The U.S. has a shameful maternal mortality rate, and it’s especially awful for black mothers, who are more than three times as likely as white mothers to die during or shortly after childbirth. Last month, Senator Kamala Harris (D-California) and 13 other Democratic Senators introduced the Maternal Care Access and Reducing Emergencies (CARE) Act, a bill to reduce the racial disparities in maternal mortality and morbidity. The bill would devote resources to two grant programs: one that would extend implicit-bias training to healthcare providers, and another to create pregnancy medical home demonstration projects (based on a North Carolina program that early evidence suggests might narrow black-white maternal mortality disparities) in up to 10 states.
The bill has won praise from organizations ranging from the Black Mamas Matter Alliance to the American College of Obstetricians and Gynecologists, but several commenters have also noted that much larger steps will also be necessary to fix the conditions that put black women at elevated risk of a range of health problems — including, but not limited to, maternal health conditions.
Rewire’s Katelyn Burns asked Monica McLemore, PhD, MPH, RN, an assistant professor at UC San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH), about the bill, and she zoomed back to highlight the bigger picture:
“Specific to Senator Harris’ bill—this is a program that is designed to reduce health disparities if its stated goals are met because it uses existing infrastructure which is inherently inequitable (based on insurance type, access to providers, etc.),” said Assistant Professor Monica McLemore … “A health equity approach would begin with seeing the women experiencing the burden as experts and should be considered an integral part of the solution as opposed to privileging clinical providers.”
A health equity approach would recognize that systemic racism both within and outside of the health care system can have severe long-term effects on the physical bodies of women of color, which can increase pregnancy risks, even before a patient requires prenatal care.
In an op-ed for The Hill, Marcela Howell, founder and executive director of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, and Linda Goler Blount, president and CEO of Black Women’s Health Imperative, focus on the range of policy decisions that harm black women’s health:
Many nonpregnant women of reproductive age who may become pregnant fall into the gap of people who make too much money to qualify for Medicaid and too little to qualify for ACA subsidies. This means that nonpregnant women of reproductive age who may become pregnant likely will not have insurance coverage to receive preconception care, or timely diagnosis and proper management of chronic conditions (such as diabetes and hypertension) that can later influence maternal outcomes.
We need a multi-faceted approach that addresses black women’s health across the lifespan; addresses bias in provider care and systems of care delivery; improves access to quality care; addresses social determinants of health; and provides greater economic security. To improve black maternal health outcomes, social determinants of health must be addressed through policies that raise incomes and build wealth; provide access to clean, safe and affordable housing; improve the quality of education; prioritize reliable public transportation and transport for medical appointments; and increase the availability of healthy, affordable food.
We also need to change the system of care delivery to ensure providers listen to black women and incorporate their lived experiences into the care they provide.
To reduce the appalling racial disparity in US maternal mortality, we need both short- and long-term solutions. Addressing social determinants of health and racism is essential but will take decades; grant programs can save and improve lives in the meantime. Black mothers deserve appropriate care now, and better opportunities for health in the future.