To Improve Maternal Health, We Must Depoliticize Racial Equity
June 9, 2022
Terrance E. Moore, MA, Chief Executive Officer at the Association of Maternal & Child Health Programs (AMCHP)
Cheryl L. Clark, DrPH, RHIA, Associate Director, Equity, Epidemiology, and Evaluation at AMCHP
Jonathan Webb, MPH, MBA, Chief Executive Officer at the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN)
Chad Abresch, PhD, Executive Director at CityMatCH
Deborah Frazier, CEO at the National Healthy Start Association (NHSA)
Lidyvez Sawyer, EdD, MPH, Equity Implementation Strategist at NHSA
Scott D. Berns, MD, MPH, FAAP, CEO at the National Institute for Children’s Health Quality (NICHQ)
Stacy Scott, PhD, MPA, Executive Project Director and Equity Lead at NICHQ
Earlier this spring, Black Maternal Health Week challenged systems of maternal care to improve racial disparities. Led by the Black Mamas Matter Alliance, it highlighted jarring, persistent inequities and meaningful conversations about the root causes of poor maternal health outcomes for Black women and birthing people. The Biden Administration made additional commitments, among them establishing “Birthing-Friendly” hospital designations, strengthening Maternal, Infant, and Early Childhood Home Visiting Programs, and supporting state-level development of proven strategies to address disparities. And last month, many of our families celebrated Mother’s Day, a time where we show appreciation and cherish caregivers who dedicated themselves to helping us grow. May was also Maternal Mental Health Month, which highlighted the need to prioritize maternal mental health, particularly in the post-partum period.
Despite all of that, Black women and birthing people die at three times the rate of white women and birthing people in this country. This happens because bias persists in healthcare systems, stemming from enduring, interlocking systemic racism, sexism, and ethnic and racial stereotypes that exist and are well-documented.
Earlier this year, data from the Centers for Disease Control and Prevention (CDC) showed that maternal mortality rates increased during the first year of the pandemic, continuing a decades-long trend of increasing pregnancy-related deaths. The CDC reports that 861 women and birthing people died of "maternal causes” during pregnancy or within 42 days of the end of pregnancy in 2020. The total number of maternal deaths increased by 14 percent from 2019-2020, and the rates of maternal deaths increased most significantly among non-Hispanic Black and Hispanic women and birthing people.
These data are jarring, as every death is a tragic loss to families with rippling effects throughout communities. Unfortunately, these new data are not surprising. Longstanding racial inequities in maternal health outcomes were exacerbated during the COVID-19 pandemic, which furthered negative health outcomes for communities of color, with many people working in essential frontline roles, particularly Black women and birthing people. This is important: these persistent inequities in maternal health outcomes are not due to something intrinsically different or wrong with communities of color.
The majority of maternal deaths are preventable. This fact is devastating because this represents avoidable loss. However, this fact is also hopeful because we have opportunities to make changes – in our systems and our policies – that can prevent future maternal deaths.
Our five organizations each play a role in advancing maternal health and hold significant responsibility to end the racial inequities in maternal health outcomes. In many ways, we are only now joining the decades-long work of people of color and organizations led by and representing populations who have been systematically marginalized. We have work to do, and part of that work is advancing systemic, political, and individual changes that move racial equity forward. Our Joint Organizational Commitment acknowledges that racism is a public health crisis and lays out our commitments to critically analyze and change our organizational systems with the goal of advancing racial equity.
We strongly urge:
1. Congress to pass the Black Maternal Health Momnibus Act of 2021 and make 12 months of comprehensive postpartum coverage the federal standard for Medicaid. According to the CDC, nearly 25 percent of pregnancy-related deaths after the day of delivery occur between six weeks and the end of the first year after delivery. Based on estimates from the Department of Health and Human Services, approximately 720,000 people would benefit if all states adopted the American Rescue Plan’s new option to extend postpartum Medicaid and CHIP coverage for a full 12 months.
2. The Biden Administration to continue its prioritization of advancing maternal health equity. This prioritization needs to be reflected across departments and agencies, and especially within the context of the administration’s work to advance health equity and racial equity. As an example of where this prioritization unfortunately fell short, the final report and recommendations of the Presidential COVID-19 Health Equity Task Force does not mention pregnancy or maternal health despite the disproportionate and intersecting impacts of COVID-19 on pregnant women and birthing people of color.
Further, gaps in the data remain. While the latest report from CDC on maternal mortality shows the impact of COVID-19 on maternal health outcomes and the exacerbation of maternal health inequities, only the first 42 days postpartum are examined rather than a full year postpartum. The 42-day timespan does not capture the totality of the issues discovered by examining underlying structural, historical, and systemic causes of maternal deaths. Hopefully, state maternal mortality review committees can start adding their findings from these realms for a more nuanced and explicit picture.
3. Federal, state, and local political leaders to depoliticize racial equity. The data are clear: Poor health outcomes in the U.S., as exemplified by our abysmal maternal mortality rates, are driven by our systems that fail Black families, Indigenous families, and other communities of color. We cannot bury our heads in the sand or respond defensively out of feelings of personal attack. Acknowledging and seeking to counteract and root out racism makes us stronger as individuals and as a society.
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Patient and family partnerships are an essential element of health equity. By supporting patient and family voices and encouraging space for collaboration, public health professionals can help ensure shared vision and values are at the forefront of determining solutions to improve a community’s health outcomes.
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Evidence demonstrates that fathers play a critical role in children’s health and development, beginning in the prenatal period and continuing through early childhood and adolescence. On this episode of Before Birth & Beyond, NICHQ honors Men's Health Month and Father's Day, both celebrated in June, by sitting down with two Black fatherhood experts to discuss the importance of including fathers in maternal and child health work, policy considerations to improve father engagement, and men's mental health and its impact on outcomes for children and families.
After Action Reviews Improve Systems, Strengthen Teams
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Look for NICHQ at Upcoming Spring Maternal Child Health Conferences
Teams at the National Institute for Children’s Health Quality are preparing for an exciting spring 2023 conference season, where staff will give poster presentations and facilitate workshops at a variety of national maternal and child health conferences.