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Thursday
Apr112019

It’s Black Maternal Health Week!

Why Black maternal health must be a priority

Today is the start of Black Maternal Health Week, which runs through April 17. The Black Mamas Matter Alliance (BMMA) has organized this week’s activities, and Raising Women’s Voices is proud to be a co-sponsor. Several RWV regional coordinators are active in BMMA and have been working in their own states to address maternal health disparities through establishment of state Maternal Mortality Review Boards, Medicaid funding for doulas and extension of Medicaid coverage for pregnant women for up to a year following childbirth. We present highlights of their work below.

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. In some parts of the country, the problem is even worse. In New York City, for example, Black maternal mortality is 12 times higher than for white women.

Poor maternal health also has a severe impact on Black infant health. Black infants die at rates 2.4 times higher than for white infants, primarily because Black women have high rates of preterm births. While pre-term births are typically associated with low-income women, Black women from all socio- economic backgrounds experience higher rates of preterm births and infant mortality than other women, suggesting that income is not the sole driving factor.

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.

Congressional action is underway

Sen. Kamala Harris (D-CA) and Rep. Alma Adams (D-NC) are introducing a resolution today officially recognizing Black Maternal Health Week, in order to bring national attention to the maternal health crisis in the Black community. Reps. Adams and Lauren Underwood (D-IL) this week officially launched the first-ever Black Maternal Health Caucus.  Meanwhile, Sen. Doug Jones (D-AL) and Sen. Martha McSally (R-AZ) are circulating for Senate co-signers a bipartisan Dear Colleague letter that urges funding for programs at the Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) that seek to prevent maternal mortality, improve maternal health and eliminate disparities in maternal health outcomes.

There have also been several bills introduced in Congress addressing maternal mortality. Incremental progress has been made with the passage of the Preventing Maternal Deaths Act of 2018, which was sponsored by Rep. Jaime Herrera Beutler (WA-3). It established a program under which HHS may make grants to states for such actions asestablishing maternal mortality review committees to investigate the causes of maternal deaths and improving the quality of maternity care through provider education.

Recently, Rep. Robin Kelly (D-IL) and Senators Dick Durbin (D-IL) and Tammy Duckworth (D-IL) reintroduced the Mothers and Offspring Mortality & Morbidity Awareness (MOMMA) Act (H.R. 1897 and S. 916.) This measure would (1) expand Medicaid coverage to the full postpartum period (one year) for mothers; (2) standardize data collection and empower a designated federal agency to collect uniform data; (3) ensure the sharing of best practices between practitioners and hospital systems (4) establish and enforce national and emergency obstetric protocols; and (5) improve access to culturally competent care. 

Rep. Adams and Sen. Harris have introduced the Maternal Care Access and Reducing Emergencies (CARE) Act. This bill focuses on increasing comprehensive and quality health care access by creating two grants: (1) implicit bias training program grants to support specific training programs in medical, nursing and other training schools; (2) Pregnancy Medical Home Demonstration Project to establish a demonstration project to assist up to 10 states with developing and sustaining pregnancy medical home (PMH) programs.

State action: Maternal mortality review boards, post-partum Medicaid coverage, doulas!

One of the most important things states can do is to establish and support Maternal Mortality Review Boards, with confidential protections for providers that require a review for every pregnancy-related death, and which can develop recommendations to prevent future deaths.

Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR),our Denver-based regional coordinator, 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.  Raising Women’s Voices - New York is applauding the state Legislature, which overwhelming passed a bill to create a maternal death review board, and included funding in the state budget to support it.

The Afiya Centerour Dallas-based regional coordinator and an active member of theBlack Mamas Matter Alliance, has been a leader on maternal mortality work, successfully advocating for the passage of a 2017 bill to address the maternal mortality crisis in Texas.The Texas Moms Matter Act 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.

In the last month of the Texas state legislative session, the Afiya Center has been working with Rep. Toni Rose, Rep. Shawn Thierry and Rep. Victoria Neave on maternal mortality-related legislation. They worked with Rep. Rose to provide language on how to extend Medicaid for pregnant mothers from 60 days to one year post partum (HB744). Afiya Center Policy Director Deneen Robinson testified at the hearing (photo below) on the bill, which is still pending.

With support from RWV, the The Afiya Center has been working to train doulas – hosting a Full Spectrum Doula Training presented by Ancient Song Doula Services, which honored the legacy and traditions of Southern midwives and birth doulas. 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, our RWV 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.

According to an article in Uprise RI, the bill was announced at “what may have been the first press conference held at the Rhode Island State House in which all of the speakers were women of color.” Speaking at the press conference, Kavelle Christie, Public Policy and Organizing Specialist of Planned Parenthood of Southern New England (pictured above in a photo from Uprise RI), said “Planned Parenthood of Southern New England believes that carrying a pregnancy to term should not put women’s lives at risk. As a member of the Rhode Island Coalition for Reproductive Freedom, 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.” Click here to see Kavelle’s full speech.

New Jersey Citizen Action, our regional coordinator in that state, recently joined other health care advocates for a roundtable hosted by New Jersey First Lady Tammy Murphy. The roundtable highlighted the $1 million in funding in Governor Murphy’s proposed 2020 budget to provide coverage for doula care services to expectant mothers on Medicaid to help combat New Jersey’s Black infant and maternal health crisis. 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.  This is just one of several initiatives the First Lady is actively promoting as part of her push to address maternal health inequities for women of color in New Jersey.  Other proposals pending include a bill to extend Medicaid coverage for 12 months post-partum. Currently, pregnant women with incomes under 200% of the federal poverty limit can qualify for Medicaid, but that coverage expires 60 days post-partum. 

As part of New Jersey Citizen Action’s advocacy efforts in support of the First Lady’s initiative, Maura Collinsgru, Health Care Program Director at New Jersey Citizen Action, included these proposed maternal health bills in her budget hearing testimony. In her testimony on behalf of New Jersey Citizen Action, Collingsru cited the alarming statistic that 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,” she said.

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