Nationwide, the maternal mortality rate for Black people who are pregnant is three times the rate for White non-Latinx people. In response to calls for Virginia to mitigate disparate maternity outcomes, Governor Ralph Northam announced in June 2019 that his administration would prioritize eliminating the racial disparity in the state’s maternal mortality rate by 2025. Virginia has since taken definitive actions to reach that goal, including hosting statewide listening sessions with communities of color and developing a comprehensive Maternal Health Strategic Plan. The plan outlines recommendations and related budget investments to support maternal health equity and address structural racism.
Virginia’s efforts mirror trends at the federal level to address systemic maternal health racial disparities. In April 2021, the Biden Administration outlined early federal actions to address the U.S. maternal mortality crisis, its disproportionate impact on Black and Indigenous pregnant people, and ‘address the systemic racism that has allowed these inequities to exist.’ Actions in the first 100 days of the Biden Administration include funding for the implementation of implicit bias training for healthcare providers, the creation of state pregnancy medical home programs, and the enhancement of Maternal Mortality Review Committees.
The Black Maternal Health Momnibus Act of 2021, recently introduced in the House, builds on existing federal legislation to comprehensively address social and health systems that impact the care of pregnant people throughout the country. Other recent federal legislation such as the Maternal Health Quality Improvement Act of 2020, passed by the House in September 2020, includes similar goals to address maternal mortality such as supporting provider implicit bias and health equity training, funding for state perinatal quality initiatives, and expanded provider access to people living in rural communities.
Virginia reflects a growing call by states and federal agencies including the Centers for Disease Control and Prevention, to focus on racism as a public health emergency, creating opportunities for state policy makers to highlight a root cause of health inequities faced by people of color. This focus also led the state to view maternity care through a holistic lens, including policy interventions that address social and health systems that serve people who are pregnant and their families. In particular, Virginia’s doula Medicaid benefit mirrors a growing national trend to utilize this service as a key component of a comprehensive strategy to improve maternity care outcomes for people of color.
Virginia’s policy targets six areas with actionable recommendations specific to eliminating racial inequity: insurance coverage, the healthcare environment, criminal justice and child welfare response, community-based services, contraception, and data collection. Governor Northam’s Administration outlined key lessons learned from community listening sessions during the plan’s development, often centering the voices of people of color with lived experience. This process reflects the state’s desire to engage with traditionally marginalized communities, which can be an important step in addressing structural racism in health care. State policy recommendations include:
- Investing in a doula Medicaid benefit,
- Requiring provider cultural humility trainings,
- Ensuring health systems are connected to community programs,
- Mandating maternal mortality specific education for primary care providers,
- Investing in home community health workers and home visiting services, and
- Identifying strategies to improve mandated reporting of race/demographic data related to maternal health outcomes, among others.
Virginia also demonstrates a commitment to addressing racism through an emphasis on both a diverse maternity care workforce and integrated cultural humility training among health care professionals serving people who are pregnant. Workforce development activities include behavioral health training, certification, and licensure practices that create opportunities for people of color. Culturally appropriate educational campaigns to destigmatize maternal health are another prominent component of the plan. The state also explicitly identifies opportunities to encourage the adoption of evidence-based clinical practices to support positive birth outcomes including expanding the state’s Maternal Health Learning Collaborative.
The state’s plan is accompanied by new investments in maternal health care. Virginia’s 2021-2022 budget includes funds to advance maternal health initiatives, many of which were designed based on community feedback. Budget initiatives support increased access to substance use disorder treatment for pregnant people, greater access to contraceptive care, and new medical coverage options for pregnant individuals who were previously ineligible because of their immigration status. It also includes extended postpartum coverage for Family Access to Medical Insurance Security (FAMIS) MOMS beneficiaries, a program that provides insurance for people who are pregnant and meet a certain income threshold. Extended postpartum coverage is a policy trend states are increasingly advancing to reduce maternal mortality rates.
As states advance maternal health equity and work to eliminate the current maternal mortality crisis, they can look for opportunities to address systemic racism in part by ensuring community voices are at the center of policy development. Virginia’s Maternal Health Strategic Plan presents an opportunity for the state to reimagine maternity care while holistically addressing intersecting social and health systems. It also demonstrates the power of cross-sector partnerships to align goals and improve the quality of care for pregnant people of color and their families.
NASHP continues to work with Virginia and seven other states (Georgia, Idaho, Illinois, Iowa, Louisiana, Pennsylvania, and South Dakota) on building capacity and implementing policy changes to address racial inequities in maternal mortality through the Maternal and Child Health Policy Innovation Project (MCH PIP).