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April 16, 2019

Black Maternal Outcomes a Concern, New State Action Can Help

April 11-17 is Black Maternal Health Week. To learn more about issues and stories concerning Black maternal health, please visit or follow the social media hashtags: #BMHW19 and #BlackMaternalHealthWeek

The welcoming of a child should be an exciting time for families. People that call Virginia home hope to have good health outcomes for mothers and their child while starting their new journey as a family. Unfortunately, for too many Black women and families this has not always been the case, and there is clear evidence of this when looking at maternal mortality outcomes. Thankfully, there are a couple of legislative moves that are expected to help provide more health coverage and insight into how the state should respond to these outcomes.

The United States as a whole has seen maternal mortality rates more than double since 1999. And disparities in maternal mortality have come under continued scrutiny. A report from 2017 noted that Black women in the United States are roughly 2.6 times more likely than all women to die during pregnancy or within one year of pregnancy.

A similar trend is seen here in Virginia, where the last two years of data (2015-2016) show higher mortality rates for women overall, including Black women. But maternal outcomes for Black women continue to be a particular and significant concern. In the last decade for which there is available data, Black women in Virginia were 1.4 to 3.3 times more likely to die during pregnancy or within six weeks of the end of pregnancy than the total population.

Graph: Concerning trend in Black mortality -- In the last decade for which there is available data, Black women in Virginia were 1.4-3.3 times more likely to die during pregnancy or within six weeks of the end of pregnancy compared to all women in the state. Medicaid expansion and the newly established Maternal Mortality Review Team coupled with ongoing monitoring and intervention can help.

With expanded Medicaid coverage having taken effect earlier this year, more women will receive ongoing care prior to and after pregnancy. Prior to expansion, pregnant women were only covered from pregnancy to two months after the end of pregnancy. With newly increased eligibility, many new mothers will be able to continue having health insurance after those two months.

State lawmakers also passed legislation that created the Maternal Mortality Review Team, under the umbrella of the Virginia Department of Health. This team will investigate and review data on maternal mortality in order to help better understand and address issues in maternal mortality. Their work will eventually lead to recommendations on policies and programs. The legislation is written to investigate all instances of maternal mortality, but without the intentional study on the outcomes of Black women, the recommendations will run the risk of missing the mark.

While this legislation can help improve maternal outcomes for all women, it won’t fix the racial discrimination Black women experience in medical settings and in everyday life. Black women more often experience a lower quality of health care compared to their white counterparts. Additionally, the experience of discrimination and the stress associated with it, including while accessing health care, has been shown to lead to poorer health outcomes for mothers and their children during pregnancy. Finding ways to further boost Black participation in the medical field, such as lowering the out-of-pocket costs of attending medical school, and ensuring access to quality and culturally responsive treatment could help address the physical and mental tolls of racism in expecting Black mothers.

One avenue the state should consider is increasing access to doula services. Doulas are trained professionals who provides physical, emotional, and informational support to a mother before, during, and shortly after childbirth. Their services are generally seen as part of a more holistic and culturally responsive system of care. Currently, Minnesota, Oregon, and New York offer Medicaid reimbursements for these services as a way to address the issue of maternal mortality. If Virginia followed suit, it could help to protect the lives of new mothers and their children, because doulas are positively associated with lower rates of pre-term birth and cesarean delivery as seen in the Minnesota Medicaid population.

Medicaid expansion was a step in the right direction towards lowering the number of Black lives lost during or after pregnancy by promoting access to quality coverage. Meanwhile, the work of the Maternal Mortality Review Team will only prove helpful if bolstered by future state action and investments. Targeted interventions are needed in order to see meaningful progress in health outcomes for Black mothers in Virginia.

Health Care

Freddy Mejia

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