This week marks the second annual Black Maternal Health Week, which runs through April 17. The Black Mamas Matter Alliance (BMMA) has organized this week’s activities, and Community Catalyst is proud to be a co-sponsor through our co-coordination of the Raising Women’s Voices national initiative.
The United States is the only developed country where the maternal mortality rate has increased over the last two decades. This problem is especially acute for Black women, who are dying in childbirth, or the immediate post-partum period, at rates three to four times higher than for white women. Poor maternal health also has a severe impact on Black infants, who die at rates 2.4 times higher than for white infants.
Factors contributing to Black maternal and infant mortality include lack of access to quality, culturally-sensitive health care services. One area of focus is implicit bias on the part of health providers, who may unconsciously discount the concerns and reported symptoms of Black pregnant women. Studies are also showing that Black women who deliver at hospitals that primarily serve the Black population are much more likely to experience complications and death during and after delivery. Black women are also disproportionately experiencing health conditions that can increase maternal mortality risks, including hypertension, diabetes and obesity.
What can we do?
Advocates and policymakers at both the state and federal level are focusing on a few key policy solutions to help address the maternal health crisis:
- Creating State Maternal Mortality Review Boards.
- Extending Medicaid coverage for pregnant women up to a year following delivery.
- Providing Medicaid coverage for doulas for low-income women.
At the federal level, policymakers recently reintroduced the Mothers and Offspring Mortality & Morbidity Awareness (MOMMA) Act (H.R. 1897 and S. 916.), which would expand pregnancy-related Medicaid coverage to cover the full post-partum period (one year). A sizeable percentage of maternal deaths occur in the post-partum period. Among its other important provisions, the MOMMA Act would require coverage of oral health care during pregnancy. Untreated dental disease may be associated with preeclampsia and preterm birth. Both of these adverse pregnancy outcomes are more common among Black women, who also face greater structural barriers to oral health care and more dental disease.
Creating State Maternal Mortality Review Boards
One of the most important things states can do is to establish and support Maternal Mortality Review Boards that investigate every pregnancy-related death and develop recommendations to prevent future deaths. The federal Preventing Maternal Deaths Act of 2018 established a program under which the U.S. Department of Health and Human Services (HHS) may make grants to states for establishing maternal mortality review boards and improving the quality of maternity care through provider education.
Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR), a Raising Women’s Voices regional coordinator in Denver, is advocating for the inclusion of funding that would give the state’s Maternal Mortality Review Committee the authority and resources needed to ensure robust participation and strong, timely recommendations to the legislature to prevent future maternal deaths. COLOR notes that Colorado’s maternal mortality rate roughly doubled between 2008 and 2013, and is urging its members to call on the state to treat this as a public health crisis. Meanwhile, Raising Women’s Voices - New York is applauding the state Legislature, which overwhelming passed a bill to create a maternal mortality review board, and included funding in the state budget to support it.
The Afiya Center, the Raising Women’s Voices regional coordinator in Dallas, TX, and an active member of the Black Mamas Matter Alliance, has been a leader on maternal mortality work. Afiya and its Texas allies successfully advocated for the passage of the 2017 Texas Moms Matter Act, which created a Maternal Mortality and Morbidity Task Force within the Department of State Health Services to review cases of pregnancy-related deaths and trends in severe maternal morbidity, which has disproportionately affected Black women.
Extending pregnancy-related Medicaid coverage for up to a year following delivery
In the last month of the Texas state legislative session, the Afiya Center has been working on legislation (HB744) that would extend pregnancy-related Medicaid coverage from the current limit of 60 days following childbirth to one year post-partum. Post-partum coverage is particularly important, since a large portion of maternal deaths occur not during labor, but in the months after labor (a time during which many women have lost their Medicaid coverage). The Afiya Center’s Policy Director, Deneen Robinson, testified at a hearing on the bill, which is still pending.
New Jersey Citizen Action, the Raising Women’s Voices regional coordinator in that state, has been supporting a policy proposal that would extend pregnancy-related Medicaid coverage for 12 months post-partum. Currently, pregnant women with incomes under 200% of the federal poverty limit can qualify for Medicaid (which is higher than the 138% of FPL eligibility ceiling for regular expanded Medicaid), but that coverage expires 60 days after childbirth. As part of New Jersey Citizen Action’s advocacy efforts, Maura Collinsgru, the group’s Health Care Program Director, included this policy priority in her budget hearing testimony. She explained, “Extending Medicaid coverage for one full year would mean complications (like hypertension, diabetes or post-partum depression) have a better chance of being identified, properly managed and treated before becoming more serious. Black women in New Jersey are five times more likely than their white counterparts to die from pregnancy-related complications. Providing support to moms during and after pregnancy is vital if we are to turn around this unacceptable statistic.”
Other state advocates across the country, including RWV regional coordinators EverThrive Illinois and Northwest Health Law Advocates in Washington are pushing for similar proposals that would expand pregnancy-related Medicaid coverage to 12 months post-partum.
WV FREE, Raising Women’s Voices Charleston-based regional coordinator, supported a different policy approach to expanding pregnancy-related Medicaid coverage. Instead of extending the length of Medicaid coverage post-partum, SB 564 expands eligibility for pregnancy-related Medicaid to more women with higher incomes. The new law would expand Medicaid coverage to pregnant women up to 185 percent of the federal poverty level (from the previous 163 percent limit). According to advocates, this measure will make pregnancy-related care – including prenatal care, delivery, and 60 days post-partum care – accessible to more West Virginian women. The bill is expected to affect about 800 expectant mothers who currently make too much to qualify for Medicaid but can’t afford health insurance. The average cost of childbirth in West Virginia is out of reach for many, ranging from $10,000 for a vaginal birth, and $14,000 for a C-section, combined with $20,000 for pre- and postnatal care, West Virginia Center on Budget and Policy reports.
Providing Medicaid coverage for doulas for low-income women
Doulas are trained professionals that serve as a physical and emotional support to women before, during, and after pregnancy, and also help to connect them with other social supports. Patients with doulas for pre-natal, labor and post-partum support have better birth outcomes and are less likely to have cesarean births. Currently, doulas are mainly affordable only for upper middle-class or affluent women and families who can pay out-of-pocket for these services. Advocates hope that making doulas more accessible to low-income women and women of color could help address maternal health disparities.
In Rhode Island, Raising Women’s Voices regional coordinator Planned Parenthood of Southern New England is advocating for legislation ensuring that doulas are covered by Medicaid in that state. Under H5609, qualified, trained doulas would be eligible for reimbursement through private insurance and Medicaid for up to $1,500 per pregnancy. If this legislation passes, Rhode Island would join Oregon, Minnesota, and a pilot program in New York allowing Medicaid coverage for doula services.
Speaking at a press conference on the legislation, Kavelle Christie, Public Policy and Organizing Specialist of Planned Parenthood of Southern New England, said “Carrying a pregnancy to term should not put women’s lives at risk. We will fight to ensure black women receive the high-quality care they deserve, and perinatal doulas are fairly compensated for the care they provide. Maternal mortality in the United States is a public health crisis and its severe impact on black women is unacceptable.”
New Jersey Citizen Action recently joined a roundtable hosted by New Jersey First Lady Tammy Murphy that highlighted the $1 million in funding in Governor Murphy’s proposed 2020 budget to provide coverage for doula care services through Medicaid. In the program’s initial phase, community doulas will be trained to provide services in Newark, Trenton, Camden and Atlantic City. So far, 50 community doulas have been trained, and another 50 are in the pipeline.
Tammy Boyd of the Black Women’s Health Imperative contributed to this blog.