The Crisis in Black Maternal Mortality
David R. Jones, The Urban Agenda
Reproductive rights will be on the ballot this Election Day, as they should be.
Ten states including New York will ask voters on November 5 to weigh in on constitutional amendments that would protect or expand reproductive freedoms. In New York, voters will be asked to amend the state’s equal rights amendment prohibiting discrimination on the basis of “pregnancy, pregnancy outcomes and reproductive healthcare and autonomy,” also known as Proposal 1.
Safeguarding the fundamental rights of New Yorkers to be in charge of their personal healthcare decisions is a bedrock of modern democracy and should be something we all care about. One way to achieve that is by enshrining equal rights protections into the state constitution. If we learned anything in the past year it is that the rights of many groups of individuals, particularly women, are under attack. Unless constitutionally protected, a politician with an agenda can restrict those rights and freedoms.
It is good to see reproductive health issues getting the attention they deserve, and hopefully motivating voters to go to the polls in large numbers this November. At the same time, not nearly enough attention is being focused on the persistent racial disparities in the delivery of and access to quality health care. An issue that has serious implications for reproductive health.
For proof of that, one need look no further than health outcomes for maternal and infant mortality rates. Consider these disturbing national statistics: Black women are three times more likely to die from pregnancy related causes than White women; Black women are twice as likely to have a birth with late or no prenatal care at all when compared to White women. Cardiac health is the biggest concern for Black maternal health with postpartum cardiomyopathy being a leading cause of postpartum deaths. Finally, late maternal deaths, those occurring between six weeks and one year postpartum, are six times more likely among Black women than White women.
In New York City, the picture is even bleaker. Black women are nine times more likely to die from pregnancy or childbirth than White women, a far starker disparity than the national numbers described above.
On their own, these statistics are sobering enough. But when you add that more than 80 percent of pregnancy related deaths may be preventable, it’s no surprise that among many Black people there is a profound distrust of the medical establishment, from the doctors to the providers.
The good news is a series of recommendations in a 2023 report on maternal mortality and morbidity, commissioned by the New York State Department of Health, offers a framework for addressing disparities in maternal health outcomes. The report recommends instituting mandatory racial equity training for all staff working in health care delivery systems and for all licensed care providers. It also calls on professional physician organizations (emergency physicians, obstetricians, gynecologists) to establish guidelines that prioritize equitable care during pregnancy and postpartum periods.
Most importantly, the report acknowledges that systemic and structural racism exists in our health system, perpetuating barriers to maternal health that can lead to death or result in short or long-term adverse health consequences.
According to the Commonwealth Fund’s 2024 State Scorecard on Women’s Health and Reproductive Care, New York ranks 12th on maternal deaths. On health care quality and prevention, it ranks 27th. These two issues are interconnected and need to be addressed within a health equity framework.
For example, New York has taken important steps to improve maternal outcomes. Through a community health program called Nurse-Family Partnership, first-time mothers who are pregnant 28 weeks or less are paired with specially educated nurses from early pregnancy until the child’s second birthday. But this program has not yet been rolled out statewide. Another important statewide effort is through New York State’s Medicaid program which requires reimbursement for a specific set of Doula services for pregnancy, birthing, and postpartum care.
But there is more New York can do, starting with eliminating barriers to postpartum care. The World Health Organization “standard of care” calls for four postnatal checkups in the first six weeks. Yet, Medicaid Managed Care in New York only covers an initial postpartum visit, after a health plan’s “prior approval,” and all subsequent visits must be further approved as “medical necessity.” Midwives, other skilled providers or well-trained and supervised community health workers should be eligible to provide postpartum care under Medicaid without undergoing any insurance approvals or barriers to access this crucial component of care. New York should also eliminate cost-sharing for prenatal and postpartum services for individuals in all state-regulated health plans to ensure that small, short-term costs are never a barrier to accessing pre- or post-natal care.
Finally, more must be done to reduce implicit—and even explicit—bias in the medical and hospital community. Though it may be unrealistic to believe we can eradicate all forms of racial bias and stereotyping of people in the delivery of health care, that nevertheless should be the goal.