Reducing The Maternal Mortality Rate: What Will It Take?

Nearly 700 women in the U.S. die each year and 50,000 suffer life-threatening health issues from pregnancy-related complications, Stacey Stewart, president and CEO of the March of Dimes, told a House panel on Tuesday.

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Stewart, along with Joia Crear Perry, MD, president of the National Birth Equity Collaborative, testified on ways to stem the maternal mortality crisis.

Stewart called on Congress to ensure that all women have comprehensive insurance before, during, and after pregnancy, and to ensure that the newborn infant has the same access to care.

She also urged lawmakers to create a special enrollment period to help all women access prenatal care. Under current law, pregnant women can enroll in private health coverage only during annual enrollment periods. In addition, Stewart called for protection for families from surprise billing by streamlining the process for enrolling newborns in a family's health plan.

"We find that there are too many families who have a 30-day window to add their newborn to the health plan and then often miss that window and as a result, especially if their baby's in the NICU, they may be accepting exorbitant healthcare costs because they missed that window. And so closing that gap would be also important."

In addition, Stewart stressed the importance of safeguarding the Affordable Care Act, especially its guaranteed coverage for maternity care and protections for pre-existing conditions.

Stewart and Crear Perry spoke of how beneficial expanding Medicaid coverage for new mothers to a full year could be. Under current law, Medicaid coverage only extends to 60 days post-partum, said Rep. Donna Shalala (D-Fla.).

And while "the public image of maternal death is a woman who has a medical emergency like a hemorrhage while in labor," in reality, 80% of maternal deaths happen during the weeks and months before or after birth, Shalala said.

The witnesses also lobbied for expanding the use of doulas, with Stewart stating that studies have shown doulas can reduce cesarean section rates and improve health outcomes for moms and babies.

"We think that if these kinds of services were more available -- maybe in addition to their traditional medical care -- we could probably see some outcomes improved over time," said Stewart, who also advocated for Medicaid reimbursing these services.

Stewart noted that black women are three times more likely to die from pregnancy-related complications than white women, and that maternal death rates for black, American Indian, or Alaska Native women over age 30 are four to five times as high as for white women.

One reason for these disparities is structural racism, she said.

In response to a question from Rep. Mark Walker (R-N.C). as to whether such racism was intentional, Crear Perry, who is also a board member of the Black Mamas Matter Alliance, noted that such behavior is pervasive.

Crear Perry explained that "I was taught in medical school by my professors that there were three...races: Mongoloid, Caucasoid, and Negroid...so I believed that the reason that I had a baby pre-term was because I was black."

She told Walker that racial bias has to be unlearned; she and Stewart called for mandating anti-racism and cultural competency training for healthcare providers.

Crear Perry said an example of implicit racial bias is the belief that black women don't feel pain in the same way that white women do, or that black women "all kind of run high" when it comes to their blood pressure. The latter is a particularly dangerous misconception, she said, because if clinicians believe that all black women have hypertension as a rule, they may not treat it.

In written testimony, she called on Congress to diversify the healthcare workforce, and increase investments in the CDC's Perinatal Quality Collaboratives, which aim to improve outcomes for mothers and infants by encouraging best practices.

Crear Perry also highlighted that restrictions on access to contraception are not helpful to women or children.

"Places that have more restrictions on access to contraception have the worst outcomes for maternal and child health," she stated, adding that claims of "'We're making things safer for moms,'" are "actually making things worse. The data is the opposite of the narrative around safety...restrictions in sex education cause harm... restrictions for access to birth control for LARCs [long-acting reversible contraception]; for abortion...cause harm, cause death. The more you put policies in place putting up barriers, the more that women and children are more likely to die."

Rep. Russ Fulcher (R-Idaho) asserted that women of color were three times more likely to have an abortion than other women, and suggested that Planned Parenthood was "targeting" women of color.

"Historically, they have targeted that community, the women of color community, and they provide many more abortions there, than elsewhere. And that's just wrong to me...It just seems unconscionable to me that people are making money off that and somehow we tolerate it," Fulcher said.

Crear Perry said she does not represent Planned Parenthood, but has worked with the organization "extensively." She urged Fulcher to think of black women not as being "preyed upon by Planned Parenthood" but as being "provided a service...because we don't have access to Medicaid expansion in some states; we don't have... hourly wage jobs that we can leave. So, we don't have all the social things that people need to be able to make different choices around birth options -- "

"The result of that is that... we're losing babies," Fulcher interjected.

"Exactly," Crear Perry responded. "So, the result of us not making choices in this building to support black women means that black women have to make a lot of different choices around their bodies.... If we decide that we believe we should have access to paid leave, maybe that would impact who chooses to have an abortion or not."

Shalala also pointed out that Planned Parenthood does not "make money on abortions." It's supported by charity and over 96% of its work is unrelated to abortion.

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