Racial Justice in Health Care: Maternal and Infant Mortality
Posted May, 16 2019 by Amanda Dunker
We’ve been talking about racial disparities this week, and there may be no other area where racial disparities are as stark as maternal and infant mortality (read our first two posts here and here). The United States in general has shockingly high rates of maternal mortality and we’re the only developed country in which the maternal mortality rate has increased over the last two decades (more than doubling since 2001). In March, the New York State Task Force on Maternal Mortality and Disparate Racial Outcomes released its report, and the picture it paints is grim.
New York’s maternal mortality rate was 30th in the country in 2016, and it increased from about 15 deaths per 100,000 live births in 2001-2003 to about 20 deaths in 2014-2016. Nationally, black women are three to four times more likely to die in childbirth, or the immediate post-partum period, than white women. Poor maternal health also has a severe impact on black infants. This data is available for many counties in New York and it is horrifying. In Niagara and Westchester Counties, where the disparities are the worst in the state, black infants die before their first birthday 4.5 times as often as white infants.
The report made clear that “racial disparities exist, independent of other variables” and that both racism and access to services both play a role in New York’s maternal mortality crisis. The task force report found, for example, that black New Yorkers tend to go to hospitals with poorer obstetric care records, and that “stress caused by racial discrimination plays a significant role in maternal mortality.”
A bill awaiting the Governor’s signature would implement on of the report’s recommendations. A3276 (Joyner)/S1819 (Rivera) would establish a Maternal Mortality Review Board. The new state board (which would coordinate with a similar entity in New York City) will investigate maternal deaths in the state and make findings and recommendations to policymakers and practitioners to reduce the number of deaths and reduce racial disparities. The Governor included this proposal in his original budget and so is likely to sign.
The report author’s also recommended creating a comprehensive training program for health care providers on implicit racial bias, providing “equitable” reimbursement policies for midwives, and expanding community health workers services. Fortunately, the FY 2020 enacted budget includes an $8 million investment over two years to fund these important priorities.
Another strategy: a pilot program in Buffalo that providesMedicaid coverage for doulas. We’ll talk more about why that is such an exciting project in our next post.