In 2010, when Mylexus Patrick was 19 and pregnant with her firstborn, she felt like something was wrong with the pregnancy. The Californian woman called her doctor, who brushed her off, so she went to the hospital—but was sent home without being seen. After multiple attempts to get checked, Patrick, who is Black, was finally examined at a facility outside of her insurance network, where she learned her amniotic sac contained no fluid and her placenta was halfway calcified. She was immediately admitted for an emergency C-section.
“If she’d listened to [her primary] doctor,” Nourbese Flint, a program manager at Black Women for Wellness (BWW), tells Broadly, “her child could have died. She could have died.” The 19-year-old’s experience was one of a handful that Flint and other maternal health advocates raised during a Senate Health Committee hearing last week on California Senate Bill 464, or the Dignity in Pregnancy and Childbirth Act, which aims to address the racial disparity in maternal mortality rates in the state through bias training for health professionals and improving data collection.
Since 2006, the rate at which women die of pregnancy- or childbirth-related causes in California has reduced by 55 percent—yet Black women are still nearly four times likelier than other women to lose their lives because of such complications. Research also shows Black women comprised more than one-fifth of all pregnancy-related deaths in the state between 2002 and 2006, when the maternal mortality rate was at its highest, though they accounted for approximately 5.5 percent of births in California.
Beyond addressing discrimination within California, SB 464 has national implications.
Approximately 700 women die each year in the United States because of pregnancy or delivery complications, and Black women are disproportionately represented in that figure. According to the CDC, the maternal mortality rate for white women is estimated at 12.4 deaths per 100,000 live births; for Black women, that figure rises to 40 deaths.
Many Black maternal health advocates, including Flint, say bias training is an important part of fixing this broken system. In 2016, The Black Women Birthing Justice called for health professionals to be trained in “cultural humility, holistic care and empowering patients.” That’s because research shows education and socioeconomic status have little to do with why Black women are more likely to die during pregnancy and childbirth—rather, researchers point to racial bias.
The training outlined by SB 464 would include an evaluation to assess the biases of not only doctors and medical assistants, but also nurses, midwives and anyone else who deals in patient care. The course would touch on the history of how different races and ethnic groups have historically been treated in the health care system, particularly in perinatal care, to help medical providers consider the intersectionality of all these factors. This training would require care providers to “rearrange” their worldviews, Flint says.
Illinois and Texas are also considering implementing implicit bias training for medical staff, and according to Rewire.News, more than 80 bills addressing the Black maternal health crisis have been introduced on the state level this legislative session. One Georgia lawmaker introduced a bill on Monday to expand access to Medicaid for new mothers for up to a year. Currently, Georgia women lose coverage 60 days after they’ve given birth. Health experts believe Georgia has the worst maternal mortality rates in the country: In 2013, the state tracked 79 maternal deaths; half of those women had Medicaid coverage, and 47 percent were Black.
On the federal level, California Sen. Kamala Harris filed legislation in August to make implicit bias training mandatory, among other measures, in order to help reduce racial disparities in maternal mortality and morbidity. The bill, however, never made it out of committee.
Another federal bill crafted to address the racial disparity in maternal health care, the Mothers and Offspring Maternal & Morbidity Awareness (MOMMA) Act, was reintroduced last month after floundering in committee last year. It calls for implicit bias training, an expansion of Medicaid to include access to doulas, and a grant program to help states and health care systems improve their maternal care.
Elizabeth Dawes Gay, a co-director of Black Mamas Matter Alliance, says the US has made progress addressing the racial disparities in maternal health. Last week, Senate Democrats introduced a resolution designating April 11–17 as Black Maternal Health Week. They also launched a Black Maternal Health Caucus to study the issue.
"We have legislation that names racism, bias, and discrimination as contributing factors to poor outcomes among Black mamas,” Gay tells Broadly. “We've made some great strides, but we have a long road ahead of us.”
Within that process, Flint hopes that SB 464 will not only pass, but ultimately serve as a blueprint for other states in order to better address institutional and systemic bias. “So much of the work is around, ‘How do we make pregnant people more educated, how do we make pregnant people have better access to health care?’” Flint says. “That’s important, but how do we shift [the focus on] behavior modifications from the patient to the doctor and the institution?”
Too often, she continues, Black women don’t even realize the experiences they’re having in the perinatal space are discriminatory. “The vast majority of us don’t know what it means to get good care. They thought it was normal [to be treated this way].”
SB 464 received bipartisan support in the health committee and now awaits a hearing in the Senate Appropriations Committee, where it, like other legislative efforts across the country, may be able to codify what “good care” for Black women really means.