DENVER – Colorado lawmakers are considering a bill to improve maternal health aimed at bettering pregnancy outcomes for minority women, as the U.S. recognizes Black Maternal Health Week.
About 700 women across the country die annually from complications during pregnancy, delivery and post-partum. Black and Indigenous women are about three times as likely to die from pregnancy-related causes as White women, according to the federal Centers for Disease Control and Prevention.
“I call on all Americans to recognize the importance of addressing the crisis of Black maternal mortality and morbidity in this country,” President Joe Biden said in a proclamation announcing April 11 through April 17, 2021, as Black Maternal Health Week.
The bill which passed the Senate Health & Human Services Committee on Wednesday, aims to improve maternal health care through expanding Medicaid coverage, improving data collection on perinatal and postnatal maternal health and ensuring safe transfers of patients between health facilities.
“There are big systemic changes that will challenge the status quo, but they are necessary steps to reduce inequality and lower the maternal mortality rates for people of color,” said Democratic Sen. Janet Buckner, one of the bill’s sponsors.
The bill directs the Colorado Maternal Mortality Review Committee to collect data about race and ethnicity correlations for birth outcomes, neonatal intensive care unit stays, pre-eclampsia cases, deaths and distances traveled for care, Buckner said. It also requires the health department to make recommendations to improve numerous topics on maternal health.
Indra Lusero, founder of Elephant Circle, a nonprofit that works toward birth and reproductive justice, said the lack of data collection is a “systematic failure amongst medical providers to listen to women of color.”
“Black women should not be dying on the table because their doctor dismissed that she had high blood pressure,” said Democratic Sen. Rhonda Fields, chairwoman of the Senate committee.
Under U.S. law, women who become eligible for Medicaid while pregnant lose their coverage 60 days after giving birth. The bill would also expand Medicaid coverage for 12 months of postpartum care to those who qualified for benefits while pregnant.
“Without that coverage, they’re unlikely to get the physical and mental health care that they need to reduce maternal deaths,” said Dr. Alethia Morgan with the Colorado Section of the American College of Obstetrics and Gynecology.
Six in 10 maternal deaths are related to postpartum depression and substance abuse, Morgan said. By strengthening the screening and of treatment of postpartum depression through prolonged Medicaid coverage, Colorado can reduce the risk of maternal death, she added.
The bill calls for the state to reimburse health-care providers that provide labor and delivery services and does not discriminate on the type of provider or facility.
Jill Bergman from the International Cesarean Awareness Network, who testified in support of the bill, highlighted the importance of community birth centers under the bill’s equitable reimbursement provision.
Community home and birth centers provide care for low-risk individuals, reduce overall costs to private and public insurance providers and reduce pregnancy risks by having fewer cesarean births, Bergman said.
“By requiring health benefit carriers to equitably reimburse all licensed providers, we open up ... community birth to vastly more Coloradans, rather than limiting the choice to only those who can pay out of pocket,” Bergman added.
Virginia Love raised concerns with the proposal while testifying on behalf of America’s Health Insurance Plans, and said requiring the same payments for providers with different levels of expertise or credentials was a big concern.
“By implementing this language, you are creating a new (insurance) mandate and that is a much bigger conversation,” Love said.
The bill would also require hospitals to accept community-birth transfers without discrimination of the type of facility.
Aubre Tompkins, a midwife and president of the American Association of Birth Centers, testified in support and said that the smooth transfer of birth centers to hospitals has shown to improve birth outcomes for the mother and child based on a report that studied Washington state’s model for transfers.
Tompkins also said the bill would be a great improvement to a system where birth centers and midwives are required to have transfer policies, but hospitals do not.
Patrick Boyle from COPIC, a medical liability insurance provider, testified against the bill’s section on the mandatory acceptance of transfers. Boyle suggested that the state health department establish processes for health care exchange where obstetricians and midwives build relationships before sending an unknown patient into a hospital’s care.
He also said that midwives should identify a hospital beforehand where they would send a patient in crisis.
The bill will be heard next by the Senate Appropriations committee.
Patty Nieberg is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.