This week marks the 10th annual Black Maternal Health Week led by the Black Mamas Matter Alliance (BMMA). The theme, Rooted in Justice and Joy, honors a decade of movement-building by Black-led organizations while also naming the systemic forces –systemic oppression, reproductive injustices, and health inequities— that continue to threaten the lives of Black Mamas.
Medicaid pays for more than four in 10 births. For Black mothers, Medicaid pays for more than 60% of births, making Medicaid policy central to Black maternal and infant health outcomes. There has been important progress in Medicaid to address maternal health, such as the Medicaid postpartum extension from 60 days to 90 days adopted by nearly every state, as well as the Medicaid expansion to all low-income adults, allowing more women to get their health needs met before they become pregnant. Many states have also taken initiative to reimburse home visiting programs, doulas, and non-nurse midwives in Medicaid. Last year’s reconciliation bill, H.R.1, puts much of the country’s maternal health progress at grave risk.
With H.R.1’s nearly $1 trillion in cuts pushed to states over the next decade, we raised concerns about the threats to maternal health improvements. That reality is unfolding in real time. Montana was set to join at least 25 other states that reimburse doulas through their Medicaid programs to ease gaps in care — but the state’s Department of Public Health and Human Services postponed adding doula services to its Medicaid benefit package, citing a budget shortfall driven in part by higher-than-expected Medicaid costs. Stephanie Morton, the executive director of Healthy Mothers, Healthy Babies Montana, called the doula decision likely “the first of many rollbacks” families in Montana will face.
But pulling billions of dollars out of the health system—Medicaid or any other payor—doesn’t change health needs for moms, and the numbers remain staggering. In 2023, the maternal mortality rate for non-Hispanic Black women was 50.3 deaths per 100,000 live births — nearly 3.5 times the rate for non-Hispanic White women. And while maternal deaths decreased from 2022 to 2023 for all other racial and ethnic groups, they did not decrease for Black women. More than 80% of these deaths are preventable.
Alongside the continued maternal health crisis, the maternal health workforce has faced challenges serving perinatal moms needing their care. In Georgia, the Center for Reproductive Rights filed a lawsuit on behalf of three midwives challenging Georgia’s midwifery restrictions. Georgia law prohibits midwives without a nursing degree from practicing. Anyone who violates the law faces jail time and financial penalties. Georgia law also prevents certified nurse midwives from practicing independently to the full extent of their training, requiring physician oversight. Georgia midwives joined other states such as Mississippi and Alabama litigating for their right to practice. More than half of Georgia’s counties are so-called “maternity care deserts,” and the state’s maternal mortality rate is 37.9 deaths per 100,000 live births, with 87% of those deaths deemed preventable. As access to care remains a challenge and rural hospitals close, allowing additional, trained midwives to ease the access challenges offer an important option.
Research has shown that birth outcomes are better with the Midwifery Model of Care. Worldwide, midwives are the primary providers for pregnant women, but in the U.S., OB/GYNs are the primary providers during the perinatal period. There are three main types of midwives in the U.S., certified nurse midwives (CNMs), certified midwives (CM), and certified professional midwives (CPMs). All 50 states allow CNMs to practice and reimburse Medicaid. They only have full practice and prescriptive authority in 25 states. They primarily work in the hospital setting, but can also work in birth centers or attend home births. Certified midwives, who have a non-nursing degree in addition to midwifery training are allowed to practice in 13 states. Certified professional midwives (CPMs) are recognized in 37 states including Washington D.C. Nineteen states allow CPMs to be reimbursed by Medicaid.
With the actions of the current administration, today it is even more critical to consider improvements to the health system—including, but not limited, to Medicaid, through the lens of joy and justice and what remains possible. H.R.1 gives us a duty to advocate and educate policymakers about the harms of massive Medicaid cuts burdening states, while also demanding accountability and protection of the Medicaid funding Black families depend on. It means continuing to highlight the need to expand of doula and midwifery care, not roll it back. Joy means centering the brilliance and leadership of Black-led perinatal organizations that have been building solutions for a decade, often without the institutional resources they deserve. This journey to improve the health system—and all the payers that support it- has only just begun, now is the time to double down.
At CCF, we remain committed to the policy work that centers Black maternal health from Medicaid expansion and postpartum extension to doula reimbursement and strengthening the perinatal workforce. Black Mamas are not a footnote to health policy. They are a critical measure of whether or not our systems are working.
This week and every week, we stand in solidarity with BMMA and the entire Black maternal health movement.