Offering pregnant women help to manage their health risks might not move South Carolina out of last place for the country’s infant survival rates. But it’s a start.
Tony Keck, director of the S.C. Department of Health and Human Services, was right when he said infant mortality might be the state’s most pressing health problem. He advocates that doctors administer to pregnant Medicaid patients a simple questionnaire to identify risky behavior that could hurt their babies — like smoking cigarettes, drinking alcohol, domestic violence and drug use. There is also a question about mental health.
When warranted, the doctor recommends treatment options for the patient.
Called SBIRT (screening, brief intervention and referral to treatment), it has been successful in other states.
But not in South Carolina. Doctors have been slow on the uptake, although they are paid $45 each time one of their patients completes the test.
South Carolina also has a history of using punitive rather than therapeutic measures in an attempt to address infant mortality.
When Charlie Condon was Ninth Circuit solicitor (1981-1992), he encouraged doctors to perform blood tests on pregnant patients to determine if they were using illegal drugs and then report them to police.
The courts eventually ruled that such tests could be administered only with the patient’s consent. And if South Carolina doctors are reporting patients to police these days, it is rare.
But South Carolina also has a law that declares that once she is in her third trimester, a pregnant woman is carrying a child, who is due legal protections given to 2-, 5- or 12-year-old children.
So if a doctor discovers, during that time, that a mother is using cocaine, for example, he might feel obligated to report her to law enforcement.
No woman would agree to a test — blood test or written — that might lead to her arrest.
And if women don’t agree to answer the questions — or if they answer erroneously — they will do no good.
SBIRT, administered early in a pregnancy, relieves the health care provider of that obligation and should be more palatable to patients.
Plus, it makes sense to deal with risks early on rather than later.
Another fear for women is that the Department of Social Services will take away their children. So referrals for treatment must be just that, not referrals to DSS. If treatment specialists are not successful in helping a patient manage her behavior, and if the behavior is endangering her children, then they should report it. But the goal is health, not punishment.
Clearly every effort should be made to give every baby a healthy start in life. It is shameful that the state’s infant mortality rate is the country’s highest.
Mr. Keck is right to look for ways to address the problem. Doctors should cooperate and help develop a health care protocol that is compassionate and effective.
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