Big Picture:

The United States has the highest rate of maternal mortality among developed countries. Notably, Black women face disproportionate rates as a result of structural racism and flaws in the healthcare system. The United States must implement policies to directly address Black maternal mortality, including modification of medical school curriculum on race, free home visitations, a national requirement for paid maternity leave and reintroduction of legislative policies for longer national postpartum coverage.

Operative Definitions:

1. Maternal mortality: The death of a woman from pregnancy-related causes. 
2. Postpartum: The time after childbirth.
3. Midwife: A healthcare professional that provides guidance to pregnant women and new mothers. 
4. Doula: A woman and non-healthcare professional that provides guidance to pregnant women and new mothers. 
5. Maternity leave: The time when a woman can be absent from work before or after delivering a baby.

Important Facts and Statistics:

1. In the United States, Black women are three times more likely to die than white women as a result of pregnancy-related causes.
2. In 2018, a survey by the National Partnership for Women and Families found that Black women were more likely to face discrimination and unfair treatment in the healthcare system, compared to white women in their maternity care and birthing experience.
3. Medical students tend to hold false beliefs about racial differences, and a preponderance of studies claim that the majority of American physicians implicitly favor white Americans over Black Americans.
4. A study examining 880 lectures and 21 courses of preclinical medical curriculum found that educators misrepresented race in discussions, interpretations of race-based data and assessments of students’ mastery of race-based science.
5. The Oregon Health Authority (OHA) funds the Family Connects Oregon program, which offers home visiting to families with newborns. The service has found that 70 percent of families choose to participate and resulted in 28 percent less clinical anxiety reports from mothers.
6. Mental health conditions, like postpartum depression, affect new mothers and can lead them to have suicidal thoughts and thoughts of harming the baby.
7. Up to six months of maternity leave after childbirth is associated with decreased postpartum depression symptoms.
8. The United States is one of only two countries in the world that does not have a national paid leave law. Paid leave depends on the employer or state policy.
9. The Federal Employee Paid Leave Act grants federal employees with 12 weeks of paid leave after childbirth. Employees must have been in federal service for at least one year to be eligible.
10. The Build Back Better Act, H.R. 5376 includes a national four week partially-paid family leave funded through general revenues. As of December 2021, its passage remains uncertain.
11. Current Medicaid pregnancy coverage covers 60 days postpartum, with the option for states to choose to cover 12 months beginning in April 2022.
12. H.R. 1425, Patient Protection and Affordable Care Act Enhancement Act will require mandatory 12 months postpartum coverage in all states. It passed through the House of Representatives in June 2020, but was not passed by the Senate.

Three-Point Plan:

(1) Modify medical school curriculum on race. Modify curriculum to teach adequate and accurate information on race/ethnicity. Standardize the use of race/ethnicity language in teaching, emphasize social determinants of health, health disparities, structural racism, etc. to reduce implicit bias favoring white Americans over Black Americans. 

(2) Provide free home nurse/doula/midwife visitations for mothers with newborns across all states. Provide a source of voluntary immediate care for mothers to express their physical or emotional complications no later than two weeks after birth and available for infants up to six months old. Visitations and connections to a caregiver will help identify any health concerns, mental or physical, that occur postpartum. State budgets should fund this program. 

(3) Reintroduce legislative policies to Congress which will require longer national postpartum coverage. Reintroduce the Patient Protection and Affordable Care Act Enhancement Act, a bill associated with the Affordable Care Act (ACA). This will require mandatory 12 month postpartum coverage in all states, surpassing the 60 days required by current law, to allow women to have health coverage for a longer period of time. 

Why This Initiative is Important: 

It is pertinent to combat all health inequities, including the race disparities within maternal health. Racism is a public health threat and has a significant impact on Black maternal mortality when it comes to how Black pregnant women are treated and what resources they can access. While the Biden Administration has recognized maternal health as a problem in America, the government must continue to take action and implement policies that will address maternal health and the Black maternal mortality disparity. 

Acknowledgments:

The following students worked on this proposal: Madeline Leung, The University of North Carolina at Chapel Hill, Alexander Sejas, University of Miami.

Sources:

Amutah, Christina, et al. “Misrepresenting Race — the Role of Medical Schools in Propagating Physician Bias.” New England Journal of Medicine, vol. 384, no. 9, 2021, pp. 872–878., https://doi.org/10.1056/nejmms2025768. 

Dagher, Rada. “Can Paid Maternity Leave Help Address Disparities in Maternal Mortality?” NIMHD Insights Blog, 28 June 2020, https://nimhd.blogs.govdelivery.com/2020/06/28/can-paid-maternal-leave-help-address-the-disparities-in-maternal-mortality/. 

“Family Connects Oregon.” Oregon Health Authority : Family Connects Oregon : Home Visiting : State of Oregon, https://www.oregon.gov/oha/PH/HEALTHYPEOPLEFAMILIES/BABIES/HOMEVISITING/Pages/Family-Connects-Oregon.aspx. 

“Paid Leave in the U.S.” KFF, 17 Dec. 2021, https://www.kff.org/womens-health-policy/fact-sheet/paid-leave-in-u-s/. 

Ranji, Usha, et al. “Expanding Postpartum Medicaid Coverage.” KFF, 9 Mar. 2021, https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/. 

Solomon, Judith. “Closing the Coverage Gap Would Improve Black Maternal Health.” Center on Budget and Policy Priorities, 26 July 2021, https://www.cbpp.org/research/health/closing-the-coverage-gap-would-improve-black-maternal-health. 

Taylor, Jamila K. “Structural Racism and Maternal Health Among Black Women.” The Journal of Law, Medicine & Ethics, vol. 48, no. 3, Sept. 2020, pp. 506–517, doi:10.1177/1073110520958875.