During this year’s Black Maternal Health Week, many organizations across the country are speaking out about the importance of supporting, trusting, and listening to Black women. The existing inequities that Black, indigenous and other people of color face during pregnancy are unconscionable, and it is clear that our maternal health system is failing. The United States is the only country where maternal mortality is rising, yet we spend more money and resources per capita on health care than any other nation. We see this troubling and avoidable trend in communities across the country, including in pregnant and birthing people in the state of Colorado.
As a Black woman and physician who has provided the full range of pregnancy related care, including prenatal, delivery, and postpartum care for thousands of patients, I have seen firsthand the ways that Black women bear the brunt of our health system's failures. Black women are less likely to have quality, culturally responsive, community-centered care during their pregnancy and the postpartum period than white women, which can make the decision to carry a pregnancy to term a matter of life-or-death. Black, Indigenous, and other people of color continue to face higher rates of mortality, morbidity, and mistreatment during pregnancy and birth. And the data continually shows that these existing and ever-increasing inequities are largely related to bias and systemic racism. In fact, Black women and infants experience inequitable treatment throughout their perinatal care, and one out of every three patients report dealing with blatant disrespect when receiving maternal health care. Addressing racism and bias in our medical models of care will take both interpersonal strategies and policy-based solutions to address this systemic problem. The Colorado Birth Equity Package is necessary and meaningful progress to begin resolving this crisis.
Colorado’s Birth Equity Package would work to correct these injustices by increasing equitable access to doulas and midwives, providing critical protections to pregnant people, and improving conditions for the maternity care workforce.
Evidence shows that expanding access to direct-entry midwives, especially those who are part of the communities they support, can significantly improve the health and birthing outcomes of patients. In fact, midwives are directly associated with improved maternal health outcomes and lower rates of medical intervention. Unfortunately, right now only 14 percent of Colorado births are attended by midwives. As a physician, I fully support an integrated maternity care system where patients are able to get the full range of essential maternal health care and respect their decision about their birth attendants and place of delivery.
In addition, Colorado’s Birth Equity Package would improve conditions for the maternity care workforce by improving integration of Direct-Entry Midwives and requiring a health care provider to be reimbursed at the same rate for maternal care regardless of who provides that care.
Importantly, the package also recognizes that pregnant people who are incarcerated continue to face inhumane conditions, human rights violations, and injustices. Colorado’s Birth Equity Package would provide important protections for pregnant people who are incarcerated and work to end discriminatory practices to ensure the overall health, dignity, economic security, and well-being of all Coloradans.
Sex, pregnancy, and birth are not going to stop during the pandemic and neither is the maternal health crisis. Policies like those put forth in Colorado’s Birth Equity Package are essential to addressing existing health inequities and systemic racism in our health care system, and states across the country should follow their leadership in protecting maternal health as we continue to work on policy interventions at all levels. As a physician working on the front lines during the COVID-19 pandemic I understand that the current health crisis is only working to exacerbate existing maternal health inequities and increasing the need for proactive action in Colorado.
Jamila Perritt, M.D., MPH, FACOG.
The author is a fellowship-trained, board-certified obstetrician and gynecologist with a comprehensive background in family planning and reproductive health. She is president and CEO of Physicians for Reproductive Health.
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