Lawmakers, clinicians, and advocates highlighted solutions to racial and other systemic inequities that have led to troubling disparities in outcomes for women before and after childbirth during the inaugural White House Maternal Health Day of Action Summit on Tuesday.
The White House and CMS proposed new strategies to help prevent maternal deaths and complications related to childbirth, including new funding, such as the $3 billion proposed in the Build Back Better Act to address maternal health; new guidance aimed at extending healthcare coverage for mothers after childbirth; and a “birthing-friendly” hospital designation.
“Before, during, and after childbirth, women in our nation are dying at a higher rate than any other developed nation in our world,” said Vice President Kamala Harris during the summit, noting that these poor outcomes are worse for certain populations.
No matter their income level or education, Native American women and Black women are two and three times more likely to die of complications from childbirth, respectively, compared with white women, Harris said.
In addition, women living in rural areas are 60% more likely to die from pregnancy-related complications than women in urban areas, and “we need to do something about that,” she urged.
Maternal mortality rates have actually worsened over the last 20 years, and tens of thousands of mothers face life-altering consequences as a result of their pregnancies, including serious heart problems, hemorrhages, seizures, and blood infections, according to a White House fact sheet.
The primary driver of these adverse outcomes are “systemic inequities,” Harris said.
Charles Johnson IV, founder of 4Kira4Moms, an organization dedicated to improving maternal health policies and regulations, shared the story of his wife, Kira Johnson, who died after a routine C-section.
Johnson, an African-American man, alerted hospital staff when he saw blood coming from Kira’s catheter after the birth of the couple’s second child on April 12, 2016. A CT scan was ordered around 5 p.m., but it wasn’t until after midnight that she was taken to surgery.
“Kira was allowed to bleed internally while myself, my family, begged and pleaded for them to take action,” Johnson said.
The CT scan that was ordered never happened. When the surgeons began operating on Kira, they found around 3 liters of blood pooled in her abdomen, he explained.
Alexis Ohanian, co-founder of Reddit and the husband of Serena Williams, shared how Williams, a tennis superstar, diagnosed her own pulmonary embolism after giving birth to the couple’s daughter. Williams’s concerns were also initially ignored.
Williams, who is African-American and has a history of previous pulmonary embolism, told doctors what she needed, even naming the medications. Ohanian, who is white, said it was “surreal” to him to not be able to make his concerns and those of his wife heard.
Williams survived, though she endured a long recovery. As a result of this experience, Ohanian has become an advocate for maternal health and paid family leave, including paternity leave.
Recognizing these inequities and flaws in our health system is not enough, Harris said, urging both the public and private sectors to take action.
HHS and CMS together are leading by example, she noted. CMS has proposed to establish a “birthing-friendly” hospital designation, a quality measure to incentivize improving maternal care. The designation will be granted to hospitals participating in a collaborative program that looks to improve maternal outcomes and to establish patient safety protocols. CMS will include the designation on its Care Compare website, which will enable consumers to make informed decisions about where to seek care.
The agency also issued guidance to help more states expand Medicaid coverage to a full year following childbirth. Currently, states are only required to provide 60 days of coverage after mothers give birth. However, researchers have found that many maternal deaths and complications occur well beyond that window.
The path to expanded coverage will be available in April 2022, according to the White House fact sheet. Some states such as Virginia, New Jersey, and Illinois have already expanded coverage.
If every state expands Medicaid coverage, as the Build Back Better Act requires (legislation passed the House but has not yet received a vote in the Senate), the number of Americans with postpartum coverage would double to 720,000, according to the fact sheet, which cited a report from the Office of the Assistant Secretary for Planning and Evaluation.
In addition, the Build Back Better Act calls for investing $3 billion in new maternal health funding, to grow and diversify the perinatal workforce, to improve data collection, and to enhance “maternal health risk monitoring,” as well as address social factors that can lead to poor maternal health outcomes.
Rep. Lauren Underwood (D-Ill.) highlighted the importance of diversifying the perinatal workforce — a provision of the “Momnibus” Act, which was incorporated into the Build Back Better legislation — including funding specifically for doulas.
“Research shows that when pregnant people lack access to obstetric providers or can’t receive culturally appropriate maternity care, their risks for adverse birth outcomes are much higher,” she said.
Studies have also shown that doula-supported mothers are four times less likely to have a baby with low birth weight and two times less likely to experience birthing complications. They are also significantly more likely to breastfeed.
Funding will also be directed towards targeting substance use disorders that impact maternal health outcomes, expanding research on maternal health, and enhancing postpartum coverage, according to the fact sheet.
The legislation will also encourage innovation by enabling states to build maternal health homes, which can improve care coordination for mothers before, during, and after birth.
Th country’s maternal death rate was apparent even before the COVID-19 pandemic, and pregnant women are at increased vulnerability for poor outcomes from COVID, especially women of color, noted Sen. Patty Murray (D-Wash.).
“It should be obvious to everyone we cannot build back from this crisis stronger and fairer if we leave mothers behind,” she said. “This is a priority for women and families, and it has to be a priority for us.”