Disparities in Maternal Mortality? ‘We Know Exactly What to Do,’ Says Lawmaker

The head of the Centers for Medicare & Medicaid Services (CMS) and co-chair of the House’s Black Maternal Health Caucus shared strategies for addressing disparities in maternal health during a panel discussion at HHS’s Black Health Summit on Wednesday afternoon.

No matter their income or education level, Black women are three times more likely than white women to die from pregnancy-related complications. And these disparities are the direct result of systemic inequities, said Kamara Jones, acting assistant secretary for public affairs at HHS.

Jones shared the story of a woman she met at a CMS health panel in Virginia, who told her that her way of tackling provider bias was to immediately introduce herself and her unborn child to physicians.

“She would say ‘My name is Jasmine and this is Simone,’ and she would point to her stomach, because she wanted the non-Black doctor to see her child as a human being even before it was outside of the womb,” Jones said.

Another mother told Jones she kept a journal, not only as a keepsake but as a record, in case something went wrong.

“This is what Black women are doing daily to protect themselves and their children from these issues,” she said.

Asked what Congress and CMS are doing to promote equitable care, CMS Administrator Chiquita Brooks-LaSure spoke about the importance of having providers who listen — including doulas, midwives, and community health workers. CMS is working with states to ensure that an array of providers including those who are “health-adjacent” are part of maternal care teams, she said.

In addition to providers who listen, data collection is also critical to addressing maternal health problems, Brooks-LaSure said.

CMS is now beginning to include data requirements in its payment rules, for hospitals and providers, tracking metrics like unnecessary C-sections and excessive bleeding at delivery, she said.

In addition, 28 states and Washington D.C. have taken up CMS’s offer of a waiver to extend Medicaid coverage for women and birthing people 12 months postpartum, Brooks-LaSure noted.

CMS has also established a “birthing friendly” designation for hospitals, she said.

Rep. Lauren Underwood (D-Ill.), who joined Brooks-LaSure on the panel, shared how her bill “The Momnibus” — written with Rep. Alma Adams (D-N.C.) and other members of the Black Maternal Health Caucus — addresses both implicit and explicit bias, “a.k.a. racism,” in healthcare.

The “Momnibus” is a package of 12 bills focused on addressing clinical and nonclinical drivers of maternal health disparities, she said. One of these, “The Veteran Moms Who Served Act,” was signed into law last year.

Other provisions of the legislative package include funding for training, ensuring that institutions show “a real commitment” to change and accountability, and reducing systemic racism in the “built environment.” She noted that Black people are more likely to live near toxic pollutants.

Other parts of the package address mental and behavioral health concerns.

In Illinois, Underwood’s state, mental health and substance use disorders are the number one cause of maternal death, and communities currently lack the resources to address the problem, she said.

While the signs and symptoms of postpartum depression are pretty well known in society, there isn’t the same level of familiarity, nor are there specialists on hand to address anxiety, suicidal ideation, and substance use during the postpartum period, she said.

And to a degree, some provider groups and insurers aren’t set up to address these concerns. So, the “Momnibus” includes a bill, the “Moms Matter Act,” that would expand the perinatal mental and behavioral health workforce.

But the maternal health workforce needs to grow even beyond behavioral health specialists, as there are currently more than 1,000 counties in the country that lack a qualified obstetric provider, said Underwood.

Another bill in her package, “The Perinatal Workforce Act” would expand and diversify the number of obstetrician-gynecologists, nurse midwives, doulas, and lactation consultants in the country.

“You shouldn’t have to live in a city or a prosperous suburb. You should be able to live wherever you choose to be in our country and have access to exceptional providers and have provider choice,” said Underwood.

This is especially important for people of color, she said, because the scientific data show that when there is congruence — when a patient has the option of choosing a provider with the same background or who speaks the same language — outcomes are better.

Underwood said she didn’t want anyone to leave the summit thinking that policymakers don’t know how to fix maternal health.

“We know exactly what to do. It’s evidence-based, we know how much it costs, and when we do these things it doesn’t just save Black moms, it helps all moms … and improves the quality of care for every birthing person in this country,” she said.