Meaningful change or more of the same? Interpreting recent policy developments in the US this International Day for Maternal Health and Rights
One of the most important factors determining maternal health outcomes is where a woman or girl lives. Too often that determines whether a family has access to quality, respectful, and equitable maternity care. Approximately 300,000 women and girls die from complications related to pregnancy and childbirth every year, and 2 out 3 of these deaths take place in Sub-Saharan Africa. But place-related disparities occur among and within developed countries as well.
Increasingly, the unacceptably high rates of maternal mortality and morbidity have been attracting attention in the United States, where maternal mortality rates are more than twice those of most developed countries, including Germany, France, England, and Canada. Despite having the resources to provide optimal maternity care to every individual, the US fares the worst among developed countries, dropping from 41st to 46th in global maternal mortality rankings. The US is the only developed country where maternal deaths are on the rise, doubling between 1990 and 2015.
Racial disparities in pregnancy-related complications and deaths are alarming and intractable. For over 60 years, black women have consistently been 3 to 4 times as likely to die from complications of pregnancy and childbirth as their white counterparts. In the US, women in areas with high concentrations of poverty are twice as likely to die as women in low-poverty areas. Nearly half of all counties in the US also have no obstetrician or midwife to provide maternity care, and millions of women live in these shortage areas.
Although the US maternal health care system is in crisis, 2018 brought hope and changes that have begun to gain traction. No fewer than seven bills were introduced in Congress, marking unprecedented attention to maternal health policy. Two of these bills, originally introduced eight years prior, were signed into law: The Preventing Maternal Deaths Act and The Improving Access to Maternity Care Act, each of which helps to address place-based disparities. The Preventing Maternal Deaths Act dedicates funding and support for states to establish and strengthen Maternal Mortality Review Committees, which will standardize systems for monitoring and reporting maternal deaths to ensure that all maternal deaths are identified, that causes of death are analyzed, that recommendations are made to improve maternity care, and that these changes are implemented. The Improving Access to Maternity Care Act requires the government to identify areas that face shortages of maternity care professionals by collecting and publishing data on the availability of and need for health professionals providing prenatal and childbirth care in order to fill those gaps.
But last year’s wins are just the beginning of a bigger movement, and the momentum is continuing in 2019. This year, three bills have been reintroduced, including
- the Modernizing Obstetric Medicine Standards Act of 2018 (MOMS Act),
- the Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) and
- the Quality Care for Moms & Babies Act.
Two other bills are pending reintroduction:
- the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES Act) and
- the Maternal Care Access and Reducing Emergencies Act (Maternal CARE Act).
These bills, and others that are in the works, offer complementary approaches that encompass many of the critical components needed to fill existing gaps in the US maternity care system. A “momnibus” bill that would bring provisions of all of these bills together, might just be the next big opportunity. Some of the most important elements include:
- Extending Medicaid Coverage
- Extending Medicaid coverage for postpartum care from 60 days to a year following birth, recognizing that the postpartum period is a critical window for preventing maternal deaths and complications and for providing essential postpartum support.
- Safety Bundles
- Implementing standardized, evidence-based practices, or “maternal safety bundles” to prevent, identify, and appropriately respond to pregnancy-related complications across health systems.
- Implicit Bias Education
- Addressing implicit bias and cultural competency through patient-provider interaction education to enhance health professional training to reduce health disparities and improve the delivery of culturally appropriate care.
- Perinatal Support Services
- Increasing access to essential support services such as doula care, care navigation, breastfeeding support, home visits, childbirth education, and nutrition through Medicaid coverage and “maternity care homes.”
For too long, mothers’ voices, priorities, and values have not been taken into account when policies or programs have been developed that directly affect their lives. But together, these bills would make headway towards ensuring accountability and reflecting a comprehensive approach to meeting families’ needs. Women deserve a system that ensures accountability across the board, with dedicated data collection and reporting mechanisms, strong health systems, and trusting provider-patient relationships, which all affect the care, experiences, and health outcomes around pregnancy. Women deserve a system that listens and responds to their needs at every stage of their care and prioritizes filling in the gaps where those needs are not being met.
The right to health has little meaning if those with the greatest influence to improve health outcomes are not working to guarantee that right for everyone. On this International Day for Maternal Health and Rights, we must hold our governments and health systems to the highest standards and advocate to make access to quality, respectful, and equitable maternity care a right enjoyed by all.
The US is facing a maternal health crisis, and our policy makers are starting to listen – the solutions are not simple and will take time, but the tides are starting to change.