Biden Administration Releases Badly Needed Maternal Mortality Strategy as Dobbs Decision Could Worsen Crisis

The U.S. is in the midst of a maternal mortality crisis: rates of maternal death are rising and Black women continue to die from pregnancy-related causes at more than twice the national average. Unfortunately, the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization to allow states to ban abortion could make the maternal mortality crisis worse. Research suggests that cutting off access to abortion could increase maternal death rates and further exacerbate current racial, economic and social inequities in maternal and infant health.

This makes the ongoing federal and state-level policy work to improve maternal health even more urgent. State and federal policymakers have made important strides in supporting maternal health in recent years, including more than half the states adopting the American Rescue Plan’s option to extend Medicaid postpartum coverage to a year after the end of pregnancy.

The Biden-Harris Administration last week released a comprehensive plan to address the nation’s ongoing maternal health crisis, which disproportionately harms Black people, people with low-incomes and people living in rural areas. In addition to outlining many important health policy changes and highlighting new funding passed in the FY 22 Appropriations Bill, the plan also says the administration will, “remain keenly focused on equity, including the way policies address not only the maternal health crisis, but also the racial biases, persistent disparities, injustices, and inequities that fuel it.”

The blueprint calls for closing the Medicaid coverage gap, making 12 months of postpartum coverage mandatory and permanent, and making significant investments in supporting the perinatal workforce, implicit bias training, pregnancy medical homes, support for behavioral health needs in pregnancy and postpartum, and other systems changes to support maternal health.

The administration also committed to adding new funding in the President’s budget to grow the perinatal workforce of midwives, doulas, and community health workers. Research has shown that perinatal care provided by midwives, doulas, and community health workers is associated with fewer complications and better birth outcomes, especially for people of color. Many other policies highlighted are pulled from the Black Maternal Health Momnibus, a group of several bills designed to comprehensively address the Black maternal health crisis, which were passed in the House version of the Build Back Better Act last fall.

These policy changes were necessary before the Dobbs decision. They are even more necessary now. Research suggests that restricting access to abortion could further increase the risk of maternal death rates. States with limitations on abortion access in 2015 had a seven percent increase in maternal mortality between 2015 and 2018 than states with greater access to abortion, according to a study published in the American Journal of Public Health.  Those who were turned away from seeking an abortion were more likely to experience preeclampsia, postpartum hemorrhage and other pregnancy complications that harm theirs and their baby’s health. They were also more likely to experience maternal depression, which, if left untreated, can negatively affect the infant’s brain development.

Many of the states moving to limit or ban abortion following Friday’s decision, including Alabama, South Carolina, Texas, and Tennessee, have also not expanded Medicaid, so many low-income women who become pregnant are coming into pregnancy with unmet health needs that can exacerbate their pregnancy, such as hypertension, diabetes, high blood pressure and other conditions which can harm the mother and baby. A CCF report published last fall found that women aged 18-44 who lived in non-expansion states were more than twice as likely to be uninsured (19 percent) than women living in states that had expanded Medicaid (9.2 percent) in 2019, and the trend extended across all racial and ethnic groups.

Taken together, the evidence is clear that a national commitment to maternal and child health is long overdue. With the help of the administration’s blueprint, combined with focused work in Congress and the states, there are many concrete steps that can improve the health of women and families before, during and after pregnancy and throughout their lives. We must take this opportunity to redouble our commitment to knocking down barriers to health coverage and access to care for pregnant people, parents and families to ensure the long-term health of children and families.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.