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Public Advocate Betsy Gotbaum Opening Remarks
New York City Council Oversight Hearing on
Maternal and Newborn Health
February 7, 2008
Thank you Councilmember Rivera for holding this hearing today and for co-sponsoring Intro 575.
Last May, we introduced Intro 575 to require the city’s Department of Health and Mental Hygiene (DOHMH) to display, on their website, hospital and birth center statistics on c-sections and other maternity procedures in a user-friendly format that allows individuals to compare rates at various hospitals.
Since 1989, New York State has mandated that hospitals provide expectant mothers with informational pamphlets on caesarean section rates and other statistics about maternity-related procedures. This law, called the Maternity Information Act (MIA), requires that information be given directly to expectant mothers at the time of pre-admission, as well as to the general public upon request.
In 2004, the average annual rate of delivery by c-section in city hospitals was 28.6 percent. By 2006, this rate had increased to 30.6 percent. All New York City hospitals in 2005 had rates higher than the 15 percent maximum rate recommended by the World Health Organization. In some cases, a cesarean section may be the best option for a mother and baby, as it can be a life-saving procedure. Yet c-sections can result in a variety of problems, including infections, hemorrhage, injury to other organs, anesthesia complications, infertility, and psychological trauma.
My office conducted a study in 2005 to evaluate NYC hospital compliance with the Maternity Information Act. Unfortunately, we found that none of the city's 44 hospitals were providing the mandated information to any member of the public upon request. And our follow-up report in 2006 showed the same thing: 100% non-compliance with MIA.
After our second report, I wrote to the directors of every city hospital and asked them to provide my office with the legally-mandated MIA pamphlets. My staff made repeated calls to convince the hospitals to comply, and after many months, we succeeded. By August 2007, all 44 city hospitals had provided copies of their informational pamphlets.
But we’re a long way from our goal. Much of the information included in the pamphlets is outdated, and we are concerned about whether or not the pamphlets are distributed upon request. Because it is so important that expectant mothers have information about the hospital they choose to deliver in, we introduced this bill to ensure that information was as accessible as possible.
The good news? The New York State Department of Health has already started posting this information on-line. However, currently, the essential data that the MIA requires is not easily located on their website. It is a multi-step process that feels much like a guessing game – the data can only be found in individual hospital profiles and cannot be compared on a single screen. The path to this information needs to be streamlined and access to it on the website must be clear and simple. An expectant mother should be able to log onto this website and see a link that says “Important Maternity Data and Statistics,” and find all of the information available by clicking that link.
I had a productive conversation Commissioner Daines earlier this week to discuss changes to the way the state website delivers this important maternity information; it was refreshing to talk with a commissioner who is open to a good suggestion when he hears one. I commend him for his willingness to discuss this matter and I am confident our dialogue will continue.
The city DOHMH, as I understand it, is opposed to our bill, but would be open to linking to the state DOH website. This sounds like a good solution to me, as long as we work with the state to clean up their website so that maternity data is accessible and easy to find.
Hopefully we can work together towards a compromise. However, if we are unsuccessful attaining our goals and the state DOH will not make these changes to the website, then we plan to move forward with Intro 575, which we fully believe is an important step in getting expectant mothers important maternity information.
Accordingly, I would welcome anyone testifying today to express their support, on the record, for why this bill is important.
Expectant mothers need to make informed decisions, especially in regard to c-sections. Ensuring that women are able to access important maternity information easily and from the comfort of their own homes would allow all expectant mothers to get the information they need.
A second important issue I would like address today is access to prenatal care. Research has shown that prenatal care is associated with reduced risk of defects, low birth weight infants, premature birth, and infant death. To be fully effective, prenatal care should be accessed in the first months of pregnancy.
Yet in 2005, nearly 28 percent, almost a third of women who gave birth in New York City did not receive prenatal care during their first trimester. This fact is especially disturbing in light of the high infant morality rate in some New York City neighborhoods, such as Central Harlem, Mott Haven, Bronxville, Astoria and Corona.
In a recent report, my office investigated access to prenatal care at Health and Hospital Corporation (HHC) facilities across the city and found several administrative barriers that may discourage and delay women’s access to timely prenatal care.
Our report found that two-thirds of city HHC facilities failed to offer weekend or evening prenatal care appointments. Additionally, more than 70 percent of facilities required women to make in-person visits to the facility before making an appointment with a physician; and more than 50 percent of the clinics did not know, or did not volunteer, information about the availability of health insurance for uninsured pregnant women through the Prenatal Care Assistance Program.
While I am encouraged by HHC’s discernable effort to become more “baby-friendly” by promoting breast-feeding, as well as our administration’s financial commitment to new mother programs such as the Nurse Family Partnership, our report shows there are still many improvements to be made.
To start, the Health and Hospitals Corporation should expand evening and weekend hours, reduce wait times at its facilities, and train clinic staff to inform women about free and low-cost health insurance. Taken together, these steps will make prenatal care more accessible, particularly to low-income women. They will also help make an expectant mother's first experience with public health facilities more positive, increasing the likelihood of continued prenatal care.
Thank you.
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