Mass. House Coalition Lays Out Path Toward Maternal Health Equity

One of the first things the House did after Speaker Robert DeLeo committed in June to addressing systemic racism in Massachusetts was to push forward with a bill to study disparities in maternal health for women of color.

The legislation called for a new commission to examine racial disparities in maternal mortality and make recommendations to improve access and quality of care for Black and Hispanic women who are pregnant or new mothers.

With that bill now waiting for action in the Senate, a new coalition focused on maternal health equity during the COVID-19 pandemic stepped forward on Wednesday with a list of recommendations for how Gov. Charlie Baker and the Legislature could address the disparities in maternal health.

A new report from the Massachusetts COVID-19 Maternal Equity Coalition called on Baker to use his executive authority to create a new task force focused on maternal care, and to support the Department of Public Health with funding to collect data on maternal experiences during and after pregnancy, with the goal of improving health outcomes for mothers and infants.

The coalition has said the pandemic exposed variations in hospital policies on labor support and mom and baby separation, increases in C-sections and forceps deliveries, reduced access to anesthesia and a high level of anxiety and depression.

Expectant and new mothers in communities of color hit hardest by the coronavirus are also bearing the brunt of these issues, the coalition said.

During an online town hall in early June, U.S. Sen. Elizabeth Warren, Congresswomen Ayanna Pressley and Katherine Clark, state Senate President Karen Spika, Sen. Becca Rausch and Reps. Liz Miranda and Kay Khan called in to listen to stories about what it has been like to be pregnant or give birth during the pandemic.

The women spoke about the difficulty of having phone calls instead of in-person visits for follow-up care, having to go to doctor appointments without their partner or someone to support them, and no visitors in the hospital or the ability to lean on friends and family when they came home with a new baby.

The isolation caused by the pandemic, and the lack of adequate access to technology for many low-income women, has led to feelings of isolation and high rates of anxiety and depression, the coalition said.

"As COVID has ravaged our hospitals, economy and taken a particular toll on communities of color, we must come together to offer thoughtful policy solutions to this crisis within maternal care. I am so pleased to see this coalition come together and am committed to working collaboratively with my fellow legislators to move to action as soon as possible based on their recommendations," Miranda said in a statement supporting the coalition's six-point plan.

The recommendations include commanding the governor's task force to develop policies to reduce differences in labor support from hospital to hospital and increase access to pre- and post-birth mental health services.

The coalition also recommended that Massachusetts apply through its next Medicaid waiver to extend Medicaid coverage for postpartum patients to at least 12 months after giving birth, which has been done in more than dozen other states.

Women covered by insurance through MassHealth are almost three times as likely to die from pregnancy-related causes and have higher rates of severe maternal morbidities as those on private insurance, the report said.

The final recommendation in the report was for the state to expand access to midwifery care and community birth options to alleviate pressure on hospitals, reduce health care costs and give women with low-risk pregnancies an option that the report said has been associated with improved outcomes.

The House's bill (H 4448) to create a 23-member commission to study racial disparities in maternal health passed unanimously on June 30, but has not yet surfaced in the Senate.

The Legislature is scheduled to conclude formal sessions for the year on July 31, but that would not foreclose the possibility for a bill to pass and reach Gov. Baker's desk at a later date as long as no one opposed.

Rep. Kay Khan, the House chair of the Committee on Children, Families and Persons with Disabilities, said during the House's brief debate on the bill in June that the commission would "begin to right the significant wrong" of generations of systemic racism in health care.