Black Maternal Health Week 2023

Black Maternal Health Week, originated by the Black Mamas Matter Alliance, was created to raise awareness of diminished maternal health outcomes in America, especially among Black women. In the U.S., maternal mortality rates have steadily increased since the 1990s with a sharp 64 percent rise between 2019 and 2021, according to recent data from the Centers for Disease Control and Prevention. Although rates have worsened, the United States has had one of the highest maternal mortality rates among economically comparable countries for many years.

Furthermore, maternal mortality rates in the U.S. show significant racial disparities. Black and Native American and Alaska Native women are two to four times more likely to die of pregnancy-related causes than White women in America. Maternal death rates among Hispanic women are also worsening with a sudden increase in 2020 and 2021, rising by 44 and 54 percent respectively.  These disparities are complex, multifactorial, historically overlooked and simply unacceptable.

“Here in this Commonwealth, and throughout the country, rates of maternal mortality are rising. For Black mothers, that risk is even greater regardless of their income or zip code…We can’t accept that.”

Governor Josh Shapiro

Governors are committed to moving forward to advance maternal health outcomes.  Along with their state agencies, Governors have employed a variety of policy options to improve outcomes, including:

Maternal mortality review committees: Many states and territories have maternal mortality review committees (MMRCs) to investigate maternal deaths and recommend ways to prevent similar outcomes. MMRC recommendations often focus on racial and ethnic disparities, access to care, behavioral health, and other social determinants of health. These committees include clinical providers, public health experts, and community members. Indiana’s MMRC focuses on these and other issues that align with Governor Eric Holcomb’s plan to diminish mental health stigma, grow the mental health workforce, reduce infant mortality, and reduce pregnancy-related deaths associated with substance use.

“My Next Level Agenda prioritizes investing in public health like never before, curbing infant and maternal mortality, providing mental health assistance to Hoosier vets and their families, and addressing substance use in our communities.”

Governor Eric Holcomb

Postpartum Medicaid Expansion: States and territories were given the option to extend Medicaid postpartum coverage from 60 days to 12 months through an American Rescue Plan Act provision. As of March 2023, 29 states have implemented this practice, allowing women to receive continuity of care – which is associated with better health outcomes – through the first year after delivery. Alaska’s postpartum Medicaid extension comes with a particular focus on maternal mental health, which is the state’s leading factor in pregnancy-related death. With extended coverage, mothers with later onset postpartum depression will be able to seek treatment for both a physical and mental strong start to their child’s life.

“As I said my State of the State address, my vision is for Alaska to be the best place in the country for families.”

Governor Mike Dunleavy

Access to Care: States and territories are working to fill both geographic and financial gaps preventing patients from accessing high-quality care. Telehealth is a dominate strategy used to reach across the state and improve access for patients in rural areas or those without adequate transportation. Access also includes the patient’s choice in care, whether that be birthing centers, hospitals, home births, and other perinatal care models. In Connecticut, the Governor recently proposed legislation to allow birth centers to operate more freely and improve access to doulas and home visiting for families across the state.

“It is a moral imperative that we take actions to ensure safe pregnancies, no matter a family’s background.”

Governor Ned Lamont

Maternal Health Data Collection and Analysis: Some states and territories have implemented maternal health data collection and analysis programs to better understand the factors contributing to maternal mortality. These programs can identify disparities and inform the development of targeted interventions. California created groups to collect, assess, and inform policies specially around maternal and perinatal quality. These two collaboratives are devoted to innovative research to improve maternal and infant health (MIH) outcomes.

“It is unacceptable that the maternal and infant mortality rate among Black and Indigenous communities remains significantly higher than the state average. California is committed to tackling discrimination and disparity whenever and wherever it occurs…”

Governor Gavin Newsom

Health Care Workforce: Governors are working to address challenges in hiring and retaining health care workers. States and territories are also implementing tactics to diversify the MIH health workforce to both reflect patient populations and expand access to perinatal care options. Some tactics include expanding educational and training opportunities, providing recruitment and retention bonuses, and improving clinical placements for communities with health care worker shortages. In Iowa, Governor Kim Reynolds has proposed initiatives to improve maternity care and rural emergency hospital access through state-sponsored fellowship and licensure programs.

“To support our families, we need a strong health care system in every part of the state.”

Governor Kim Reynolds

Improving maternal health outcomes requires a multifaceted approach with a focus on social determinants of health and access to care. To address significant disparities in maternal mortality and curb the rate of preventable deaths, New Jersey First Lady Tammy Murphy created Nurture New Jersey (Nurture NJ). Since its inception, Nurture NJ has seen 43 pieces of MIH legislation signed by Governor Phil Murphy. The initiative has also spearheaded the development and implementation of evidence-based programs and policies throughout the state. First Lady Murphy uses her platform to bring together national experts, community members, clinical professionals, and representatives from 22 state agencies to tackle pressing issues in maternal health. In January 2021, Nurture NJ released its strategic plan outlining their work to date and next steps, in the form of detailed recommendations and a robust implementation and evaluation strategy.

“Strengthening our maternal and infant health care systems will help us continue to build a stronger, fairer, and more equitable New Jersey for all families who call our great state their home.”

Governor Phil Murphy

In July of 2022 First Lady Murphy launched an NGA effort to elevate and expand the conversation around MIH nationwide. The four pillars of this effort are:

• Centering Women’s Voices in MIH Policy – This area focuses on the importance of integrating the voices of mothers and women of color in the policymaking process, making sure they have a seat at the table before the table is even built.
• Improving and Utilizing Maternal and Infant Health Data – Improving data systems by incorporating qualitative data on maternal health experiences, linking state data and increasing accessibility to data to improve accountability.
• Expanding Access and Quality of Care – Identifying ways for states to ensure citizens have access to high quality maternal and infant care, including various MIH Medicaid policies that states can implement.
• Elevating Innovative MIH Polices, Programs and Technologies – Identify and highlight innovative and novel approaches to MIH policy, including highlighting effective programs and examining the role of technology to improve MIH outcomes.

To date, First Lady Murphy has hosted two roundtables on Centering Women’s Voices in MIH Policy and Improving and Utilizing Maternal and Infant Health Data.  Additional roundtables on the final two pillars of the program will be held in Detroit this month and Philadelphia in May. Learn more about this initiative here.

“Recognizing Black Maternal Health Week in New Jersey means continuing to push forward with determination to solve our state’s Black maternal health crisis.”

New Jersey First Lady Tammy Murphy

This article was developed by Michelle LeBlanc, MPH, Senior Health Policy Analyst, National Governors Association. For more information on Governors’ health efforts please contact communications@nga.org.