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MEMORANDUM
To: Vice-President Kamala Harris
Re: Maternal Health Day of Action at the White House
Date: Tuesday, December 7, 2021
Madame Vice-President, on behalf of the National Birth Equity Collaborative (NBEC), a Black women-led organization dedicated to ending the Black Maternal Health and Infant Mortality Crisis here in the U.S. and transnationally around the globe, I would like to thank and congratulate you for your unwavering support and leadership when it comes to the health and well being of Black women and pregnant people in this country and for today’s Maternal Health Day of Action. Your leadership today in calling for the public and private sectors to help improve health outcomes for parents and infants in the United States is not only groundbreaking as today marked the first-ever White House Maternal Health Day of Action, but is imperative for the survival and sustainability of our community.
It has been four years since Black maternal health and mortality inequities captured the attention of mainstream media in the United States. Coverage by national news outlets resulted from decades of research, advocacy and storytelling about the ways in which America’s substandard maternal health system is particularly harmful to Black people who are pregnant and giving birth. Today, the systemic challenges that underlie the disparity in outcomes for Black people remain. Black women are three to four times as likely as white women to die from complications during pregnancy or childbirth and education and income status are not protective factors. When comparing maternal health in the ten richest countries in the world, the United States comes in dead last. We must adequately address maternal health inequities with a Reproductive Justice framework.
Access to reproductive health care of all kinds depends heavily on where a person lives, how much money they make, and the extent to which discrimination impedes their ability to make and act on their reproductive decisions. At the federal level, the work of multiple agencies affects reproductive health, and yet these efforts are often siloed. The National Birth Equity Collaborative offers critical recommendations for ensuring that America has the proper infrastructure and resources in place to achieve equitable maternal health outcomes.
As one of the nation’s leading authorities on Black maternal health, NBEC has put forth the following recommendations that we hope the Biden-Harris Administration will consider implementing in its efforts to turn the tide for maternal health care in the U.S.
White House:
Establish an Office of Sexual Reproductive Health and Wellbeing (OSRHW) within the White House. The mission of OSRHW would be to align federal policies and programs so they promote SRHW through a human rights, reproductive justice, and racial equity lens. OSRHW is intended to acknowledge the history of racism and reproductive coercion and how they manifest today and address barriers to full reproductive autonomy. This Office would coordinate sexual and reproductive health and wellbeing efforts across the federal entities included in this memorandum. It would also address barriers to full reproductive autonomy, such as access to health care, including contraception, maternal and infant health, quality, affordable child care, and comprehensive paid family leave.
Department of Commerce:
People across the United States rely on the Department of Commerce to conduct a fair and accurate census, as this method of data collection is used to allocate funding, resources, and political districting. However, we know there is a misalignment between data collection and the lived experiences of Black women in America. In an effort to improve maternal health, we call on the Department of Commerce to expand data collection to include more information about reproductive health across the lifecourse. We believe the inclusion of reproductive health into the census will address the ongoing maternal health crisis by allowing for better resource distribution to underserved populations, including community based health care organizations. We also ask for the Department of Commerce to create a centralized, strong national data collection center on health data, including COVID-19’s association with maternal health outcomes.
Department of Education:
We call on the Department of Education to study the barriers that prevent women – particularly from underserved communities – from entering maternity care professions and receiving equitable compensation. We ask for the development of pathways into the profession, particularly through historically Black colleges and universities and other minority-serving institutions. We also ask that ED provide funding to reduce financial barriers for Black, Indigenous, and other people of color to enter, stay in, and graduate from programs that train people to join the maternity care support workforce and for a thorough examination of medical and nursing school and training program curriculum to promote anti-racist models of care.
Department of Health and Human Services:
The Department of Health and Human Services is responsible for the health and wellbeing of people across the country, yet its offices and agencies are falling short of their duty. We call on the Secretary of HHS to improve the reproductive health and wellbeing of millions by taking a number of actions, including but not
limited to the following requests. We call on HHS and its affiliate agencies to require and support all states and U.S. territories to collect and disseminate maternal mortality and morbidity
data, disaggregated by race and ethnicity. Despite decades of rising maternal mortality and morbidity, the United States does not collect and disseminate reliable, timely data on maternal health. Just as we require states to collect data on infant deaths, we should mandate maternal mortality and morbidity review committees and the standardized collection of reliable maternal health data to promote evidence-based policy interventions and accountability for improvement. Second, we call on the Centers for Medicare and Medicaid Services within HHS to develop guidance for Medicaid reimbursement for doulas and community health workers. Doula and community health worker support reduces health disparities and promotes health equity for pregnant and postpartum people, and the benefits are significant for those who are most at risk of poor health outcomes. Third, we call on HHS to study how culturally congruent maternity care promotes better outcomes for moms, especially in communities of color.
Department of Homeland Security:
We call on the Department of Homeland Security, across agencies and offices, to adhere to standard medical recommendations and respectful maternity care practices for care for all people who have interaction with the department, including those people seeking refuge in the United States who are in need of reproductive health care. DHS must put more policies in place to provide support for maternal and infant health. For example, FEMA guidelines for natural disasters should include special guidance for pregnant and childbearing people.
Department of Housing and Urban Development:
Following the provisions outlined within the Social Determinants for Moms Act, a part of the Black Maternal Health Momnibus Act of 2021, we call on the Department of Housing and Urban Development to establish a Housing for Moms Task Force that ensures funding for safe, stable, adequate, quality housing for pregnant and postpartum people. Housing insecurity is directly related to poor maternal and infant health outcomes. For instance, pregnant people who experience housing insecurity are nearly twice as likely to have preterm births and babies with a low birth weight. Ensuring access to stable housing can contribute to improving health outcomes for both pregnant people and their babies. To further ensure access to stable housing for all pregnant and postpartum people, we call the HUD to remove restrictions for Emergency Housing Assistance to help formerly incarcerated women with a record who are pregnant and need temporary housing assistance.
Department of Justice:
We call on the Department of Justice to conduct a comprehensive study – with a particular focus on racial and ethnic disparities – to understand the scope of the maternal health crisis among incarcerated people and to make recommendations to prevent maternal mortality and severe maternal morbidity in American prisons and jails. We ask for the prohibition of shackling and restraints, routine screening, comprehensive perinatal care, collaborative birthing plans, and postpartum treatment for all pregnant people during incarceration.
Department of State:
We call on the State Department to protect and ensure that policies like the ‘Global Gag Rule’, which limits reproductive decision-making and prohibits all state and federal funding and regulations related to reproductive health, are free from coercive measures. The government should require that health care options and services be provided in a non-coercive manner that emphasizes patient choice and fully informed consent, strengthening existing protections related to the privacy and safety of reproductive health care providers and patients.
Department of Transportation:
We call on the Department of Transportation to conduct a study to evaluate the need for and utilization of free transportation for pregnant and lactating people given that inadequate transportation contributes to poor health outcomes. In addition, the DOT should direct the Federal Transit Administration to provide financial and technical assistance that helps enhance local public transit systems, ensuring that all pregnant people living in maternity care deserts have equitable access to public transportation.
Department of Veterans Affairs: The Department of Veterans Affairs promises to provide veterans the world-class benefits and services they deserve. To uphold this promise, we call on the VA to comprehensively study the unique maternal health risks facing pregnant and postpartum veterans and support the VA’s maternity care coordination programs. The VA needs to ensure coordination between VA facilities and non-VA facilities, identify mental health risk factors associated with service that could have potential impacts on maternal health, and provide supports to pregnant and childbearing people, including lactation support and parenting courses.
Environmental Protection Agency:
The Environmental Protection Agency’s mission is to protect human health and the environment, which are inextricably linked. Pregnant people, particularly those who are Black and low-income, are especially vulnerable to adverse outcomes related to climate change such as exposure to extreme heat, which has been demonstrated to increase the likelihood of preterm births and low birth weight. High temperatures can make it challenging for the body to regulate itself and exposure to prolonged heat can be dangerous to all people, but especially pregnant women who have higher body temperatures naturally. To that end, we call on the EPA to develop a national heat vulnerability index to protect pregnant and postpartum people against extreme heat. We also call on the EPA to conduct a study on the effects of environmental risks to maternal and infant health outcomes and make recommendations for steps to end racial and ethnic disparities.
It is NBEC’s position that achieving better birthing outcomes for all moms – especially for the Black moms and babies we serve – will require a holistic approach including from private and the public sectors and we look forward to being in the fight with you to ensure better outcomes for Black mamas, their babies, and their villages.
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