On Tuesday, November 19, Congresswoman Lauren Underwood (D-IL) and Congresswoman Alma S. Adams (D-NC), co-chairs of the Black Maternal Health Caucus, partnered with March of Dimes and First Focus to bring attention to the significant maternal health crisis happening in America today.
“Mothers in our country are more likely to die giving birth than in any other developed nation, and most of those mothers will be Black women,” said Congresswoman Adams. Congresswoman Underwood reiterated the focus of the 94 member caucus was to raise awareness of the alarming data indicating moms dying from childbirth and the disproportioned rate for black mothers. She shared the tragic death of her friend and classmate, who died three weeks after giving birth at the age of thirty-six.
The briefing featured a panel of four distinguished women: Rachel Hardeman, Assistant Professor from the University of Minnesota School of Public Health, Kelsie Landers, Policy and Advocacy Director from EverThrive Illinois, Usha Ranji, Associate Director of Women’s Health Policy from the Kaiser Family Foundation, and Charleta Guillory, Associate Professor of Pediatrics at Baylor College of Medicine and Director of the Texas Children’s Hospital Neonatal-Perinatal Public Health Program.
Hardeman dove into the root cause of the racial disparities, concluding that 400 years of slavery has created inequities in housing, educating, and infant and maternal health. Implicit bias and structural racism go hand in hand, and the long-term psychological stress of discrimination creates poor health outcomes for Black mothers. She assessed that maternal health disparities are worsened by inequalities in education access and quality, access to quality healthcare, house affordability and options, and work and economic opportunities. Hardeman stresses the importance of finding solutions that dismantle systems and institutional beliefs.
Dr. Guillory reported that in Houston, Texas, 50 percent of the babies in the neonatal unit at Texas Children’s Hospital are Black, while 20 percent of the population is Black. Statistics show that Black infants are much more likely to be born premature and are dying at 2.3 times the rate of non-Hispanic White infants. The leading causes of infant deaths in Texas are congenital malformation, low birth weight, materialize complications of pregnancy, and sudden infant deaths. With health insurance being predeterminate of care, some of the contributing factors to infant mortality are access and availability to nutritious food and health care. Dr. Guillory asserts that if we can improve the levels of care, we can decrease infant mortality.
In Illinois, an average of 73 women die each year of a pregnancy-related cause. Landers from EverThrive Illinois gave the staggering statistic that in her state of Illinois, non-Hispanic Black women are six times as likely to die of a pregnancy-related complication as a non-Hispanic White woman. The Illinois Department of Public Health 2018 report policy recommendations included: increasing access to substance use and mental health services, requiring that hospitals have clear policies for emergency departments and identify triggers that show signs of potential complications, and instructing insurance plans to unbundle postpartum visits and separate payments for visits in the postpartum period from labor and delivery.
As Congresswoman Underwood mentioned, more than half of the maternal death is preventable, and expanding postpartum Medicaid coverage for low-income women in all states would be a step in the right direction for maternal and infant health. Senator Kirsten Gillibrand (D-NY) re-introduced the Modernizing Obstetric Medicine Standards Act (S.116) or the “MOMS Act,” that would protect moms before, during, and after they give birth. The MOMS Act would also help to identify and appropriately treat pregnancy-related complications, create a grant program to states and hospitals funding training and implementation of best practices, and develop a system of reporting for states to submit maternal death statistics.
Usha Ranji continued the conversation about infant and maternal health by speaking to health care coverage, particularly Medicaid, where states determined coverage standards. Medicaid covers 43 percent of births nationally, 1 in 5 reproductive age women, and 4 in 10 children. Ten percent of children in Alabama, Texas, and Wyoming are uninsured, and total monthly enrollment in Medicaid and Children’s Health Insurance Program (CHIP) have declined. The minimum federal income threshold for Medicaid coverage for pregnant women is 138 percent of the federal poverty level (FPL), and under traditional Medicaid, services end 60 days postpartum. Ranji stressed that moms need care before and after pregnancy, and in expansion states, most postpartum mothers can continue Medicaid or qualify for subsidies. California, Illinois, Michigan, Tennessee, and Wisconsin have extended postpartum coverage beyond the 60 days.
The MOMS Act would provide a state plan amendment option to increase the 5 percent federal matching rate and extend postpartum coverage to one year. “Coverage is one part of the solution,” remarked Ranji. Dr. Guillory believes some solutions for the health profession are that “you must look at patients in the eyes, look for opportunities to empower them, look to evidence-based practices, and listen to them without judgment and with empathy.”
