Slate of bills seeks to improve Black maternal health outcomes

By Jennifer Fernandez and Rose Hoban

For the third legislative session in a row, Democratic lawmakers are pushing a series of state bills to address maternal health, especially Black maternal health disparities.

Legislators and advocates held a news conference on Wednesday to urge the state Senate to put more funding toward the issue when it crafts its budget in the next few weeks.

The U.S. has the highest maternal mortality rate in the developed world, said Sen. Natalie Murdock (D-Durham).

Overall maternal mortality rates in North Carolina increased from 22 to 44 deaths per 100,000 live births from 2019 to 2021, according to federal data compiled and analyzed by the investigative news organization MuckRock.

Black women are three times more likely to die in connection with childbirth than white women in the United States. The most recent report from America’s Health Rankings broke down state-level data from the Centers for Disease Control and Prevention by race and ethnicity from 2016 to 2020. North Carolina’s Black maternal mortality rate for that period was 52.8, more than three times the 17.3 rate for white mothers. It was nearly five times higher than the rate of 10.7 for Hispanic mothers.

The rate of infant mortality is also extremely high in the state, said Rep. Julie von Haefen (D-Apex). North Carolina is among the 10 worst states in the country for infant deaths between 2018 and 2020, she said. While 10.6 percent of the state’s babies were born preterm, that jumps to 49 percent of babies born to Black women, she said.

More than 80 percent of maternal deaths are preventable, according to data collected from Maternal Mortality Review Committees — multidisciplinary groups that gather at the state and national levels to examine deaths during or within a year of pregnancy.

Murdock said the numbers “speak for themselves.”

“We know that we have to get a handle on how Black women and women of color are treated in health care settings,” she said.

The plea comes on the heels of Black Maternal Health Week, observed annually from April 11 to April 17. It also comes after the state’s inaugural Black Maternal and Infant Health Conference, which was April 14-15 in Colfax.

MOMnibus Act

Legislators, mostly Democrats, filed several bills this session. 

The key bill is Senate Bill 467/House Bill 552, or the MOMnibus Act. If passed it would:

• Establish and fund a Maternal Mortality Prevention Grant Program.
• Establish an implicit bias training program for health care professionals who work in perinatal care.
• Outline the rights of perinatal care patients.
• Support and diversify lactation consultant training programs.

Other bills addressing maternal health issues would:

At the federal level, U.S. Rep. Alma Adams (D-Charlotte) is leading a similar movement. Also called the MOMnibus Act, the federal legislation consists of a dozen bills tackling issues around Black maternal and infant health. 

Personal experience

At Wednesday’s news conference, Charity Watkins shared her own experience as a Black woman who nearly died after giving birth.

“Seven short years ago, on this very day, I was Charity, a worried 30-year-old mother who feared she wouldn’t survive to see her infant daughter grow up,” said Watkins, now an assistant professor at N.C. Central University and researcher at Duke University whose work focuses on how institutional racism impacts the well-being of Black Americans. 

Watkins told the audience she ended up in the intensive care unit with peripartum cardiomyopathy, or pregnancy-related heart failure, after repeatedly telling her doctor something wasn’t right after she gave birth to her daughter.

What if her providers had reviewed her records and noted her family’s history of cardiovascular disease, she asked. What if her OB-GYN had looked at that same history when Watkins reported symptoms? What if she had a doula to also monitor her and advocate for her?

“What if I was white?” she asked. “Would my complaints of heart attack symptoms have been taken seriously and received immediate care?”

Doula support

A baby gurgled in the background as von Haefen spoke about the importance of doulas to improving health outcomes during pregnancy and childbirth. 

Using doulas has lowered the number of cesarean sections, allowed more spontaneous vaginal births with less pain medicine, increased breastfeeding rates, decreased postpartum depression rates and reduced rates of other complications, she said.

She encouraged the use of community-based advocates who have lived experiences in these issues.

“If we want to improve the health disparities of Black women and babies in the state, we must center their efforts,” she said. “We must listen to their voices, we must lift up their unique insights and partner together to find solutions.”

Implicit bias training

Dr. Sarahn Wheeler, an obstetrician-gynecologist with Duke Health, said physicians come to her asking for help.

“They are horrified with the stories that we are hearing and horrified to be part of a system that is creating inequitable outcomes over and over and over again,” she said.

Wheeler said she was glad to see implicit bias training in the proposed legislation, calling it an important start for people to understand how their brains are wired.

Funding for community-based groups is also important,she said.

After the news conference, she talked about changing attitudes toward different approaches to maternal care, such as doula services.

“Doctors are increasingly understanding that there is a need for an all-hands-on-deck approach,” she said, “and understanding the value of doulas — particularly community doulas who understand the lived experience of our patients in a way that our medical training doesn’t prepare us to do.”

What’s next?

Murdock said there seems to be bipartisan support on the doulas bill. She said she’s also been speaking with Republican Sens. Jim Burgin (Angier) and Kevin Corbin (Franklin) about the TANF bill.

The House has put forward its proposed budget bill for the next two years. It includes money for a grant program on improving birth outcomes, improving overall child health through age 5, and decreasing the infant mortality rate.

The Senate is expected to put forward its proposed spending plan in several weeks.

Murdock encouraged budget writers for the Senate to include maternal health issues in its plan.

After both plans are public, negotiators from the two chambers will try to develop a spending plan that will be accepted by the House and Senate before sending a budget to the governor.

Murdock may not see all her maternal health requests included in that document, but she says it’s important to let people know that she and other lawmakers are trying to do what they can to close the gaps.

“I believe in filing legislation because it’s the right thing to do,” Murdock said. “We have to put these items out there.”