As we’re increasingly learning, the experience of preconception, prenatal, birth, and postpartum health for moms flows directly to their infants, setting up the health status of the young family in the critical first years of life. This is why ZERO TO THREE’s State of Babies report this year calls special attention to hurdles faced by babies and mothers of color, who have the worst health outcomes on nearly all of the hundreds of wellbeing measures reported in the annual release. In addition to unpacking the historical and cultural reasons why families of color experience challenges, they also offer recommendations for ways Medicaid, among other policy levers, can catalyze positive change.
In a standalone brief, ZERO TO THREE shares state-level disaggregated data by race and ethnicity for many indicators, including maternal and infant mortality, low birth weight, and receipt of prenatal care. The data paint a stark picture that clearly shows Black and Hispanic mothers and babies experience inequities that begin even before pregnancy and birth.
The report points to several factors as the cause of racial and ethnic health disparities, including cumulative stress associated with interpersonal and institutional racism, as well as poverty, which can manifest in poor-quality and unstable housing, exposure to environmental toxicants, interpersonal and neighborhood violence, and an overall lack of resources.
In addition to Medicaid policy recommendations, such as Medicaid expansion to ensure women have coverage before and after pregnancy, extending Medicaid pregnancy coverage to 12 months postpartum, and ensuring that Medicaid covers screening and treatment for maternal depression, they also call for a renewed focus on the systemic racism that Black, Hispanic and other non-white mothers and babies face and offer solutions for how to move forward.
Starting with simply recognizing the existence of racism in health disparities, the authors also recommend fully engaging with community members in planning and decision-making around policies affecting young families For example, they point to Minnesota’s “Comprehensive, Racially-Equitable Plan for Universal Healthy Child Development,” which was developed by the state’s prenatal-to-three coalition, in recognition that racial disparities start even before birth and require focused attention and policy solutions.
They also recommend more robust state maternal mortality review committees with standard processes to make data comparable across states, deeper research into promising practices such as group prenatal care and doulas, and improvement in data collection and disaggregation by race and ethnicity to better help target supports to communities most in need.
Racism is a public health crisis that, “harms children’s health, even before they are born,” said American Academy of Pediatrics President Dr. Sally Goza in a statement following the police killing of George Floyd and widespread protests erupted in June. But just as policies rooted in racism produce health disparities, policy decisions based in equity and anti-racism can create opportunites for everyone to thrive. As the brief points out, the opportunity to break free from the racist structures that produce health inequities starts with getting it right for mothers and babies.