April 11–April 17 is Black Maternal Health Week, a week dedicated to amplifying the stories of Black mothers and elevating effective policies and solutions to eliminate racism, bias, and inequities in maternal care. To celebrate Black Maternal Health Week, Ready, Set, Soar Ohio has invited members of the Ready, Set, Soar coalition to participate in a Black maternal health Q&A. Throughout the week, we will be sharing Q&A articles featuring different experts on a range of topics related to Black maternal health.
Q: What role does public policy play in supporting Black maternal health and eliminating racial disparities in maternal care?
Public policy can affect Black maternal health in direct ways: like extension of Medicaid for post-partum women from 60 days to 12 months; certification and Medicaid reimbursement of Doulas; and better outreach and support to help women find health coverage. Racism in the health care system discourages some people from seeking care. Policies such as targeted grant and forgivable loan programs could move more Black, Indigenous, and other students of color into medicine. The health of Black mothers can also be improved if lawmakers required private employers to pay a living wage, offer paid sick days and family leave, and require and enforce predictable scheduling.
Public policy also plays a role in addressing Black maternal health in indirect ways. For example, lawmakers can act to reduce Black maternal mortality by greatly increasing funds for programs that can improve the social determinants of health – such as expansion of rental subsidies and creation of more safe, healthy and affordable housing; increases in basic safety net services like monthly and emergency support through the federal Temporary Assistance for Needy Families grant program; more public transit; greater funding of workforce training; and more access to child care assistance.
Q: How does Ohio compare to other states when it comes to Black maternal and infant health?
In Ohio in 2008-2016, Black maternal mortality was 29.5 for every 100,000 live births, while white maternal mortality was 11.5 for every 100,000 live births. The same alarming disparities hold true for Black babies as well. The Ohio Department of Health’s most recent quarterly infant mortality scorecard reported that between July 1 of 2019 and June 30 of 2020, the average Black infant mortality was 15 deaths for every 100,000 live births and white infant mortality was 4.8 for every 100,000 live births. We’re at the bottom of the barrel among states: Ohio may be in the middle of the pack when it comes to infant and maternal mortality overall, but we are one of the worst when it comes to Black infant and maternal mortality.
Q: What role does the ongoing state biennial budget process play in advancing Black maternal health?
A budget is a statement of values and the state budget should demonstrate that it values the lives of Black women and mothers. Previous budgets have not, they continue not to, and policymakers must address this. In the current budget, lawmakers must embrace the federal matching funds offered through the American Rescue Plan and extend Medicaid coverage for all post-partum women from 60 days to 12 months. In addition, they must fund training, implement certification, and push for Medicaid reimbursement of Doulas for all women – including those insured by Medicaid. Doulas are not midwives, they are health care professionals who assist women during the year before and the year after birth, providing support, guidance, and protection. At present, they are not certified in Ohio, so they can not file claims for reimbursement in the Medicaid system.
State legislators should also double funding for Help Me Grow, Early Intervention Part C, and the Ohio Commission on Minority Health HUB programs. They should fund and implement the 34 recommendations of the Minority Health Strike Force blueprint. That is how they demonstrate that they value Black maternal health. The state budget is where lawmakers walk the talk.
Q: From your perspective, where are we as a state when it comes to Black maternal health?
We do very poorly in terms of Black maternal health. The infant mortality rate is the international indicator of quality of life of a people or a region: and Ohio’s high infant mortality rate reflects the insidious effect of racism, embedded in housing and lending policies, employment practices and many other public policies, with deadly and tragic outcomes. The focus on infant mortality has obscured the problem of maternal mortality. The unconscionably high rate of Black maternal and infant mortality in Ohio is – if not the greatest failure of public health in the state –among the greatest failures.
Q: What will it take to get where we need to be? What are things that policymakers, government agencies, and health care providers must do to address racial disparities in maternal health?
Make direct investments to improve Black maternal health (see response in question 1, above):
Expand Medicaid coverage for post-partum women to 12 months;
Train and certify doulas and pay for their services under Medicaid;
Increase health care accessibility in underserved communities of color, require Medicaid managed care plans to have satellite provider offices in communities where Medicaid enrollment is high, and offer grant funding for new Federally Qualified Health Center (FQHC) satellite centers (see Policy Matters Ohio's “A Budget for everyone”); and
Expand grant programs for students of color in medical fields.
Make indirect investments to improve Black maternal health (see response in question 1, above):
Boost state investments in affordable housing and rental assistance;
Increase in monthly TANF payments, expand TANF eligibility to the maximum allowed by the federal government; boost use of TANF dollars through the emergency assistance offered through the “Prevention, Retention and Contingency” program;
Enact the Fair School Funding Plan and expand post-secondary education financial aid;
Raise child care eligibility from 130% to 200% of the Federal Poverty Level;
Raise the minimum wage to a living wage of $15 an hour, require paid sick days and family leave for working Ohioans, and require predictable scheduling; and
Provide public transit agencies $150 million a year in state funding.
Wendy Patton is the Senior Project Director of the State Fiscal Project at Policy Matters Ohio. Learn more about Policy Matters Ohio at www.policymattersohio.org/