The United States has a dismal track record when it comes to maternal and infant mortality. One of the wealthiest countries in the world, the U.S. has fallen behind and now ranks 32nd in maternal mortality and 33rd in infant mortality out of the 36 wealthiest nations. Within the U.S., the infant mortality rate varies across place and race. However, African Americans have consistently experienced higher infant mortality rates than their white peers. Likewise, African American babies are more than twice as likely to die before their first birthday than white babies in America, and statistics show that the risk of dying from pregnancy- and childbirth-related complications is three to four times higher for African American woman than any other group of women in the United States.
The persistence of racial disparities in adverse perinatal outcomes led the Congressional Black Caucus Foundation to spotlight the issue at its recent 2018 Annual Legislative Conference. To kick things off, DC Mayor Muriel Bowser hosted an inaugural Maternal and Infant Health Summit. The summit brought together more than 1,500 mayors, healthcare experts, policymakers, thought leaders, and community members to explore strategies to improve perinatal health and address racial disparities in birth outcomes. Attendees shared promising practices on how to improve preconception health, advance best quality health care and services, strengthen families, and promote healthy environments. Ideas for technology-driven innovations to overcome disparities in underserved populations, improve perinatal health care experiences, and reduce risk factors for poor birth outcomes before, during, and after pregnancy were also discussed.
While this is a complex problem, the summit highlighted a simple strategy underway in D.C. to integrate the One Key Question® tool into electronic health record systems at community health centers to help women achieve their optimal health before pregnancy. One Key Question® encourages women’s health providers to routinely ask: “Would you like to become pregnant in the next year?” From there, providers can support women who choose to become pregnant to achieve their optimal health through smoking cessation support, weight management, and control of chronic disease. For women who respond “no,” providers can help them choose the most effective family planning method that meets their needs and preferences.
There are also hopeful signs of bipartisan congressional interest in reducing maternal mortality. Earlier this year, IL Rep. Robin Kelly, who chairs the Congressional Black Caucus Health Braintrust and the Congressional Caucus on Black Women and Girls, introduced legislation that would extend Medicaid coverage for new mothers from 60 days after childbirth up to a year. This would help address the significant impact of postpartum depression and anxiety that not only affects the health and well-being of the mother, but can also have a lasting, detrimental impact on the health of their infants and families. According to the Centers for Disease Control and Prevention, postpartum depression is a serious and widespread condition that impacts one in nine U.S. women. Extending the period for postpartum Medicaid coverage is a key policy option that can help safeguard the health of both new mothers and their children.
To sum it up, African American women mayors are leading the way in local government policy-making that is both compassionate and economically smart. Mayor Bowser led the U.S. Conference of Mayors to adopt a resolution on maternal and infant health this year based on the District’s framework to improve maternal and infant health outlined in this year’s Perinatal Health and Infant Mortality Report. These mayors get it. They know that to save the lives of black women and children in their cities, they need to prioritize legislation and policies that focus on better caring for the health of black women before, between, and after pregnancy. They get just how essential expanding and maximizing Medicaid coverage, improving customer service in healthcare, and providing integrated mental and physical health services are to reducing racial disparities in maternal and infant health outcomes. Their efforts, along with state and federal leaders, offer a renewed opportunity for maternal and child health advocates to advance local policies and practices that can address the maternal and infant mortality crises across America.