A new Massachusetts bill will examine the racial inequities plaguing Massachusetts’s maternal health system.
In a historic move to combat systemic racism, Massachusetts lawmakers have passed Bill H.4818, An Act to Reduce Racial Inequities in Maternal Health. Signed by Gov. Charlie Baker on Jan. 13, the bill creates a legislative committee that will examine the racial inequities plaguing Massachusetts’s maternal health system.
This committee will make recommendations to reduce racial discrimination’s role in maternal mortality (deaths occurring during childbirth); and severe maternal morbidity, meaning any health condition that is aggravated during pregnancy and childbirth.
Studies show that states which create similar legislative committees can decrease the maternal mortality rate by 20-50 percent by identifying key factors and gaps in their state’s health care system.
The bill comes as the U.S. health care system is completely overwhelmed due to COVID-19, a virus which has only worsened racial disparities in health care. But while this bill is a major step towards decreasing racial discrimination in health care, it is only the beginning of a long list of reforms needed to support people of color in the health care system. Health care reform is critical to address socioeconomic and institutional racism—Black women are twice as likely to die of preventable pregnancy-related causes than white women.
A ‘Maternal Mortality Crisis’
Racial discrimination occurs in all facets of America’s health care system, but mothers are particularly affected. According to the CDC, Black, American Indian and Alaska Native women are two to three times more likely to die from pregnancy-related causes, with the likelihood increasing with age; past the age of thirty, the likelihood of maternal mortality increases to five times higher than the risk for white women.
These persistent disparities have remained stable since the CDC began tracking them in 2007—and a majority of these pregnancy-related deaths are preventable.
Compared to other high-income “developed” countries, pregnant people in the United States are more likely to die during pregnancy and childbirth, making it one one of only thirteen countries whose maternal mortality rate is worse than it was fifteen years ago. Currently, there are 17.3 deaths per every 100,000 births in America—more than double of that of most high-income countries, like France, Canada, the U.K. and Australia.
Massachusetts Must Take Further Action to Alleviate Racial Inequality
While Massachusetts itself is considered to be historically Democratic and liberal-leaning—being the first state to legalize gay rights and more recently codifying equitable abortion access to all Massachusetts residents into law—the state still has deep roots in racial inequality.
Massive discrepancies in life expectance, at least partly informed by racism, exist across the commonwealth. Citizens in wealthier Massachusetts cities like Newton, which is majority white, average a life expectancy of 94 years old, while those in lower-income, majority POC cities, like New Bedford, average a life expectancy of 68. Inconsistent access to education, high-paying jobs, and health care drive these statistics—and all of these systems are deeply racially biased.
The U.S.’s high rate of racial disparities in pregnancy-related health care is the result of many complex factors, with racial disparities in socioeconomic status and education level being the main causes. Black women make just 61 cents to every white man’s dollar, resulting in an ever-widening socioeconomic gap for Black households and households of color. A lack of government investment in social systems, like family support programs, contribute to these alarming health care trends. These complex interrelated factors result in a lack of access to competent medical professionals and comprehensive insurance.
Additionally, implicit biases and discrimination by health care providers greatly affect the quality of care women of color receive, and their health outcomes. Structural racism often means that Black women receive poorer health care than white women, which creates the dismal survival rate for Black women during and after birth.
On June 3, 2020, the Massachusetts COVID-19 Maternal Equity Coalition held a virtual town hall to address racial disparities in maternal health care, specifically during the COVID-19 pandemic. Over 300 policy makers, doctors, advocates and pregnant people participated to speak about the dismal state of maternal mortality and maternal health care in Massachusetts.
Testifiers spoke about being pressured by hospitals to induce labor early, higher rates of forced cesarean sections in order to speed up deliveries and reduce the time in hospitals, reduced access to anesthesia, and the denial of sterilization procedures after birth. Because the health care system in Massachusetts is overwhelmed as a result of over 510,000 COVID-19 cases and 14,304 deaths, the strain on the already fraying maternal health care system is massive—exacerbating racial discrimination in health care settings.
A U.S. Movement to Improve Maternal Health
Other states have already implemented policies similar to Massachusetts’s H.4818. In fact, as of 2019, 13 states had created similar legislative committees and task forces that focus on investigating racial disparities in maternal health care.
In 2006, the California department of Public Health launched a maternal mortality review committee and undertook key legislation to address the maternal mortality crisis. In 2019, California enacted Senate Bill 464, which mandates implicit bias training for perinatal health care workers—the first state to do so.
California’s approach attempts to address racial biases directly in the health care system, and have been adopted by the Biden administration as a key facet of their health care plan. California’s multifaceted strategies have halved their maternal mortality rate, and implementing this legislation nationwide could have groundbreaking results.
There is also movement on the federal level to alleviate this crisis of motherhood, especially Black motherhood: Earlier this month, several members of the Black Maternal Health Caucus unveiled the Black Maternal Health Momnibus Act of 2021—a legislative package to address the urgent maternal health crisis in the U.S.
While the new Massachusetts bill will work to reduce systemic racism in maternal health care, it is impossible to address the maternal mortality rate without addressing the implicit racial discrimination in the rest of our government’s systems. Massachusetts’s state government needs to address the stark contrasts in the quality of life for citizens living in lower-income areas versus those living in wealthy neighborhoods. This includes providing equitable funding to school districts, access to affordable and reliable transportation throughout the state, and further investing into social services that provide housing and nutrition assistance to families.
Additionally, ensuring diverse political representation throughout the state will help address these racial disparities—in the Massachusetts legislature, white people are overrepresented by 16 percent, which only exacerbates the unbalanced quality of life among the commonwealth.
Bill H.4818 is a positive step forward to reducing racial disparities, but it is not the final step, nor is it a band-aid that can fix the multifaceted issues of racial discrimination in Massachusetts.
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