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PAGE 4 Out of Work and Eating Less PAGE 6 Medicaid Expansion Benefits Missouri's Health and Bottom Line PAGE 8 Medicaid Expansion Benefits Hardworking Missourians PAGE 12 A Pandemic Within the Pandemic PAGE 15 COVID-19 Cases in Lafayette County, MO PAGE 17 Black Suicide Rates Coexist with Rural Suicide Rates PAGE 21 Remembering Those Who Struggle to Maintain Sobriety Amid the Pandemic PAGE 27 Farmer Suicide Rate Continues to Rise in Rural Missouri PAGE 29 Amendment 2 Ballot Language The Department of Health and Senior Services (DHSS) is pleased to announce the release of the Missouri Pregnancy-Associated Mortality Review: 2017 Annual Report. DHSS is required per RSMo 192.990.7, to annually submit a report on maternal mortality in the state. The report is the product of over a year's work of the Pregnancy-Associated Mortality Review (PAMR) board and is based upon deaths that occurred in 2017, the most recent data available. The multidisciplinary board of experts from across the state is tasked with examining the causes and contributing factors associated with maternal mortality and ultimately determining interventions that could prevent these deaths from occurring in the future. "We are incredibly appreciative for the work that the PAMR board has accomplished," said Dr. Randall Williams, Director of DHSS. "It is extremely important to understand what can be done to protect the health of our mothers and babies and we are committed to working with partners in the state to decrease our maternal mortality rate." The 2017 annual report contains data including the timing of maternal deaths and factors that contributed to these deaths, such as substance use disorder. The report also reflects the disparities that exist in Missouri and among the most vulnerable populations, including Black and publicly- insured communities: ● In Missouri, Black women are four times more likely to die within one year of pregnancy than white women. ● In Missouri, Black women also experience a higher rate of severe maternal morbidity (213 per 10,000 live births) than white women (92 per 10,000 live births). ● In Missouri, women on Medicaid are five times more likely to die within one year of pregnancy than those with private insurance. The multidisciplinary board of experts from across the state found that the pregnancy-related mortality ratio (PRMR) in Missouri was 26 deaths per 100,000 live births and that 80 percent of these deaths were determined to be preventable. Cardiomyopathy was the leading underlying cause of pregnancy-related deaths. The leading causes of injury-related deaths were motor vehicle crashes (MVC) (41%), followed by overdoses/poisonings (33%). In 85% of the MVCs, the mother was NOT wearing a seat belt. "We have a lot of work ahead of us, but through addressing the issues identified by the PAMR board, the state of Missouri will be able to decrease our rate of maternal mortality, while simultaneously improving those situations related to this issue," said Ashlie Otto, PAMR Coordinator. The board continues to review cases and is nearly finished reviewing 2018 deaths and will begin reviewing 2019 deaths. These reports will be made available once all cases have been reviewed. The 2017 annual report can be viewed at https://health.mo.gov/data/pamr/. Missouri's Pregnancy- Associated Mortality Review board publishes first annual maternal mortality report Heidi Koger Proofreader Melissa Riggs Proofreader Marjorie Langas Graphic and Layout Margaret Phillips Developer/Programmer Tempest Wright Print/Digital Illustrator Tonia Wright Publisher Editor-in-Chief We want to hear from you! Let us know how we are doing on Facebook, Twitter @accessHealth1 or write: accessHealth is published by Grace Advertising & Consulting, Inc. 325 Broadway Lexington, MO 64067 A big thank you to our advertisers. #YesOn2 Vote August 4, 2020 for Medicaid Expansion PAGE 02 July 2020

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