PRC transitions to a medical model, they can have providers in-house that can conduct these assessments. If a disorder is confirmed, clinics can provide and refer patients for other specialized medical services not already provided within their home clinic.
A holistic model also includes spiritual support to patients to support needs in this domain, which many PRCs already offer and can thus be maintained. This could start with more generalized pastoral support followed by enhanced, faith-specific counseling. Therefore, adding medical services, like mental health assessments and referrals, to the core offerings of PRCs makes for more of an effective and “one-stop shop” approach in assisting the women they desire to reach.
Medicaid – Why Pregnancy Clinics Can & Should Accept It
Medicaid, the state–federal health insurance program for individuals with low incomes, serves as a safety net for women throughout their life span. It is the largest payer of pregnancy services, financing between 40% and 50% of all births in the United States.8 Research shows that women with Medicaid coverage use primary care and preventive services at rates that approach those of privately insured women and are less likely to forego care due to cost than their uninsured counterparts8; making these women a reliable source of clinic clientele. In contrast, uninsured women receive less preventive care and treatment for medical conditions, are more likely to be diagnosed at advanced stages of illness, and have higher mortality rates from certain diseases, including breast cancer8; and have the potential to increase rates of maternal morbidity.
Women who meet the financial criteria for Medicaid have presumptive eligibility for Medicaid with a positive pregnancy test validated by a healthcare professional. When a PRC becomes a licensed clinic within the state it operates in, women can be enrolled at the very first visit when pregnancy is often confirmed. This then allows the clinic to bill forward and retroactively for services rendered including ultrasound, laboratory testing, mental health screening, prenatal visits, group prenatal visits, and more. While there are variations that exist between states, most states cover prenatal vitamins and most other prescribed medications. Many mental health services, breastfeeding support and specialist referrals, dental care, and prenatal education are also covered. Best of all, services also extend through the 60-day post-partum period with advocacy to extend services to a full year.9
Medicaid Enrollment Drives the Operational Health & Funding of Clinics
When a PRC decides to switch to a full medical model and enroll its patients in Medicaid when they meet those requirements, a new revenue stream is created which can be re-invested back into services. Meanwhile, insured patients mean simply, a clinic can cover its operating costs.
Conversely, within the traditional structure of PRC models, there is an increased likelihood of dependency on philanthropic donations. Often these grants and donation sources come with requirements and conditions that can be difficult to navigate. At times, this often results in not only inconsistent income streams, but also unpredictability in clinical operations and funding.
Alternatively, when a clinic can depend on Medicaid or private insurance to cover the costs of care provided to the patients in the clinic, it frees up any grants and donations to support their larger mission and serve patients in new and innovative ways. The benefits of enrolling pregnant women in Medicaid are two-fold. It will cover the costs of clinical services and, most importantly, sets a woman up to be an agent of her own health and a recipient of the healthcare support she may desperately need.
Maternity Deserts – We Are Uniquely Positioned to Help
Despite Medicaid enrollments there is an alarming trend underway in the United States. Many clinics are either deciding to not accept Medicaid patients in favor of more lucrative private-payer contracts or are closing their doors to the provision of obstetrical care altogether. This is creating a dire situation in certain parts of the country where maternity care is becoming difficult, if not impossible to find. Areas where there is low or no access to pregnancy care affect up to 6.9 million women (about twice the population of Oklahoma) and almost 500,000 births across the U.S.10 This includes a five percent increase in counties that have less maternity access since 2020. In maternity care deserts alone, approximately 2.2 million women (about the population of New Mexico) of childbearing age and almost 150,000 babies are affected.10 PRCs do exist in these maternity deserts but unfortunately, the full medical services that are so desperately needed are often not available within them.
PRCs that transition to a full medical model are uniquely positioned to not only support a woman through their pregnancy from start to finish by providing prenatal and postnatal care but can become a “medical home base” for that woman for life. Not only can complete care be provided within a current pregnancy, but also in needed future care such as subsequent pregnancies, preventative health screenings, STD/STI screenings and treatment, or as a safe place to discuss reproductive health needs.
Caring for the Whole Woman
Caring for women should mean caring for the whole woman. By approaching care with the provision of a holistic and full medical model, uninsured women can become insured under Medicaid and receive a wide range of fully covered services. Exceptional and coordinated care can be provided that empower women to achieve optimal outcomes for themselves and their babies.
References
1. The Ethics & Religious Liberty Commission of the Southern Baptist Convention. A Brief History of Pregnancy Resource Centers. https://erlc.com/resource-library/articles/a-brief-history-of-pregnancy-resource-centers/. Retrieved 3/23/2023.
2. Simply Psychology. Maslow’s Hierarchy of Needs. Mcleod, Saul. March 21, 2023. https://simplypsychology.org/maslow.html
3. WHO. Launch of the WHO guide for integration of perinatal mental health in maternal and child health services. Sept 19, 2022. https://www.who.int/news/item/19-09-2022-launch-of-the-who-guide-for-integration-of-perinatal-mental-health . Retrieved 3/23/2023.
4. American College of Obstetricians & Gynecologists (ACOG). Caring for Patients Who Have Experienced Trauma. Committee Opinion. No. 825. April 2021. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/04/caring-for-patients-who-have-experienced-trauma . Retrieved 3/20/2023
5. Intimate partner violence. Committee Opinion No. 518. American College of Obstetricians and Gynecologists . Obstet Gynecol 2012 ; 119 : 412 – 7 .
6. Sexual assault. ACOG Committee Opinion No. 777. American College of Obstetricians and Gynecologists . Obstet Gynecol 2019 ; 133 : e296 – 302 .
7. Adult manifestations of childhood sexual abuse. Committee Opinion No. 498. American College of Obstetricians and Gynecologists . Obstet Gynecol 2011 ; 118 : 392 – 5
8. Henry J. Kaiser Family Foundation. Medicaid’s role for women . Menlo, CA: KFF; 2019. Available at: https://www.kff.org/womens-health-policy/fact-sheet/medicaids-role-for-women/. Retrieved 3/20/2023
9. Henry J. Kaiser Family Foundation. Women’s health insurance coverage . Menlo, CA: KFF; 2021. Available at: https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/. Retrieved February 16, 2021.
10. March of Dimes. Maternity Care Deserts Report. Nowhere to Go- Maternity Deserts Across the U.S. (2022) https://www.marchofdimes.org/maternity-care-deserts-report Retrieved 3/19/2023.
