COVID-19 and Maternal Equity: Two Crises that Intersect

In a pandemic that disproportionately affects Black individuals, it is abundantly clear that racism in medicine is both prevalent and fatal. It is especially scary when those conditions coincide with pregnancy. Numerous studies have shown us that Black women die from pregnancy-related causes at three to four times the rate of white women every year in the United States, a rate far worse than our international counterparts.

In June, the Massachusetts House of Representatives passed H.4818, an Act to Reduce Racial Inequities in Maternal Health within the Commonwealth. In addition, the Massachusetts COVID-19 Maternal Equity Coalition launched to develop policy recommendations to address equity and evidence related to perinatal healthcare across the Commonwealth. The bill has now passed the Senate and has been referred to a committee, but the Coalition has already released their first report.

The report, Giving Birth in a Pandemic: Policy Recommendations to Improve Maternal Equity During COVID-19, makes six policy recommendations, all aimed at addressing comprehensive and equitable pre- and perinatal care in Massachusetts. The first three focus on learning more about what’s happening to our Black mothers and making sure they don’t fall through the cracks should they experience mistreatment or negligence.

The Coalition first recommends forming an emergency task force in collaboration with the Secretary of Health and Human Services. Diverse membership within the taskforce will ensure stakeholders represent the full spectrum of voices that need to be heard. The second recommendation is for robust data collection on the intersection of COVID-19, race, and pregnancy outcomes.

These data can help inform the development of the third recommendation, which is standardization of care. Because of how little is known about COVID-19, there have been limits to the number of guests allowed at or after the birth, together with debates about mother-infant separation and breastfeeding. The WHO and CDC advocate for keeping the mother and newborn together as soon and as long as possible and are still encouraging mothers who have suspected or confirmed COVID-19 to breastfeed anyways as the risks of transmission are outweighed by the benefits to the baby.

The Coalition recommends that uniform policies be developed that emphasize shared decision making between birthing people and their medical staff. Additionally, the birthing person’s partner should be allowed in the room after being screened. A hotline should be developed to report instances of medical mistreatment so they can be documented and addressed in a timely manner.

The final three recommendations focus on overall support for birthing people within our state. Ensuring adequate mental health support is the first step as the Coalition advocates for increased perinatal mental health services through support groups and postpartum doula care. Given the dual-pandemic of COVID-19 and racism, Black mothers face extra stress and deserve extra support.

Insurance coverage remains a concern during the COVID-19 pandemic, as COVID-19 has resulted in mass unemployment, which coincides with the loss of employer-sponsored health insurance. The fifth recommendation encourages Massachusetts to extend full Medicaid coverage to postpartum people for a full year after giving birth to ensure they are able to access the care they require. Lastly, the Coalition advocates for expanding community birth options and midwifery care, both of which have been associated with better health outcomes in low-risk pregnancies. Opening more facilities and reimbursing for birth centers and midwives via MassHealth would expand access and lower health care costs  across the Commonwealth.

While H.4818 awaits further action in the Massachusetts State House, racial disparities in our medical system are endangering Black mothers and babies. The Massachusetts COVID-19 Maternal Equity Coalition has a clear handle on where the Commonwealth needs to go to advance maternal health equity and prevent birthing people from falling through the cracks – all we have to do now is take action.