Decolonize Birth Now
Structural racism is the primary motivating factor behind maternal health disparity in the US. We need to deconstruct the implicit bias and inequities present in our hospitals, from the waiting room to the delivery room, to the child’s first annual check-up a year later.
Problem
Black women in the US are three times more likely to die during childbirth, and their infants are twice as likely to die in the first year of life. The US is the only industrialized nation in the world where rates of maternal and infant mortality are worsening. Additionally, given that there is no universal collection of data in this area, we do not know the extent of the harm being done. Racism creates social inequity that shapes health behavior, and access to quality care. It also influences interactions between clinicians and patients, which are often wrought with subversive racism and implicit bias, leading to health disparities and poorer outcomes.
Our Plan
We need to decolonize birth and ensure that everyone has appropriate medical support and agency throughout their birthing experience.
Elevate Black-led community-based providers, and integrate doulas, midwives, lactation consultants, and community health workers into Medicaid reimbursement structures.
Expand New York’s Doula Pilot Program, which covers doula services for Medicaid fee-for-service and Medicaid Managed Care enrollees.
Promote value-based payment models that link reimbursement to quality of care, and mandate equitable Medicaid reimbursement for doulas and community health workers.
Promote midwifery-led, freestanding birth centers as options for patient-centered, low-risk birth.
Recruit underrepresented minorities into health care fields, and support efforts to pay for recruitment, training of diverse workforce, as well as ongoing training and continuing education as it relates to pregnancy and birth.
Integrate pregnancy doulas as part of medical care teams.
Support initiatives reinforcing birth choice, or out-of-hospital birth for low-risk women, and ensure it is paid for by insurance.
Move away from biased certification systems towards culturally competent education structures.
Review material being taught in light of the disrespect that black people face in the healthcare system.
Support policies and provider training aimed at eradication of cultural bias and discrimination in medical practice, medical education, and hospital systems.
Require universal data collection and disaggregation by race and ethnicity, sex, pregnancy, and postpartum status.
Ensure morbidity and mortality review committees outside of the hospital review the causes and circumstances of every maternal, fetal, and infant death.
Create accountability structures for hospitals, clinics, and other medical practices that fail to provide evidence-based, unbiased, high-quality care.
Expand and maintain health care coverage.
Extend Medicaid postpartum coverage to at least one year.
Support universal health care measures to ensure access to comprehensive primary care throughout the lifespan, with the goal of treating illnesses that increases the risk of poor birth outcomes.
Create accountability structures for poorly designed systems, and “bad apple” players
Link insurance payments to outcomes data - with incentives for improved outcomes
Promote patient-driven feedback systems that inform practice and policy change.
Implement a general input forum or body that could collect information from the ground up.
Support patient advisory boards.
Support the Black Maternal Health Momnibus Act, which looks at maternal health beyond the hospital, and addresses social determinants of health like unstable housing, transportation access, and food insecurity.
Expand paid family leave policies at the federal level.
This Matters
Maternal health is bigger than pregnancy and birth and needs to be approached holistically. Food insecurity, economic inequality, trauma, and violence can all impact the health of birthing people and their children.