Racism as a Public Health Crisis: maternal and infant health

By: Hope Lane-Gavin and Natasha Takyi- Micah

Of all of our priority areas this year, the time we’ve invested in maternal and infant health has garnered a lot of attention and ultimately, results. We continue to promote dialogue on every platform and emphasize the importance of the issue to policymakers at all levels, especially where maternal health intersects with racial equity, another defining theme of our work in 2022.

At our largest event of the year, Celebration of Human Services, we devoted an hour to maternal health, featuring Ohio Senator Matt Dolan and Franklin County Commissioner Erica Crawley; moderated by Marcia Egbert, Program Director, The George Gund Foundation.

Maternal health bills to watch during lame duck

Commissioner Crawley made a pitch for a bill she introduced prior to her appointment to the Franklin County Commission, House Bill 42: Save Our Mothers Act. If passed, key maternal health provisions will be enacted to improve protections for birthing people in hospitals, specifically people of color. The focus is on the implementation of Alliance for Innovation on Maternal Health (AIM) safety bundles in labor and delivery hospitals. Mental health is a priority, including addiction treatment, overdose prevention, and support for anxiety and depression. Common physical issues like hemorrhage and hypertension would also be closely watched. Most important, however, is the requirement that all providers who would interact with a pregnant person participate in anti-racism training.

Two other bills would support expanded birthing options that evidence has continued to show improved outcomes. HB 142 supports doulas as perinatal health care providers; HB 496 creates clearer regulation parameters for midwives. Community Solutions have advocated extensively for both of these outcomes, including in a recent Public Testimony: May 19, 2022, House Bill 496, Families, Aging & Human Services Committee on Midwives and Maternal Health. HB142 was passed by the House on June 1, 2022 and is currently in Senate.

An eye on Dobbs

Late in the discussion, Ebgert posed a question about the Dobbs decision and its effect on maternal health, birth outcomes, and reproductive care.

Commissioner Crawley commented. “When people say small government? This is government overreach. With Dobbs, unless policy changes come there will be more deaths. And the bottom will fall out of the non-existent childcare infrastructure.”

Senator Dolan, who identifies as pro-life, emphasized the importance of making sure he and other conservative candidates are held accountable post-election. With renewed interest in maternal and infant health policies, he said, lawmakers should be enacting what he called “post-birth, child-life” policies, ones that support families and their ability to safely give birth and have the resources they need to thrive in the postpartum period and beyond. “If you’re not willing right now to say—in front of voters—what you will do on abortion when you get into office?” He continued, “If we start talking about other things right after the election, calls us on it. We cannot go through an election and ignore this issue, then go sideways after. If it’s not what the voters wanted, hold us accountable.”

Before the panel concluded, Egbert noted that long-term contraception use in Ohio is up 40% and asked the panel if there appear to be threats coming to the use of contraception. Commissioner Crawly stated, “some legislators want those restrictions, yes.” But Senator Dolan opined, “Thinking about my colleagues, I don’t think a further restriction on contraception would pass.”

Maternal health and Racism as a Public Health Crisis: year in review 2022

We have been writing about maternal health and racism as a public health crisis during 2022 but our Celebration forum sparked inspiration to revisit (and re-share!) our work in both areas.

Ripple effects of domestic violence in infant and maternal health “Because domestic violence is listed as an adverse childhood experience (ACE), these incidents also negatively impact infants before and after birth. ACEs are based on a study on how types of trauma-exposed during childhood affect an individual later in life. Intimate partner violence during pregnancy has been correlated with preterm birth and low birth weight; both contributing factors to infant mortality.”

National Maternal Mental Health Hotline provides critical support for birthing people and families “In 2015, about 16 percent of Ohio women who experienced a live birth suffered depressive symptoms; a percentage higher than the United States overall (at around 13 percent). Racial disparities are part of this issue: Black women are more than twice as likely to suffer from MMH conditions but half as likely to receive treatment compared to their white counterparts.”

Increasing, diversifying the perinatal workforce will save lives of Black mothers and babies “When a Black doctor cares for Black newborns, the mortality rate is reduced to half in contrast to white newborns. Prenatal care from midwives compared to physicians offers a lower risk of experiencing preterm births by 42 percent.”

Latest Ohio Department of Health infant mortality report: crisis and disparities remain “Black infants are 2.7 times more likely to die than white infants. The infant mortality rate for Black infants was 13.6 per 1,000 live births compared to 5.1 per 1,000 live births for white infants. The neonatal mortality rate for white infants was 3.4 per 1,000 live births and 8.9 per 1000 live births for Black infants. Black infants experienced a higher post-neonatal mortality rate at 4.7 per 1,000 live births whereas white infants had a rate of 1.6 per 1,000 live births.”

Following Roe reversal, Cuyahoga County approves using stimulus funds to pay for out-of-state abortion travel “The community assistance fund [of the Greater Cleveland Reproductive Health Project] will pay to help educate people who are facing an unplanned pregnancy to better understand their options. It also includes paying for hotels and travel costs for people seeking an out-of-state abortion, according to county documents.”

White House releases Blueprint to Address the Maternal Health Crisis “People who give birth in Ohio and in the United States have worse outcomes compared to other developed nations. This is felt even more acutely by Black and brown people who give birth, for whom the maternal mortality rate is two to three, and in some cases three to four, times that of the maternal mortality rate for white people who give birth.”

Prioritize Black and brown women when addressing maternal mortality and morbidity “Studies have shown that college-educated Black women have higher risks of maternal death than high school-educated white women. Black and brown women face three to four times the risks of mortality white women. Structural racism within hospitals and health care settings along with the toxic stress that Black women are subjected to creates higher risks in pregnancy, as well as for other health conditions.”

New guidance to implement 12 months of postpartum Medicaid coverage, up from 60 days “Ohio’s 2022-23 state budget that was signed into law in June 2021 included a provision that would provide Medicaid coverage for birthing people up to 200 percent of the federal poverty level for a full year after giving birth. The current policy is to provide Medicaid coverage for 60 days postpartum for this group. Moving from 60 days to 12 months of postpartum coverage was made easier by a provision in the federal American Rescue Plan Act of 2021 that streamlines the process for states to make this policy change in their Medicaid plan.”