Women of color, in particular, would benefit if state expanded access to Medicaid
The United States has the worst rate of maternal death of any industrialized nation, and the rate of pregnancy-related deaths in the U.S. is more than three times higher for Black women than it is for white women.
Advocacy group leaders and doctors, including Dr. Shannon Dowler, chief medical officer for NC Medicaid, told the U.S. Commission on Civil Rights at a Friday hearing last week more women would live if those who use Medicaid to cover their pregnancies and deliveries were allowed to continue to use the government insurance program for a year after giving birth rather than getting kicked off after two months.
Speakers told commission members that insurance coverage is only part of the solution, because structural racism and implicit bias also play a role in the differences in death rates. Doulas, midwives, and community-health workers should be used more often, several people said.
The U.S. Centers for Disease Control and Prevention reported last year that about 700 women each year die from pregnancy or pregnancy complications.
Death rates were 3.3 times higher for Black women and 2.5 times higher for Native American/Alaska Native women than for white women.
Black women with a college degree are five times more likely to die from pregnancy-related complications that white women with similar educational backgrounds, said Shanna Cox, associate director for science in the U.S. Center for Disease Control and Prevention’s Division of Reproductive Health.
Solutions must be comprehensive and broader than looking at poverty or rest on fallacies about personal responsibility, said Dr. Joia Adele Crear-Perry.
“We know that despite income or education, Black women are still more likely to die in childbirth than their white counterparts, said Crear-Perry, president and founder of the National Birth Equity Collaborative.
“This idea that if we just went to school, got a good job, got some health insurance and exercised and moved to nice neighborhood, that everything would be okay – if we were just more compliant and showed up to all our appointments is not based on the actual data,” she said. “The fact is, when we do all those things, we’re still more likely to die.”
U.S. Rep. Alma Adams, a Charlotte Democrat, has brought attention to the disparity, cofounding the Black Maternal Health Caucus and introducing with other caucus members a package of bills called the Black Maternal Health Momnibus.
Federal legislation called the Helping MOMS Act of 2020, which passed the U.S. House this year but was not taken up in the U.S. Senate, would have extended pregnancy Medicaid for a year after delivery and would have studied use of doula services under the insurance program.
“For many, pregnancy is the first time a young woman has access to healthcare, outside of family planning services. In states like North Carolina where Medicaid expansion has been blocked, women often only learn of preexisting conditions once they become pregnant,” Dowler told the commission.
Many women learn for the first time that they have chronic conditions, or develop chronic conditions while they are pregnant, she said. Cardiovascular conditions are responsible for more than one-third of pregnancy-related deaths, she said.
“High blood pressure, anemia, dental caries, depression – these conditions too often go untreated because women lose coverage before they can pause from the demands of a new infant so they can care for themselves,” Dowler said. “One of the single most impactful things we can do in this country today is to allow, actually to insist on, one year of postpartum coverage for women with pregnancy Medicaid.”
A study published in September concluded that Medicaid expansion lowered the rate of maternal deaths.
In North Carolina, the rate of pregnancy related deaths for white women was 40.2 per 100,000 live births between 1999 and 2013, and the rate for Black women was 49.8 per 100,000 live births in those years.
North Carolina has a five-year, $10 million federal grant to reduce maternal mortality.
As part of the grant, the Jordan Institute for Families at UNC is going to work with clinics and community health groups on improving postpartum care, institute Director Sarah Verbiest said in an interview. Verbiest helped launch the 4th Trimester Project, a website for new mothers where they can find heath information and communicate with one another. A Spanish-language version of the website is about to launch, Verbiest said.
The clinics will decide what they want to work on first, Verbiest said. Clinics will have the opportunity to learn about and build connections with local community resources, she said, and will have money to call together groups of new mothers to find out what they want and need.
“We know North Carolina is ready to come up with better and more mom-centered ways of giving care,” she said.