The August day her twin boys were born should have been one of the happiest of Antoinette Ramos’ life. Instead, she told Broadly she thought she was going to die. During an emergency C-section, she started hemorrhaging, and for a moment, her doctors didn’t seem to know how to stop the bleeding. “I was so scared,” she recalled. She remembers thinking, “‘This is it. Tell [her husband] Jesus, make sure the boys are OK. It’s my time to go.’”
Thanks to a number of interventions, Ramos and her sons survived the birth experience; today, all three are healthy. But her story offers an example of how black women are more than twice as likely to experience a life-threatening complication during pregnancy/childbirth compared to white women. They are also three to four times more likely to die from pregnancy- or childbirth-related complications.
That’s why Illinois Rep. Robin Kelly announced new legislation on Wednesday that aims to save more women from dying during pregnancy or childbirth. In particular, the bill, titled the Mothers and Offspring Maternal & Morbidity Awareness (MOMMA) Act, addresses the deep-seated racism that pervades the health care system.
“Starting or growing your family shouldn’t mean putting your life at risk,” Rep. Kelly said in a statement. “Every momma deserves the chance to be a momma – that’s why I’m working to pass the MOMMA Act.”
One of the problems with trying to address the country’s maternal mortality problem is that, simply put, we really don’t know how bad it is. The United States has not submitted an official maternal mortality rate to international data-gathering groups since 2007. States are responsible for collecting information on deaths, and currently there is no federal entity that standardizes data related to maternal deaths. To address this gap, the bill tasks the CDC with providing states the technical assistance they need to better track data.
The legislation also aims to streamline protocols for obstetric emergencies, standardize the best practices to help prevent such deaths from even occurring, and tasks the federal government with creating and supporting programs that ensure health care providers are educated in implicit bias and cultural competency in order to improve their interactions with patients.
That cultural sensitivity training is going to be key in really addressing discrimination in the health care setting, says Tammy Boyd, the director of health policy and legislative affairs at Black Women’s Health Imperative. The organization has come out in full support of the bill.
Another important component of the MOMMA Act is that it expands the period of Medicaid coverage for a new mother to a full year after her child is born. Currently, half of births in the United States are paid for by Medicaid, and that coverage ends two months postpartum. The extension would be critical in helping to implement some of the new postpartum care recommendations published this month by the American College of Obstetricians and Gynecologists on. Rather than a single six-week follow-up visit after childbirth, the organization is pushing for “ongoing care,” including a comprehensive visit at three-months postpartum.
“We know that better care for both women’s physical and mental health after giving birth can help save lives,” Dr. Hal Lawrence, executive vice president and CEO of ACOG, said in a statement. “Every new family should have a comprehensive care plan and a care team that supports the mother's strengths and addresses her multiple, intersecting needs. By extending Medicaid coverage for postpartum women up to a year, we can actualize the 'fourth trimester' for underserved new mothers."
The Medicaid extension would particularly be beneficial for black mothers and mothers-to-be, says Rebecca Berry, a legal and policy fellow at BWHI, because it would allow reimbursements for doulas and midwives. “Black women really do benefit from holistic care. If there are ways to … make sure black women are getting care from multiple places in the system,” she says, that would also help reduce some of the negative birth experiences, including incidents of discrimination, black women too often report.
In states that didn’t expand Medicaid under the Affordable Care Act, Berry continues, studies have shown “huge disparities” in coverage. “The issue with care is that it needs to be continuous and black women experience that break in continuity for all kinds of reasons—circumstances change, you lose a job, anything can happen,” she says. “By extending that coverage, you’re basically ensuring that mothers after birth have that access and ... that care.”