April 14, 2019 Liz Borkowski, MPH 0Comment

It’s Black Maternal Health Week, which the Black Mamas Matter Alliance explains is intended to “Provide a national platform for Black-led entities and efforts on maternal health, birth and reproductive justice.” To focus Congressional attention on the issue, Representatives Lauren Underwood (D-IL) and Alma Adams (D-NC) announced the launch of the Black Maternal Health Caucus, which will help develop policies to address the shameful racial disparities in maternal morbidity and mortality.

Representative Underwood is a nurse and, as she noted to ELLE’s Rose Minutaglio, “I’m the youngest black women to ever serve in Congress and I’m the only black women of reproductive age in the Congress.” She also has a personal connection to the issue: a close friend, Dr. Shalon Irving, died after giving birth to her daughter Soleil in 2017. Irving was a CDC epidemiologist, and her story was featured in ProPublica’s excellent Lost Mothers series. Nina Martin and Renee Montagne spoke with another one of Irving’s friends about what her death demonstrated:

The fact that someone with Shalon’s social and economic advantages is at higher risk highlights how profound the inequities really are, said Raegan McDonald-Mosley, the chief medical officer for Planned Parenthood Federation of America, who met her in graduate school at Johns Hopkins University and was one of her closest friends. “It tells you that you can’t educate your way out of this problem. You can’t health-care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.”

BMMA co-director Elizabeth Dawes Gay summarized week’s focus for PEOPLE:

“Black women are also more likely to have a stillbirth, give birth prematurely, have low birth-weight infants, have a miscarriage even. There are a lot of challenges that folks are dealing with,” Black Mamas Matter Alliance co-director Elizabeth Dawes Gay tells PEOPLE. “It boils down to toxic stress, racism in society, in the healthcare setting, disparities in access to care. There’s a lot of work to do. I think we will see a change but it is going to take a long time.” … “Our motto is listen to Black women, trust Black women and invest in Black women,” Gay tells PEOPLE. “We want people to walk away more empowered to have these conversations with folks interested in changing Black maternal health — and more empowered to change it themselves!”

The week has featured trainings, workshops, webinars, and other events; local events are listed here.

Federal and State Proposals

Last year, Congress passed the Preventing Maternal Deaths Act, which instructs HHS to create a grant program to help states establish maternal mortality review committees. (At ThinkProgress, Amanda Michelle Gomez notes that President Trump signed the bill into law but didn’t publicize it; instead, he tweeted about the border wall.) Two bills introduced in the current Congress could also advance maternal health. Senator Kirsten Gillibrand (-D-NY), joined by Senators Kamala Harris (D-CA) and Cory Booker (D-NJ), introduced the  Modernizing Obstetric Medicine Standards (MOMS) Act, which would create a grant program to help states and hospitals implement maternal safety best practices and strengthen CDC’s Pregnancy Mortality Surveillance System. The FAMILY Act, introduced by Senator Gillibrand and Representative Rosa DeLauro (D-CT), would create a social insurance system for paid medical and family leave.

In 2018, Senator Harris introduced the Maternal CARE Act, which included provisions to advance implicit bias training for healthcare providers and establish pregnancy medical home demonstration projects. Representative Robin Kelly (D-IL) introduced the MOMMA Act, which not only addressed emergency obstetric protocols and culturally competent care, but would have expanded postpartum Medicaid access from 60 days to the full postpartum year. (The federal requirement is for Medicaid coverage of pregnant women with incomes of up to 133% of the federal poverty level; in states that have adopted the Medicaid expansion, people with these incomes are now eligible for Medicaid regardless of childbearing, but those in non-expansion states still lose coverage 60 days after giving birth.)

At the state level, one promising area is Medicaid reimbursement for doulas, who support pregnant clients before, during, and after birth and whose care is associated with better maternal and infant outcomes. (Read Linda Villarosa’s excellent New York Times Magazine article both for its reporting on racism and maternal health and for the story of one doula-assisted birth.) Oregon and Minnesota already allow Medicaid reimbursement for doulas, although both states have faced challenges in implementation. New York is launching a pilot program to cover doula services for Medicaid enrollees in Brooklyn and Erie County, though some doulas and maternal health advocates warn that its reimbursement is inadequate.

Big-picture solutions

BMMA’s April 2018 black paper Setting the Standard for Holistic Care of and For Black Women offers recommendations for transforming the care Black women receive. Lead author Sunshine Muse and collaborators highlight models of care, like the JJ Way® and Centering® health care, that research has found to improve outcomes, while also recognizing that interventions such as group prenatal care aren’t on their own sufficient for fixing a broken system:

Holistic care for Black women requires that providers, practices, and medical staff understand the cultural context, historical richness and complexity that Black women embody and live with every day. In order to provide holistic care, providers and medical staff must unlearn and self-correct implicit and unconscious bias. They must also continue to push back against a productivity model that does not give them enough time to build strong relationships with their patients. Implicit bias trainings may not change behavior, but they can increase awareness of one’s position within the spectrum of advantage, privilege, and responsibility. A harm-reduction approach to how care is delivered is extremely important. It will help to create a medical system that supports systemic policies and behavior to address the social determinants of health and promote health equity.

In the Black Women Birthing Justice piece “An inconvenient truth: You have no answer that Black women don’t already possess,” Karen A. Scott, Stephanie R. M. Bray, Ifeyinwa Asiodu & Monica R. McLemore emphasize the importance of centering Black women in work to address maternal mortality disparities. They recommend four broad solutions: Authentic engagement with Black women, investment in Black women (as a future workforce and in general), unapologetic support of Black women in paid leadership and research roles, and reinvestment in the social safety net.

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, describe specific solutions for the healthcare system and our society as a whole:

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.

Black Maternal Health Week will end on April 17. With Black women’s leadership, the fight for reproductive justice and health equity will continue year-round.


Recent related posts:

Two perspectives on reducing US maternal mortality
Addressing black maternal mortality: Large and small steps
Improving maternal health in the US requires better policies and less racism
ProPublica’s exploration of why black mothers are more likely to die



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