by Nina Ahmad, Ph.D.

The timely, informative panel on maternal and infant mortality, “Why are Black Mothers & Babies Dying?” convened by Jovida Hill, Executive Director of the Philadelphia Commission for Women, drew a standing-room only crowd at the Lucien Blackwell West Philadelphia Regional Library on Dec. 15, 2018. The panel included such maternal care providers as obstetricians, midwives and lactation specialists, as well as legislators and advocates for reproductive justice.

African American women are nearly 3.5 times more likely than white women to die from pregnancy-related conditions. Until recently, the racial disparity in maternal mortality was largely ignored. The Philadelphia Health Department report titled “Maternal Mortality in Philadelphia 2010-2012,” published in 2015, acknowledged the problem, but not once was the fundamental cause of the disparity in the data regarding African American women discussed in the recommendations. We are just beginning to acknowledge the roots and extent of problem. A recent feature-length New York Times article identified racism as the fundamental cause of what is clearly a public health crisis.

The higher maternal death rates of African American women have recently been in the news since tennis star Serena Williams shared her near-death experience after giving birth to her first child. Her story underscores the fact that the disproportionate number of black mothers dying within a year of giving birth is not tied to socioeconomic factors.

What can be done?

To devise a solution to this problem, we have to listen to the women affected and bring critical information straight to the community; at the same time, we have to integrate multifaceted anti-racist measures in every strata of our medical institutions. While our entire society struggles to dismantle racist and gender-based barriers, we need to put the spotlight on our medical institutions, because these barriers are literally a matter of life and death for African American women. We need immediate measures such as ongoing implicit bias training and strong consequences when such bias is detected.

A recent New York Times opinion piece quotes Stephanie Teleki, who leads the maternity care portfolio at the California Health Care Foundation: “Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.” The problem is not that pregnant women are uneducated or uninformed; the problem is that those in charge aren’t listening to them.”

Another problem may be that medical professionals would rather rely on expensive procedures that feed the bottom line of the health industry.

There are other effective measures that can immediately reduce the number of black mothers dying. One such option is the use of doulas – trained birth coaches who provide women with physical and emotional support during pregnancy, preparing them with what to expect and amplifying their voice at childbirth and the postpartum period. Research shows that with this continuous support system, doulas positively impact both mothers and babies, and help families achieve a healthy and positive birthing experience.

From a dollars and cents perspective, continuous care from doulas can improve birth outcomes for both mothers and infants, resulting in fewer preterm and low birth weight infants and reductions in cesarean sections, all which contain costs. The Association of State and Territorial Health Officials has published a State Policy Approach to incorporating doula services into maternal care. It models savings averaging $986 for Medicaid if it covered doula services.

Just recently, Senator Kamala Harris (D-California) and 13 of her Democratic colleagues introduced the Maternal Care Access and Reducing Emergencies (CARE) Act, a bill that would reduce the racial disparities in maternal mortality and morbidity.

Instead of dancing around the elephant in the room, Harris clearly articulates, “Health equity for Black women can only happen if we recognize and address persistent biases in our health system.”

The House of Representatives also recently passed a bipartisan bill, the Preventing Maternal Deaths Act of 2018, aimed at reversing the maternal mortality crisis.

I am interested to see whether Governor Wolf’s recently created Maternal Mortality Review Committee, tasked to collect information and to investigate and disseminate findings related to maternal deaths, will use a racial equity lens in analyzing its data. As recommended by ASTHO, including doulas as members of key advisory committees is also critical to meaningful reform. I hope that some of our notable doulas are at the table as well.

But most importantly, we already have solid data that doulas are an important resource in fighting maternal mortality. Like Oregon (2012) and Minnesota (2013), Pennsylvania should institute Medicaid reimbursement of doulas. Not only will it help mitigate the tragic problem of maternal mortality, it will be a job creator for our communities as well. It will be critical to ensure that African American doulas are front and center in addressing the needs and advocating for African American mothers who are dying due to the racism embedded in our health care institutions.

Nina Ahmad is the Former Deputy Mayor, Public Engagement for Philadelphia and a candidate for Lt. Governor. She is presently Executive Vice President, Community Development for JNA Capital, Inc. She lives in East Mt. Airy.