More spending on municipal services may improve maternal outcomes
Local ambulances, libraries and even parks can impact labor and delivery fatalities, according to a study published by JAMA Network Open, as researchers assessed associations between public services and maternal morbidity.
“We’ve known little about how municipalities’ spending patterns are related to their residents’ health until now,” study co-author Felix M. Muchomba, PhD, MPH, assistant professor at the Rutgers School of Social Work, said in a press release.
The findings suggest that increased public health spending can increase community health care resources that could in turn improve maternal health. For example, more spending on libraries, which provide the only access to the internet for many people, can provide education or health information leading to better health outcomes, Muchomba said.
Similarly, community health programs could reduce conditions associated with poor maternal outcomes such as obesity, hypertension and diabetes, the researchers said. Public transportation could enable residents better get to work, grocery stores and doctor appointments, which all improve health.
Spending on fire and ambulance departments can improve emergency transportation, the researchers continued. Parks provide opportunities for exercise and recreation. Stable and safe housing can provide health benefits during pregnancy as well.
As many as 60,000 women in the United States experience unexpected outcomes during labor and delivery each year, the researchers added.
Muchomba and colleagues examined 1,001,410 birth records from 2008 to 2018 across all 562 municipalities in New Jersey and linked 94% of these to at least one maternal hospital discharge record for inpatient hospitalizations at the time of delivery or within 6 weeks after giving birth. The mean age of the mothers was 29.8 years (SD 5.9 years), and 19,962 (2%) of them experienced severe maternal morbidity.
Between 2008 and 2018, New Jersey had a severe maternal morbidity rate of 199.3 per 10,000 births. The mean total municipal expenditure was $2,159 (SD $1,581) per capita.
Also, researchers analyzed data from the U.S. Census Bureau on overall municipal spending in each mother’s municipality of residence and specific spending on education, public health, fire and ambulance services, housing and community development, public welfare, police, transportation, libraries and parks, recreation and natural resources.
Education and police represented the largest categories for expenditures per capita with means of $353 (SD $1,010) and $337 (SD $222) respectively, together accounting for about one-third of total municipal expenditures. In contrast, researchers said, municipalities spent a mean of $7 (SD $16) per capita on public welfare, or less than 0.5% of total spending.
With each additional $1,000 spent per capita in these categories, the odds of having a bad maternal outcome, such as heart failure, kidney failure, cardiomyopathy and needing a blood transfusion, fell by 35.4% to 67.3% (OR = 0.33, 95% CI 0.15-0.72 to OR = 0.65, 95% CI 0.46-0.91).
However, increased spending on police had a negative association with better maternal outcomes instead of a positive association (OR = 1.15, 95% CI 1.04-1.28).
More research is needed to determine why, researchers said, but they noted modern policing uses a preemptive approach that involves more frequent interactions with civilians that can be stressful and traumatic with adverse health effects. Greater police spending could reflect underinvestment in services that promote maternal health, they added.
The northern region of New Jersey experienced better maternal outcomes than the southern region, with some exceptions such as the city of Newark at 339.2 cases of severe maternal morbidity per 10,000 births. Rates ranged from a low of 107.5 cases per 10,000 births in the northern suburb of Westfield to a high of 378.5 cases per 10,000 births in the southern city of Bridgeton, which is more than 2.5 times the nationwide rate, according to the CDC.
The 107.5-case rate in Westfield is only 36.5 cases lower than the estimated national severe maternal morbidity rate, which the researchers called surprising because New Jersey has one of the highest median incomes and lowest poverty rates in the United States.
Surveillance at the municipal level would be crucial for targeting resources that address maternal illnesses and death, said Muchomba, who also is an associate faculty member at the Rutgers Institute for Health, Health Care Policy and Aging Research.
By understanding differences in maternal outcomes at finer geographic levels, researchers added, problem areas and potential buffering and exacerbating factors also can be identified.
“Our research provides important information for policymakers interested in improving maternal health in New Jersey by pinpointing problem areas and identifying types of municipal spending that appear to be important, such as spending on health, transportation and housing,” study co-author Nancy E. Reichman, PhD, professor of pediatrics at Rutgers Robert Wood Johnson Medical School, said in the press release.
“This information has the potential to greatly benefit women in the state,” Reichman said.
Reference:
Muchomba FM, et al. JAMA Network Open. 2021;doi:10.1001/jamanetworkopen.2021.35161.