By Giana Seltzer and Erick Salgado
The lack of cost-effective and quality healthcare for women of color in California has become its own epidemic in recent years.
Maternal and infant mortality rates remain high in low-income and minority communities, as many Black and Indigenous women face racial, economic and environmental disparities and healthcare professionals deal with a shortage of resources to serve these communities.
California’s statewide infant mortality has fallen in recent years to 4.2 deaths per 1,000 live births; however, the infant mortality rate amongst women of color in the state is significantly higher, according to a recent analysis by staff at the California State Senate. Black infants have a mortality rate of 8.7 per 1,000 live births, while Indigenous/Native American infants have a mortality rate of 11.7 per 1,000 live births.
In a 2018 study conducted by the Sacramento County Department of Health Services, the infant mortality rate in Sacramento County was 4.8 per 1,000 live births. Black babies had the highest infant mortality rate in 2018 of 12.6 infant deaths per 1,000 live births.
A new law seeks to change that. Senate Bill (SB) 65 requires counties to thoroughly report the effects and causes of infant and maternal mortality in California. It will provide midwives with the proper resources to train a diverse range of new hires and expand Medi-Cal coverage for doula services.
State Sen. Nancy Skinner (D-Berkeley) authored the bill. She said that although California faces lower maternal and infant mortality rates compared to other states, there is an urgency to combatting the increasing rates of pregnancy-related deaths.
“We initiated some policies over the last five to ten years to try to address it, and our outcomes were better than other states’,” Skinner said. “However, even California started falling behind and across the whole country. We started to see that infant mortality and maternal mortality and bad health complications were increasing.”
Skinner also noted that there were a variety of organizations that helped formulate the law.
“The bill this year was really building on the past work of health organizations and advocacy groups like Black Women for Wellness. Also, groups trying to combat poverty — March of Dimes, Planned Parenthood — just a really broad coalition that is concerned about this came together and said that California needs to do more,” Skinner said.
Paris Maloof-Bury, certified nurse-midwife and president of the California Nurse-Midwives Association, said that the funding provided by the law is necessary to create a better training program for midwives.
“The piece of the bill that directly affects midwives is workforce development, and it creates a place-holder for a funding stream for midwifery training programs and that’s for all types of midwifery training,” Maloof-Bury said. “In our state, we have three universities [CSU Fullerton, San Diego State and UCSF] that have midwifery training programs; two are for certified nurse-midwives and one is for licensed midwives, and this bill creates a funding stream for those programs.”
Midwives are health professionals that aid mothers during the process of delivering their babies and after delivery, as well. Midwife centers provide a variety of resources for mothers that involve prenatal care, gynecological exams, along with labor and delivery support.
Maloof-Bury said that better representation among midwives across all communities will help serve new mothers of different backgrounds.
“Bringing in more student midwives and aspiring midwives of color and supporting them to go back to communities that are dealing with the highest rates of racism and healthcare disparities, as well as bringing midwives to underserved communities in general,” Maloof-Bury said.
In order to implement these training programs for midwives, California has set aside $6.7 million from the general fund in the state budget. The money will be primarily used towards the implementation of the California Pregnancy-Associated Review Committee (CPARC).
The legislature’s bill analysis explains that CPARC will be overseen by the California Department of Public Health (CDPH) and will conduct in-depth investigations of infant mortality cases in the state. CPARC will be in charge of working more closely with the families that are going through a maternal death and will be reviewing medical records, death certificates, and other pertinent reports.
To have a better understanding on the mortality rate information across the state, counties will have to annually report all infant deaths to their local health departments. The health departments will then have to investigate a minimum 20% of cases within the county and report the causes of why those infants have died.
Although there is not a definitive reason as to why many Black and Indigenous mothers are dying at disproportionate rates, Senator Skinner said that environmental factors might be a cause.
“When we look at the concentration of where many of our Black community lives and some of our other communities of color, it can often be in areas that have higher pollution, air water and soil contamination, that have less access to basic medical services and less access to healthy foods,” Skinner said.
The final piece of the law relates to doulas: new mothers in the Medi-Cal program will soon have the option to use doula services for 12 months after they give birth. The new law requires the state to report on the implementation of that benefit.
Doulas are trained to provide support and guidance to pregnant women during, before, or after labor. Doulas are often utilized as emotional support and provide a wide variety of practices to help ease the labor process for pregnant women through emotional support, touch and massages.
“I think it was really helpful to have someone who had been to many births because my husband hadn’t been, so he did not intuitively know what to do, so she would provide reassurance,” said Carolyn Bernstein, nurse practitioner at Kaiser Permanente. “It reduces anxiety. It’s easy to get anxious during birth, because you don’t know what’s happening, and the doula was just a very grounding force and helped reassure and especially helped my husband help me.”
Bernstein said her birth lasted 24 hours and her doula stayed with her during 12 of those hours. She added that she believes first-time mothers who have no experience with the labor process should get a doula.
“I think making doula care more accessible to all women [is important]. I know I paid cash for my Doula so that limits the access other women have to it,” Bernstein said. “I was lucky because I delivered in Berkeley, California, so there’s lots of midwives but that’s not the case for everyone.”
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