Introduction
The protection of motherhood and childhood is a priority in the health care of any country. It includes a system of state public and medical measures to ensure the birth of a healthy child and the preservation of the mother’s health. In the maternity protection system, there are several stages of providing medical and social assistance.
At the first stage, a woman is assisted outside of pregnancy and is being prepared for motherhood. At this stage, women’s consultations, family planning centers, and medical and genetic consultations play an important role. At the second stage, therapeutic and preventive care is provided to pregnant women to preserve the health of the fetus and the pregnant woman. At this stage, the leading role belongs to women’s consultations, departments of pregnancy pathology in obstetric hospitals.
The quality of medical care encompasses several of its most essential characteristics, reflecting important aspects of care provided to a pregnant patient. Among them are the timeliness of medical services provided, as well as the correctness of the choice of patient management methods, their diagnosis, and rehabilitation. The health policy in maternal and child health should ensure that specialists achieve the highest possible outcomes in the provision of medical services.
The concept of medical care quality proposed by the legislator encompasses the full range of approaches to its assessment. Each assessment method is based on different criteria applied by experts. Therefore, the existing health policy issue is the need to introduce a clear list of aspects that make up high-quality and adequate medical care.
Issue Identification
There is a specific State legislative bill addressing the guarantee of quality care for pregnant women. This is SB 256: Pregnancy Support and Wellness Services bill. It represents an act relating to pregnancy support and wellness services (The Florida Senate, 2024). This act revises existing contract requirements for the Florida Pregnancy Care Network, Inc. (The Florida Senate, 2024). SB 256 requires the Department of Health to conduct annual visits to each organization within the network (The Florida Senate, 2024). Moreover, it establishes visit requirements and sets an effective date.
According to the bill, the department contract must include the contract deliverables, such as financial reports and other reports owed to the department (The Florida Senate, 2024). They should also include timelines for meeting contractual commitments and any additional conditions the department deems appropriate, such as staffing and location requirements. The contract must obligate the network to create, implement, and monitor, through subcontractors, a comprehensive system of care to fulfill the pregnancy, parenting, and wellness needs of qualified clients.
SB 256 is aimed at establishing and managing subcontracts with a sufficient number of providers to ensure the delivery of pregnant and parenting support services. It also regulates wellness programs so that they are available to qualified clients and that such services are maintained and managed during the contract term (The Florida Senate, 2024). According to SB 256, at least 85% of the contract money should be spent on pregnancy and parenting support services (The Florida Senate, 2024).
Wellness services should be provided through vouchers or other acceptable arrangements that allow patients to purchase services from authorized healthcare providers (The Florida Senate, 2024). They should require a background screening for all paid workers and volunteers of a subcontractor who offer direct client services to an eligible client who is a minor, an older adult, or a person with disability.
Issue Background
One of their most essential components of the issue background was the medical and social health problems in the state of Florida related to reproductive health care for the population. During the period of economic crisis and the transition to market relations in economic activity, deterioration in the medical and demographic situation was noted (Paton et al., 2020). This has led to the progressive negative trends in the health status of women and children (Yu et al., 2020). Over time, the population’s reproductive health reserves decreased, as did the quality of all stages of the reproductive cycle, including fertilization and pregnancy.
Government agencies paid much attention to finding ways to reproduce a healthy generation, which is associated with a woman’s pregnancy and childbirth. According to statistics from the state of Florida, the deterioration of population reproduction rates occurred against the background of a decrease in the quality of health of pregnant women (Pizzarossa & Nandagiri, 2021). Therefore, the background of the issue concerns the influence of medical and social factors on pregnancy and childbirth complications, and ways to prevent them in modern conditions.
The health of maternity patients is reliably associated with a minimum set of characteristics, such as the number of antenatal clinic visits. The frequency of visits to the antenatal clinic is due to the cost of this procedure (Paton et al., 2020). Therefore, special conditions are necessary to control the appearance of chronic extragenital and gynecological diseases. Their absence was part of the components that formed the issue background, since not everyone could afford frequent doctor visits during pregnancy (Yu et al., 2020). This has become one of the fundamental stages in the formation of the pregnancy health problem in Florida.
Legislation Background
Several legislative acts have already prepared the ground for the introduction of benefits for pregnant women in healthcare. For example, a pregnant woman cannot be fired, forced to work at night or on weekends, or sent on business trips (Nabugoomu et al., 2020). A woman working under an employment contract can count on maternity payments (Nabugoomu et al., 2020). After the child turns three, she will be able to return to her workplace (Daley et al., 2020). These legislative acts aim to give the expectant mother time to focus on her health.
To avoid unpleasant situations at work, a pregnant woman can get a pregnancy certificate from a women’s clinic and register it with the human resources department. The presence of this document means that she can now refuse night shifts, hazardous production, shift work, overwork, and business trips (Nabugoomu et al., 2020). If a pregnant woman needs to visit her doctor, she does not need to ask her boss for permission to leave (Daley et al., 2020). The labor code article exempts a pregnant woman from work for the time necessary for a visit to a specialist (Lin et al., 2021). At the same time, a medically conditioned absence should not affect wages.
Position Statement
The position on the health policy issue is that it is not very convenient for many mothers. Preferences and attitudes regarding the social status of women applying for a position have persisted in many companies. Since, according to SB 256, the employer will take over most of the expenses for pregnancy, women without children will be more likely to be discriminated against when applying for a job (Yu et al., 2020). Employers will look more carefully for reasons not to employ women, so as not to be responsible for future maternity payments.
The fact that companies already have tacit prohibitions against specific categories of women is evidenced by HR managers’ attitudes. Most often, they are afraid to hire married women without children (Lin et al., 2021). 70% of companies reported that a woman’s marital status does not affect the decision to hire her (Pizzarossa & Nandagiri, 2021). However, this figure differs from the previous adoption rate of SB 256, which was 86% (Falck et al., 2021). Thus, the health policy issue that imposes responsibility on employers may increase discrimination against women during job applications.
At the same time, there were no prohibitions on hiring men with a certain social status. The absence of children was an obstacle in only 5% of companies (Yu et al., 2020). The marital status of men is not important, because when a male employee decides to have a child, the employer will not be responsible. Therefore, the health policy adopted in Florida to increase responsibility for the health care of a pregnant woman on the part of the employer may complicate the hiring of women.
Position Defense
The argument is that the co-worker will primarily provide care for pregnant women if the co-worker is officially employed. However, if a woman is not officially registered during pregnancy, she lacks social guarantees (Paton et al., 2020). She is deprived of paid leave, hospital benefits, and insurance at the birth of a child.
Moreover, health policy provides uncertainty in labor relations. In the absence of an employment contract, there may be uncertainties in the relationship between the employee and the employer, who is not obliged to provide a pregnant woman with leave or retain her in the workplace (Daley et al., 2020). Thus, in the case of pregnancy, the employment contract provides the employee with certain rights and guarantees that are lost when working without a signed contract.
Modern legislation does not include specific guarantees of the level of social security for families with children, thereby preventing them from adequately supporting and raising their children. The employer support provided by SB 256, even if officially employed, may not be sufficient (Yu et al., 2020). Its size is determined by the salary, which can be pretty low (Yu et al., 2020). In the case of pregnancy, payments are indexed, but they often do not cover the cost of expensive pregnancy medications. Therefore, this health policy applies only to a small portion of the population and does not provide the necessary care for most pregnant women.
Supportive Evidence
Pros
The main advantage of SB 256 is that a pregnant woman does not have to pay for the medical care she receives. This is a social work program, contributions to which are automatically deducted from earnings as part of taxes, and a basic program that includes all essential specialists (Falck et al., 2021). Such insurance requires significant financial resources to support it. Such a health policy allows risks to be distributed among all participants in society.
Insurance premiums paid by citizens are used to compensate pregnant women (Falck et al., 2021). This reduces the financial burden on individual citizens and society as a whole. Moreover, the organization’s maternity insurance is administered by the state (Paton et al., 2020). The state sets the rules and conditions for participation in the program, determines the amount of insurance premiums and payments, and controls the financial stability of the insurance system.
Cons
The proposed policy does not adhere to the principle of social justice. The principle of social justice holds that state insurance is intended to provide social protection to the most vulnerable categories of citizens (Nabugoomu et al., 2020). This may include low-income people, people with disabilities, retirees, and other groups who need exceptional support. These principles form the basis of public insurance and ensure its effective functioning in the interests of all participants (Nabugoomu et al., 2020). They guarantee equal rights and opportunities for all citizens and ensure social justice and stability in society (Lin et al., 2021). However, in Florida, only citizens with official employment will receive pregnancy assistance, which contradicts the principle of social justice.
A violation of the principle of universality can also be identified as a cons health policy. It ensures that all participants in the insurance program have equal rights and opportunities to receive insurance benefits in the event of an insured event (Yirmiya et al., 2021). No one can be excluded from the program based on their position, age, or other factors (Falck et al., 2021). However, informally employed or unemployed pregnant women will be excluded from the program, rendering the policy non-universal.
State insurance is usually available to all citizens, regardless of their income or health status. This enables social protection and financial support for all segments of the population (Daley et al., 2020). However, in this case, the health policy action is not publicly available. Moreover, it requires significant financial resources to support it. High insurance premiums can place an additional financial burden on citizens and businesses (Paton et al., 2020). Health policy may even result in a refusal to hire women due to the need to continue to bear financial responsibility in the event of an employee’s pregnancy.
Health policy is associated with bureaucratic processes and complex procedures for obtaining payments for pregnant women. This can lead to delays and inconveniences for citizens who need quick financial assistance (Nabugoomu et al., 2020). The financial activities of organizations are regulated by separate legislative acts (Daley et al., 2020). Organizations have an autonomous status, which ensures transparency in the mechanisms for distributing funds for social benefits. However, the lack of social equality across categories of citizens without employment undermines the potential benefits of health policy.
Key Stakeholders
Pregnant Women
Pregnancy is a period when a woman needs frequent medical care. She needs a guarantee of free high-quality medical care for her unborn child. Medical care for women during pregnancy, childbirth, and the postpartum period involves the stages of its provision (Lin et al., 2021). At the same time, each trimester has its own list of medical services, which are often expensive (Yu et al., 2020). Therefore, a pregnant woman, as a stakeholder, is interested in getting help from her employer.
Employer
The employer is interested in the health policy because it imposes certain restrictions on him. Refusal to conclude an employment contract for reasons related to pregnancy or having children is prohibited (Friedman et al., 2020). The law guarantees that a pregnant woman will be employed regardless of whether the employer knows of her pregnancy (Pizzarossa & Nandagiri, 2021). However, the employer is not interested in paying higher medical care costs for a pregnant woman, according to the health policy (Yirmiya et al., 2021). Therefore, an employer may, for various reasons, choose not to hire a woman.
State
Due to the declining birth rate, the state government is interested in accepting benefits that motivate women to give birth. Moreover, the adoption of a health policy to reduce the state’s financial burden by shifting it to the employer (Paton et al., 2020). This health policy can be attributed to improvements in tools that allow the combination of professional and family responsibilities (Paton et al., 2020). It will help citizens to increase their motivation to have children without fear of lowering their standard of living.
Potential Solutions
Health policy SB 256 should be made voluntary within organizations, rather than mandatory. Bona fide employers can use the profits of the organization to create a trust fund within the organization, from which payments are made to their employees at the birth of a child (Falck et al., 2021). This payment may be additional to the monthly child care allowance, but it should not be mandatory.
Organizations offering such funds are actively pursuing policies to expand the social package, increase motivation, and retain valuable employees. Moreover, they create a positive image in the labor market (Paton et al., 2020). Therefore, instead of a mandatory health policy that would lead to the refusal to hire women, employers can be encouraged to make additional payments to pregnant women through incentives. It is advisable to encourage this category of employers by providing benefits, for example, by helping them pay income tax (Nabugoomu et al., 2020).
Employer’s contributions, from which a fund is formed to make payments related to maternity, should be treated as labor costs and reduce income tax. It is also possible to relieve responsible employers who support pregnant employees by paying insurance premiums into off-budget funds. Insurance premiums should not be accrued on the amount of the employer’s payments from the organization’s fund (Yirmiya et al., 2021). It is possible to provide individuals with the opportunity to avoid taxation of income from employer cash payments.
Thus, to increase social protection for motherhood, it is necessary to develop a voluntary form of protection to improve the welfare of working citizens during this period. It is supposed to constitute an additional form of social protection at the expense of employers and citizens’ personal incomes (Falck et al., 2021). A citizen can independently compensate for lost income in whole or in part by participating in the purchase of insurance products, including voluntary medical insurance, or by opening bank deposits.
Alternatives & Recommendations
It is commonly thought that payments for children are mainly due to mothers. However, it is possible to issue such a health policy that allows men to receive them as well. They do not give birth, but they care for children, participate in their maintenance, and can receive money from the state, from their wives, and even from children. At the moment, this requires exceptional circumstances (Falck et al., 2021).
However, if the employer were also obliged to make payments to the husbands of pregnant women, the number of cases of gender discrimination in the workplace would decrease (Yu et al., 2020). Currently, only mothers can count on most payments, because only women have the right to take maternity leave. However, an alternative policy may apply when an employer helps an employee support a family with payments if his pregnant spouse is not employed (Falck et al., 2021). Then the future father can receive support payments from the employer.
The father should be entitled to receive a mandatory child care allowance. This should happen not only if he takes care of the child, but also if the father officially uses the baby care leave. Currently, fathers are increasingly using this type of vacation (Yu et al., 2020). Accordingly, it is they who should receive a monthly child allowance for the father at their workplace (Friedman et al., 2020). Therefore, an alternative health policy that will guarantee social justice is to pay future parents through an officially employed father if the expectant mother lacks an official source of income.
Conclusion
The SB 256 health policy is a system in which an employer provides protection against risks and financial support to employees during pregnancy. It has its own goals, objectives, and principles, which, however, fail to ensure social protection and justice. This policy has its advantages, such as accessibility, but also has disadvantages, including high costs for employers and the potential to create obstacles to hiring women. Health policies play an essential role in ensuring social protection and the well-being of citizens, but SB 256 does not apply to all pregnant women; therefore, it needs to be corrected.
The legal regulation of the work of pregnant women has its own peculiarities, providing for certain guarantees. It is prohibited by labor legislation to refuse to conclude an employment contract for circumstances that are discriminatory, including for women on grounds related to pregnancy. However, the research revealed that after adopting the new health policy, the employer’s desire to hire female employees decreased. This is another negative long-term consequence of SB 256.
To restore the principle of social equality, it is necessary that both a working and a non-working pregnant woman can receive financial assistance. Health policies should be addressed not only to working mothers, but also to established fathers. Moreover, government budget assistance, not employer funds, will stop the further widening of the gap between the number of male and female colleagues and their salaries. Therefore, the SB 256 adopted in Florida needs significant improvements and adjustments, as it currently does not advance social equality and instead contributes to workplace gender discrimination.
References
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