The persistent maternal health crisis in the United States is no secret. The national maternal mortality rate for 2021 was 32.9 per 100,000 births—up from 23.8 in 2020, 20.1 in 2019, and 17.4 in 2018. And what’s equally clear is the racial disparities in these numbers. Disparities in maternal health care access and chronic stress—created by generations of structural racism—mean that Black women are three to four times more likely to die from a pregnancy-related issue than White women.
Maternal health advocates in Michigan are clearly seeing this crisis at work in their state. Between 2016-2020, Black women were 2.2 times more likely to die from pregnancy-related causes in Michigan compared to white women (36.5 and 16.3 per 100,000 live births, respectively). Compounding the tragedy is the fact that—for that same time period—74.5 percent of pregnancy-related deaths were classified as preventable.
So advocates in Michigan continue to fight not only for prevention resources, but for culturally congruent policies and programs aimed squarely at racial disparities in death rates.
One powerful example of this work is Michigan’s Perinatal Quality Collaborative (PQC). The PQC has nine regional collaboratives across the state that utilize local data and local resources to achieve the goal of improving birth outcomes for Michigan families and advancing maternal health care equity. Thanks to this regional approach, RPQCs can focus on the disparities experienced by Black and indigenous mothers, whose lack of access to effective perinatal care can be very different, from metro Detroit to the “maternity care deserts” of the state’s more rural Upper Peninsula.
Michigan’s Perinatal Quality Collaboratives are focused on equitable outcomes.
Among the RPQC’s strategies are doula training (Michigan’s Medicaid program provides coverage for doulas), virtual childbirth and breastfeeding classes, and working with a local public health expert to implement the High Touch High Tech (HT2) project, which is used during prenatal visits to screen for mental health needs and trauma.
PQCs, which exist in all 50 states, are part of the National Network of Perinatal Quality Collaboratives, which is funded by the Centers for Disease Control and Prevention. But they are not mentioned in state laws. Michigan’s legislature has provided $10 million in state funding for their PQC and the work implemented by the RPQC’s but structure has no permanent statutory standing. Michigan advocates are working to change this by passing House Bill 5166, which would add the PQC to the state’s public health code and establish these practices in state law.
“Budgets are only for a year,” Amy Zaagman, the Executive Director of the Michigan Council for Maternal and Child Health, says, “and if the funding doesn’t stay in the budget, then you don’t have a systemic approach to care.”
Another example of a program that also has $10 million in state funding but no statutory standing is an initiative that implements “safety bundles” in birthing hospitals. Bundles are safety protocols developed by the American College of Obstetricians and Gynecologists to address various drivers of maternal morbidity and mortality. Bundles include training for hospital staff, specific equipment, and a continuous quality improvement process.
And bundles have a strong equity component.
Each bundle has a “Respectful Care” section that, according to the Alliance for Innovation on Maternal Health, highlights “best practices in offering and providing respectful, equitable, and supportive care to every patient in every setting from every provider.” Culturally congruent care concepts can also be found in the other sections of a bundle.
The program is managed by MI AIM, the Michigan Alliance for Innovation on Maternal Health. And one goal of the state’s five-year plan to advance healthy births is to increase hospital’s implementation of the hypertension bundle.
A proposed law that would codify this effort in state statute is House Bill 5172, which calls for implementing “a program to register a perinatal facility as a level I, II, III, or IV maternal care facility.” Level I facilities would provide basic care. Level II facilities would provide specialty care for moderate to high-risk pregnancies. Level III facilities would provide subspeciality care, serving patients with complicating conditions such as adult respiratory system. And level IV facilities would provide advanced care for “the most complex maternal conditions.”
Zaagman knows that getting statutory changes increases the likelihood of greater and more stable resources for maternal health in the state. And putting policies in place that specifically address the disparate outcomes driven by the legacy of structural racism is real progress.
“We want improved care and more resources across the board,” she says, “but we also need to make sure—from Detroit to Grand Rapids to Marquette—that perinatal care is equally effective for the community. Only with both can you begin to reverse this crisis.”
