October 10, 2019
Improving Maternal Health: Solutions to Keep Black Mothers in Virginia Alive & Healthy
Nationally, Black women are 3.3 times more likely than white women to die during pregnancy or within one year of pregnancy. Research has shown similar trends for Virginia where Black women were about 2 to 3 times more likely to die during that same time period than their white counterparts. In June 2019, Gov. Northam announced plans to address maternal health outcomes, with a goal of eliminating racial disparities in maternal health by 2025. With a comprehensive Maternal Mortality Review Team established through legislative action and a listening tour and community discussions in progress, Virginia is gathering crucial information to improve maternal health outcomes and protect the lives of Black women. The next step: state lawmakers need to take action and advance a set of policies that are responsive to the lived experiences of Black women and promote safe and healthy families.
Medicaid expansion has provided 190,000 women with the health coverage they need. And for those who may have children one day, this health coverage could be crucial. Building on this success, the Department of Medical Assistance Services and the Department of Social Services are now fast-tracking Medicaid enrollment for those who are pregnant and eligible for the program, which could result in more people receiving health care earlier in their pregnancy. While this is significant for those who are pregnant research has shown that receiving care early and often during pregnancy will result in better outcomes for both mother and child there is significantly more work to do.
A major factor in the differences in outcomes for mothers is the racial discrimination that Black women experience in everyday life and in medical settings, where they experience a lower quality of health care more often than white women. The experience of discrimination, including while accessing health care, and the stress associated with it have been shown to lead to poorer health outcomes for mothers and their children during pregnancy.
Connecting Black women to doula care could be part of making sure that every new mother has the opportunity for good health. A doula is a trained professional whose role is to provide tailored, patient-centered, non-clinical physical and emotional care to someone who is pregnant before, throughout, and after a pregnancy. Doula care has proven to be beneficial in helping women of color successfully navigate the stress and trauma that systems can often cause. Research has also shown that those who receive doula care have lower rates of cesarean sections and are less likely to experience low-weight births, and some studies have found lowered risk for postpartum depression. Women with low incomes and from culturally diverse backgrounds have been found to benefit from doula care but have not always had access to or knowledge of these resources.
Lawmakers in Virginia could help connect women with low incomes to doula care by allowing Medicaid to reimburse doula professionals. Minnesota and Oregon have passed targeted legislation allowing doula care to be reimbursed through Medicaid, and nine other states have introduced similar legislation. While there are practical challenges with implementation, like ensuring a living wage and a diverse workforce for doulas, doula care could be effective in improving maternal health and addressing maternal mortality disparities in Virginia.
State lawmakers should also consider increasing the eligibility threshold for pregnant people for Medicaid/Children’s Health Insurance Program (CHIP). Federal law requires that states extend Medicaid/CHIP eligibility for those who are pregnant to at least 138% of the federal poverty line (FPL), which is $17,236 annually for an individual. While most states, including Virginia, go beyond the minimum, Virginia should join 3 other states and D.C. in extending coverage for people who are pregnant up to 300% FPL. This would ensure that more people who are pregnant can get the care they need.
It’s also important for the state to consider that the need for care doesn’t end at birth. Federal law requires that Medicaid/CHIP health coverage last for at least 60 days following pregnancy. Two months is not enough time. The Centers for Disease Control and Prevention (CDC) considers pregnancy-related deaths to be those that occur within a year after pregnancy. The state should focus on making sure families are thriving — not just surviving — and extend coverage to a full 12-months after the end of pregnancy, allowing them to continue accessing vital health services for themselves and their children.
A combination of all of these policies could go a long way in helping to eliminate racial disparities in maternal health. And to better protect the lives of Black women during and after pregnancy, there are numerous additional steps that must be taken at the same time:
- Implement a statewide paid family and medical leave policy to allow women of color, who are more likely to be key or sole breadwinners in their families, to take paid time off to care for themselves and their families without risking financial security.
- Ensure access to behavioral health services during the first six weeks after childbirth to allow families the opportunity for a healthier start.
- Eliminate the 40-quarters rule to help lawfully present immigrants access Medicaid in the state.
- Streamline access to Medicaid, the Supplemental Nutrition Assistance Program, and the nutrition program for women, infants, and children (WIC) to deliver benefits to families efficiently and improve their health and well-being.
- Adopt value-based reimbursement, which may incentivize health care providers to provide a high-quality level of care that is most appropriate to the situation; this model has been shown to significantly decrease c-sections, which adds an unnecessary risk of surgery when not medically necessary.
- Reduce the impact of institutionalized racism in medical settings by ensuring more diverse student bodies in medical schools, encourage Black representation in medical settings, and mandate continuing racial bias training and education within existing curriculums and for current doctors.
- Fund voluntary home visits through Medicaid to help new families adjust, learn new skills, or be further supported in current skills that are valuable to their families.
- Break out findings by race in order to better inform policy recommendations. The lives of Black mothers are invaluable. Rather than solely focusing on the fiscal impact of a policy, each policy recommendation from the newly-formed Maternal Mortality Review Team should include a racial impact assessment to determine anticipated impacts to women of color and Black women in particular.
There is no shortage of practical solutions to stop these preventable deaths.The heightened risk of maternal mortality for Black women is the result of structural inequities, and it won’t be solved with one policy alone. The state needs to look at the issue with intentionality to address maternal mortality as a whole and the overwhelming impact on Black women.
Virginia’s Secretary of Health and Human Resources Daniel Carey is currently embarking on a Maternal Health listening tour “to hear from individuals with lived experience and discuss strategies to improve maternal health outcomes.” Listening to Black women and letting their lived experiences guide state policy solutions is a necessary and long-needed step towards making childbirth a safer experience in Virginia. Black women should not have to risk their lives in order to have children. And Virginia lawmakers have a duty to reverse the trend.