Good infant health starts before birth, and equitable access to high quality, culturally competent pregnancy, childbirth, and postpartum care are critical to long-term health for babies and their parents. Yet disparities in maternal health treatment and outcomes continue to manifest at an alarming rate in the U.S., with Black and Native American women experiencing significantly higher rates of maternal mortality than non-Hispanic White women—regardless of income and educational and income levels.
Despite a rallying cry from advocates and improvements to the health coverage landscape, the maternal health crisis in this country has persisted. Why? And what more can be done at the federal, state, and community levels to address this health crisis that critically impedes our ability to support the optimal health of all babies and birthing parents?
The Alliance for Early Success brought together experts from the maternal health policy and practitioner disciplines to discuss the drivers for these alarming disparities and what policies and practices have been implemented nationally and in the state of Georgia to improve maternal health outcomes.
Maggie Clark, a senior state policy analyst specializing in Medicaid and CHIP policy at the Georgetown Center for Children and Families, began the conversation by providing maternal health statistics from a recent Commonwealth Fund report that finds the U.S. continues to face a significant maternal health crisis, demonstrating a maternal mortality rate that is three times the rate in most other high income similarly developed countries. When looking within the U.S. population, the picture becomes even worse, indicating that the maternal mortality rate for all women has been increasing since 2018 and that significant racial disparities persist and have widened, especially for Black, Native American, and Alaskan Native women.
An analysis conducted by state Maternal Mortality Review Committees (MMRC) revealed that 80 percent of maternal deaths happened after the child was born and were preventable. Clark went on to say that every year an additional 60,000 women experience severe maternal morbidity episodes or “near-miss” life-threatening experiences during the perinatal period and these events disproportionately affect people of color and low-income women. Clark highlighted several social determinants that contribute to poor maternal health outcomes, such as housing instability and chronic stress, concluding that it’s racism, not race driving these outcomes.
Attendees then heard from Ky Lindberg, chief executive officer of the Healthy Mothers, Healthy Babies Coalition of Georgia. She shared what they are doing to address the maternal health crisis in Georgia. Georgia has consistently ranked among the worst in the nation for maternal mortality rates—nearly three times the national average of deaths to birth givers. In addition to the organization’s advocacy, education, and referral efforts, Lindberg serves on the the Georgia Maternal Mortality Review Committee (GA MMRC), the state’s multidisciplinary committee that comprehensively reviews pregnancy-associated deaths and demographics data. The GA MMRC teams found that among rural birthers (where maternal mortality rates are slightly higher than even the state average), the most common causes for maternal mortality stem from chronic conditions like high blood pressure, diabetes, heart disease, and obesity, as well as poor access to health insurance, hospitals, and labor and delivery units. The Coalition emphasizes these drivers in their work to raise awareness with elected officials and government and business leaders, to increase funding to support the perinatal workforce, and to improve access to maternal mental and physical care.
“Every maternal death represents a family who has experienced loss during a time that was supposed to be full of joy; each number represents a family experiencing the reverberating negative impacts on their life and their ability to be there to support that sweet baby.”
Because of the associated trauma, it is important, Lindberg said, to avoid asking people with lived experience to relive trauma in advocacy efforts. Instead she recommends using the data as evidence as much as possible and reminded advocates that respectful, effective partnership with people with lived experience requires us to avoid transactional relationships—and should include diverse and sometimes opposing perspectives to inform the best strategies for moving forward.
Lastly, attendees heard from Sekesa Berry, founder and executive director of the community-based Atlanta Doula Collective, who shared opportunities to systemically address staggering maternal mortality at the community level. Berry’s organization is focused on the provision of positive prenatal health care and professional support and training of community birth workers in predominantly Black communities in Atlanta. The Collective offers a bevy of free and accessible programs to encourage more people to enter and sustain a career as a Doula, and deepen their knowledge and expertise.
“We want to lift up more doulas and midwives to expand the workforce that supports positive, culturally relevant perinatal care in our Black communities. We understand that informational support at the ground level for Black mothers and the birth workers that support them is critical to improving maternal wellness.”
Awareness about the need for a national approach to addressing the maternal health crisis and the associated disparities has led to an unprecedented amount of federal and congressional legislation and unprecedented calls-to-action.
- The Biden Administration’s 2022 Blueprint for Addressing the Maternal Health Crisis represents a cross-government strategy to address poor maternal health outcomes.
- The Consolidated Appropriations Act of 2023 includes provisions for nursing mothers at the workplace and provisions of the Pregnant Workers Fairness Act that expands mandatory requirements for supporting the wellbeing of pregnant employees.
- The Momnibus Bill of 2021 is a suite of proposed bills offered by the House Black Maternal Health Caucus that take a comprehensive approach to the maternal health crisis by promoting federal and state actions to invest more in perinatal social determinants of health strategies, mental and physical health community based organizations and the workforce who supports pregnant people. Additionally, the bills also call for better data collection and technological resources to improve access and payment for perinatal services.
Because Medicaid covers over half of births in the U.S, state-level leaders are using Medicaid expansion strategies to address poor maternal outcomes at scale. As many as thirty-three states have already begun to take action by extending the Medicaid postpartum coverage period to 12 months after the birth event, and some have also increased eligibility levels. However, the U.S. Supreme Court’s Dobb’s decision, which strips away pregnant people’s constitutional right to an abortion, presents a growing set of challenges to addressing maternal health. While the full ramifications of this decision continue to play out, the decision has prompted a renewed look at state maternal and child health policies.
Alliance partners and allies understand that ensuring positive child outcomes is inextricably tied to our ability to address the U.S. maternal health crisis. This discussion is but one of many the Alliance has had and will continue to have about the persistence of disparate poor maternal health outcomes among Black pregnant people. This challenge remains a fundamental aspect of our work as early care and education advocates and in our journey to name and dismantle functions of structural racism in the systems that touch the lives of children, families, and caregivers.
Policymakers Have More Work to Do to Address the Black Maternal Health Crisis
2020 Mom (soon to be the Policy Center for Maternal Mental Health)
Access to Maternal Reproductive Healthcare and Maternal Mental Health
Disparities in Maternal Health
What Can Be Done About Disparities in Birth Outcomes? Follow The BIPOC Leaders
Federal Government Efforts
White House Blueprint for Addressing the Maternal Health Crisis
Legislative Updates related to Reproductive Justice, Health, and Rights – January 2023
Healthy Mothers, Healthy Babies Coalition of Georgia’s State of the State Report
Expanding Eligibility and Postpartum Period and Other Medicaid Maternal Health Strategies
Opportunities to Support Maternal and Child Health Through Medicaid’s New Postpartum Coverage Extension
Postpartum Medicaid Extension An Opportunity to Improve Maternal and Child Health, But Impact Limited Without Medicaid Expansion
Doula and Home Visiting Services Coverage by Medicaid
National Health Law Program: Doula Medicaid Project
Promoting Maternal and Child Health Through State Medical Coverage fro Doula Care
Improving Our Maternity Care Now Through Doula Support
Getting Doulas Paid Policy Brief
State Medicaid Financing of Home Visiting in Seven States
How Are States Using Medicaid to Pay For Home Visiting?
Reproductive Rights and Maternal Health
Biden Administration Releases Badly Needed Maternal Mortality Strategy as Dobbs Decision Could Worsen Crisis