Every year, roughly 700 people die during pregnancy or in the year after giving birth in the United States. This is despite the US being one of the richest nations in the world and a global superpower. Yet, it is the only developed country with double-digit deaths and ranks highest among these nations for maternal mortality — at 26.4 percent of 100,000 live births. The victims in the majority of these deaths are women of color.
CDC data shows that 42.8 percent of the maternal deaths in the US are Black birthing people. That’s three times higher than the maternal mortality rate for White women at 13 percent and studies show the number of maternal deaths—especially among Black women—has only gotten worse amid the COVID-19 global pandemic.
Despite the bleak reality facing women and birthing persons nationwide, this crisis has not gone unnoticed. To respond to the maternal care crisis and the dire outcomes facing Black women and other birthing people of color, a bipartisan coalition in Congress known as the Black Maternal Health Caucus has been working since March of 2020 to pass a number of bills to address the maternal care crisis in America.
The twelve bills listed below comprise the Black Maternal Health Momnibus Act of 2021. I spoke with Irnise Williams, JD RN—known as the nurse lawyer online—to break down each bill, what it will do and how it will have a direct impact on the Black maternal care crisis.
This bill is focused on where people “live, learn, work and play.” The conditions in these areas of people’s lives can affect their birth outcomes. If someone lives in a community that does not have easy access to transportation, low rates of health insurance or other necessary aid, this bill will make sure the programs to improve quality of life are funded.
Williams said this bill will make sure that mothers have wrap-around services from housing to healthcare and everything in between to make sure that they can properly care for their child. This also includes expanding Medicaid to care for mothers through their pregnancy and a year after delivery. The current cutoff in places where Medicaid has not been expanded is 60 days after delivery even though birthing people can experience complications up to a year after delivery.
In the states that do not opt in to the Medicaid expansion, birthing people in need will be able to seek help at federally-funded qualified health care centers.
Williams said, “Federal qualified health care centers are clinics that serve marginalized and underserved communities. They take you If you have Medicaid and they take you if you have no insurance. They usually put you on a sliding fee, and the government reimburses them.”
The only drawback to these federal clinics is access. In places where they are available they will help but those locations could be few and far between.
Kira Johnson died twelve hours after delivering her second child via Caesarean in April 2016. She had internal bleeding that was ignored for hours despite her husband Charles Johnson, IV alerting medical staff that there was blood in his wife’s catheter. He has been speaking out and advocating on her behalf ever since testifying before Congress twice.
This bill “supports bias and racism training” for medical staff and established the Respectful Maternity Care Compliance Program to address bias and racism in maternal care. However, there is no additional accountability to these provisions implementing these training programs.
“Forcing providers to have to go through some type of rehabilitative training in order to address some of the issues that they’re having with their patient population would probably be better,” Williams said.
This bill passed and was signed into law by President Biden at the end of 2021. The goal of this new law is to make sure the U.S. Department of Veterans Affairs (VA) has adequate maternal care programs across all of their facilities. These programs include childbirth classes, identifying mental and behavioral risks among pregnant people, as well as making sure community resources are available to veterans and/or their spouses on their pregnancy and birth journey.
The new law will also look at the rate of maternal mortality among the veteran community by commissioning a new comprehensive study of the issue to track the data.
The goal of this bill is to expand the practitioners, clinicians and support staff who all work in maternal care. This includes nurse practitioners, doulas, midwives, lactation consultants and more. The goal of this bill is to also diversify this workforce to reduce adverse outcomes—like death—because of bias, discrimination, and racism.
The way this bill will work is by providing funding. Organizations, both private and nonprofit, will be able to sign up to receive funding that will then go toward hiring the staff they need to support birthing people in their community.
This provision of the Momnibus Act builds on a previously passed law in 2018 that funded the Maternal Mortality Review Committee in states across the country. This goes to further the data collection and study of the maternal care crisis in the United States and understand its root causes. This bill will also for the first time study the maternal care crisis among indigenous people — whose maternal mortality rate makes up 32.5 percent per 100,000 live births.
Williams believes data collection of this magnitude will help identify the current trends in maternal mortality as well as establish a reason for why this is happening.
“Mass data collection in this way, forces them to find what connects all of these situations, which is really going to be qualitative and quantitative, because it’s going to be communication. It’s going to be education,” she said. “It’s going to be the information that was received or communicated from the family or to the provider.”
While the outcome of this bill will take years to collect and analyze, it will lay a foundation to hopefully reverse the current trend of escalating maternal mortality year after year.
The sixth bill in the Black Maternal Momnibus Act is one that focuses on the mental health and or substance issues associated with birthing people.
This bill specifically seeks to invest in programs that provide both prenatal and postpartum mental health care to address the stigma associated with perinatal and postpartum depression. While 50 to 75 percent of people who give birth experience the “baby blues” after delivery, 15 percent of these people experience a more lasting postpartum depression.
Untreated, postpartum depression can turn into postpartum psychosis which could lead to a parent harming themself, their child, or both.
Just because you go to prison does not mean you cease being human or that your rights cease to exist. This bill seeks to restore the humanity and dignity to incarcerated mothers. First by ending the practice of shackling pregnant people. It will also provide funding for federal, state and local prisons to establish programs and support for pregnant and postpartum women in their facilities including health workers, counselors, doulas and more.
This bill will also fund a study to determine the rate of maternal morbidity among incarcerated people as well as the negative effects associated with ending a mother’s medicaid coverage because she is incarcerated.
Despite the good intentions of the bill, Williams is concerned with its implementation by corrections officers and other prison staff.
“Yes, this sounds good, but the people who actually put these things into place, who is watching them to ensure that process actually happens?” Williams asks. “We have old ways of doing things and to actually change that by just passing a bill and providing more funding and money, it’s not realistic.”
This next provision of the Momnibus Act relates to doing more investment in telehealth. It would especially go to help moms and birthing people who live in maternal care deserts. The March of Dimes defines a maternal care desert as a county that lacks a hospital offering obstetric services or a birthing center, providing no access to an OB/GYN or a certified nurse midwife. Seven million women in the United States live in what is considered a maternal care desert.
In addition to investing in telehealth services and infrastructure — such as increased access to broadband — for moms with lack of access to maternal resources, this bill will also address racism and biases through digital tools and artificial intelligence to make sure care is not only accessible but equitable for all.
The Impact to Save Moms Act would create a new payment plan for birthing people to follow that would cover all of their maternal care needs. Williams said this bill creates a value-based care model for moms and birthing people in addition to creating accountability within the model to make sure care is prioritized over the payment.
The way it would work is that doctors would receive a certain amount of money to care for someone during their pregnancy with the contingent being that person makes it full term and without issues. To do that, providers then have to hit certain benchmarks during the prenatal treatment period to make sure the person is healthy and they, in the end, receive the full value of the person’s treatment.
“It’s gonna be a Cadillac of care,” Williams said.
This bill was proposed in direct response to the United State’s reaction to the COVID-19 global pandemic. Though it could be another 100 years before the country experiences a pandemic of this magnitude, this bill makes sure that moms are cared for through that process.
In the early days of COVID in 2020 before mass testing and vaccination were available pregnant people weren’t truly being cared for in an effort to protect against the spread of COVID. As a consequence many moms were getting sick and some died from the added complication of COVID because pregnancy is already a stressor on the body. Even once viable vaccines were released pregnant people were still not the priority in terms of research and access.
This bill will address those issues making sure pregnant people are considered and accounted for in any future pandemic response.
This bill will provide funding to identify the climate change risks that most affect pregnant and birthing people and then try to limit their exposure to those risks.
This includes heat exposure and air pollution in the areas of the United States most vulnerable to these issues.
The final bill in the Momnibus Act will provide funding for a national campaign to encourage pregnant people to get their flu shot and TDaP vaccines during their pregnancy.
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