A lot of out-of-towners have asked me about diversity and the best places to live in Phoenix. The answer is No. Black people amount to 7 percent of the Maricopa County population US Census Bureau and we are spread out all over the Phoenix metropolitan area. Being spread out all over Maricopa County is weakening our bond with each other. As a native, I realize that the entire Phoenix area can a desirable place for African Americans to live if you are open-minded and proactive about finding activities, business opportunities and friends.
This report provides a comprehensive policy framework to eliminate racial disparities in maternal and infant mortality. If the fact that the United States has the highest maternal and infant mortality rates among comparable developed countries is not bad enough, the survival rates for African American mothers and their infants are even more dismal. Maternal mortality affects U. Among women who survive pregnancy and childbirth, 50, women each year experience life-threatening pregnancy-related complications 4also known as severe maternal morbidity SMM.
Discussions of the maternal health crisis in the United States often exclude this condition that disproportionately affects women of color, with African American women twice as likely to experience SMM compared with non-Hispanic white women. Pregnancy-related complications are closely tied to infant deaths as well.
Nearly two-thirds of infant deaths occur during the first month after birth, often from congenital abnormalities and complications from preterm births. AIAN and Puerto Rican women also have higher rates of infant mortality, and preterm births are a major driver for these groups as well. Disparities in maternal and infant mortality are rooted in racism. Structural racism in health care and social service delivery means that African American women often receive poorer quality care than white women.
It means the denial of care when African American women seek help when enduring pain or that health care and social service providers fail to treat them with dignity and respect.
Although racism drives racial disparities in maternal and infant mortality, it bears mentioning that ificant underinvestment in family support and health care programs contribute to the alarming trends in maternal and infant health. Despite pervasive racial disparities in maternal and infant deaths, public attention has only recently focused on this issue as a public health crisis. Behind these statistics are the stories of individuals and families. To bring the United States in line with the rest of the developed world, policymakers and health care providers must work together to eliminate these disparities.
Too often, policy conversations about maternal and infant health take place separately despite the interdependence of pregnancy and birth outcomes. This report attempts to bridge that gap by considering solutions that address racial disparities in both maternal and infant mortality.
Eliminating racial disparities in maternal and infant mortality
The maternal and infant mortality crisis cannot be adequately addressed without first understanding and then dismantling racism and bias in the health care system. African Americans have endured hundreds of years of racism in this country. This has occurred within the various systems and institutions that are part of American society—of which the health care system is just one. Racism, not race itself, is the driving force behind disparately high rates of black and infant deaths among African Americans, and the systemic barriers are fueled by both explicit and implicit bias.
For African Americans, the social determinants of health—including income level, education, and socio-economic status—are not protective factors as they are for white Americans when it comes to maternal and infant mortality.
Dating determinants of health are conditions that affect the health and quality of life of people in a given environment, including where a person lives, earns, works, or plays. Applying a racial justice lens to contextualize this urgent public health crisis is critical.
Put simply, structural racism compromises health. Structural racism is defined as a system where public policies, institutional practices, and cultural representations work to reinforce and perpetuate racial inequity. Policy solutions to the maternal and infant mortality crisis must be grounded in social justice frameworks that are intentionally deed to address these power imbalances. Policy solutions, therefore, must prioritize communities of color and their realities to fully address racial disparities in maternal and infant mortality.
Racism in health care can also manifest in other structural forms. This can include the concentration of people of color in communities that lack quality rican facilities and providers; harsh environmental factors and toxins in predominantly African American neighborhoods; 26 inequality in the workplace; highly concentrated food insecurity within communities of color; 27 or draconian policy changes to health care programs that disproportionately serve people of color, such as Medicaid. This report focuses on women and experiences of discrimination and health disparities at the intersection of race and gender.
However, not all pregnant people identify as women, and transgender and nonbinary people face unique barriers to accessing quality health care. The authors recognize that the research reviewed here may not adequately make the distinction between cisgender and transgender women or recognize intersex people or people with men identities.
Chandler is partially due to the lack of available research that focusses on the pregnancy and parenting experiences of these populations. Underinsurance and the lack of hospitals and facilities offering quality maternity and neonatal care in underserved communities are also key factors in these disparities. The sections that follow discuss policy recommendations to address structural racism in the health care and family support systems. Some of these recommendations are deed to rectify structural racism, while others provide additional supports and services to pregnant women and new mothers to ameliorate the impact that racism has on their respective experiences.
In all cases, women racism as the underlying cause of maternal and infant deaths is critical to finding policy solutions that can effectively eliminate racial disparities. To adequately address the legacy and impact of racism, policy solutions should follow the theory of targeted universalism—an equity framework that employs targeted strategies to achieve a universal goal.
This framework allows policy solutions to meet the needs of all populations—but have an intentional focus on those most in need—African American women and families.
Ensuring access to comprehensive, affordable, high-quality health care is vital in the effort to eliminate racial disparities in maternal and infant mortality. In doing so, policymakers should prioritize underserved populations, including women and infants of color, low-income communities, and those living in rural and medically underserved areas. Lack of access to both quality, affordable health care and insurance coverage fuel poor health outcomes and racial and ethnic health disparities.
This section focuses on strengthening the existing health care system and ensuring quality care both in terms of health care outcomes and in treating patients with dignity—recognizing and respecting their autonomy and expertise related to their own experience. Furthermore, when a woman has coverage of and access to maternity care, the positive health impacts can be long lasting to both her and her child. Access to maternity care, family planning, and other reproductive health care services is central to the constellation of services women need in order to have healthy pregnancies.
Studies show that when women experience an unintended pregnancy and are forced to carry an unplanned pregnancy to term, they are likely to delay prenatal care. A crucial source of health insurance for pregnant women and mothers is Medicaid, a t state and federal government funded program that provides health care coverage to millions of low-income Americans— 25 million of whom are women.
And, in some states, the program covers more than half of births. Many states voluntarily cover these services for women whose incomes exceed the percent threshold. However, states are not required to provide full Medicaid benefits under this eligibility pathway—which includes comprehensive coverage for all medically necessary services—to pregnant women and can limit their coverage to pregnancy-related services.
As a result, a woman eligible for traditional Medicaid may receive services that vary widely from state to state depending on her eligibility pathway. Furthermore, certain pregnant women may also qualify for full Medicaid benefits if they meet other eligibility requirements.
The ACA drastically improved coverage for women—including pregnant women—by expanding Medicaid eligibility to all adults with incomes up to percent of the FPL. States that chose to expand their Medicaid programs must include coverage for essential health benefits as part of the benefits for the pregnancy pathway although this is not necessarily true for other eligibility groups. The ACA statute required states to expand their programs to include this new eligibility category.
The ACA also expanded presumptive eligibility, which allows women to access needed care more quickly. As part of the ACA, Medicaid as well as other plans participating in state health insurance exchanges must cover 10 essential health benefits, including mental health services, chronic disease management, contraception, maternity and newborn care, and pediatric men for the expansion population. These services provide important supports to mothers and infants.
Management of chronic disease ensures women receive ongoing treatment, minimizing the risk these conditions may pose throughout and after their pregnancy. Increased access to contraception helps avoid unplanned and often high-risk pregnancies. And guaranteed coverage of pregnancy and maternal care ensures women can access care Chandler has been proven to lower the incidence of risk factors such as low birth weight and early term births. Research shows that Medicaid expansion indeed saves lives; a study from the American Journal of Public Dating found that Medicaid expansion states saw infant mortality rates decline, with the greatest decline among African American infants.
At a minimum, federal law should require states to cover new mothers who receive coverage through the limited pregnancy pathway beyond 60 days postpartum to at least one year after giving birth and should require coverage for full Medicaid benefits during this period. In particular, new mothers of color stand to gain both health and economic benefits from this extension of care. Because black of color are more likely to be covered by Medicaid, which covers almost half of all births in the United States, the program is essential to addressing racial disparities in maternal and infant mortality.
Loss of insurance coverage before and after childbirth is another factor that can adversely impact maternal and infant health outcomes. Coverage loss was a common and persistent occurrence prior to implementation of the ACA. After the women of the ACA, low-income women in expansion states who would rican have lost their eligibility for pregnancy-related Medicaid coverage became eligible to receive full Medicaid coverage.
This led the uninsurance rate among new mothers those who had given birth in the past year in these expansion states to fall by 56 percent. CHIP is another vital insurance program that ensures pregnant women and their children who make up to percent of the FPL have access to comprehensive health services, although most states exceed this threshold.
CHIP covers children and pregnant women whose incomes are too high for Medicaid coverage, but for whom private health insurance may still be too expensive.
CHIP benefits include comprehensive coverage for services such as routine checkups, immunizations, and dental and vision care, among others. Today, the median income threshold is percent of the FPL. There are also disparities in the quality of health care that African Americans and non-Hispanic white populations receive.
Moreover, even within high-performing neonatal care units, white infants receive higher quality care. Preterm birth, which refers to when an infant is born before 37 weeks of pregnancy, is a leading cause of infant mortality and ed for approximately 17 percent of all infant deaths in When all these preterm-related causes of death are taken together, they ed for more than one-third—36 percent—of all infant deaths in Higher rates of preterm-related causes of death for more than half of the racial disparity in infant mortality between these two groups.
Because all the reasons why some infants are born early are not known or fully understood, the CDC is currently researching preterm birth. At the same time, the Health Resources and Services Administration HRSA is carrying out prevention efforts that it coordinates across federal agencies. Although the underlying causes of preterm birth remain unknown, research links risk factors such as smoking, stress, certain health conditions for example, infections, diabetes, blood clotting disordersand some aspects of pregnancy history prior preterm birth to preterm birth.
Because obtaining accurate self-reported health history is nearly impossible in the absence of trust, it is critical that health care providers, including physicians, prenatal care educators, and others, conduct these screenings in a way that is supportive and free of judgment.
In addition to screening women for risk factors through interviews, recent research suggests that measuring the length of the cervix—the narrow passage forming the lower end of the uterus—can also help identify women who are at higher risk of spontaneous preterm birth. To reduce the mortality and morbidity associated with preterm births, policymakers should make screening available to the full extent of current evidence-based guidelines and provide public funding to increase access to treatment through outreach, care coordination, and other supports.
In all cases, health care providers should inform parents of this screening option as appropriate; work with patients to obtain informed consent; and then determine an appropriate course of action.
Introduction and summary
If a woman is found to be at increased risk of preterm birth, either through a questionnaire or a cervical screening, doctors and other health care providers should ensure they help parents understand their treatment options and develop a plan to reduce their risk. It is important to note, given the history of racism in U. Examples of effective screening programs for preterm birth are found across the country.
In Detroit, for example, the Make Your Date program seeks to educate the community about the risks of preterm birth and encourages women to undergo a sonogram test to screen for cervical shortening. After completing this voluntary, one- questionnaire, some women may be referred to Healthy Start, a federal program that offers care coordination and outreach, parenting education, and other supports that reduce the risk of preterm birth. In some cases, administering progesterone, a hormone that reduces uterus contractions and plays an important role in maintaining pregnancy, can reduce the risk of preterm birth.