By Giana Seltzer and Erick Salgado | Special for the OBSERVER
The lack of cost-effective, quality health care 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 face a shortage of resources to serve these communities.
California statewide infant mortality has dropped in recent years to 4.2 deaths per 1,000 live births; however, the infant mortality rate among women of color in the state is significantly higher, according to a recent analysis by California State Senate staff. Black infants have a mortality rate of 8.7 per 1,000 live births, while Native/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 with 12.6 infant deaths per 1,000 live births.
A new law wants to change that. Senate Bill (SB) 65 requires counties to comprehensively report the effects and causes of infant and maternal deaths in California. It will provide midwives with the resources to train a wide range of new hires and expand Medi-Cal coverage for doula services.
State Senator Nancy Skinner (D-Berkeley) is the author of the bill. She said that although California faces lower maternal and infant mortality rates than other states, there is an urgent need to address the rising rates of pregnancy-related deaths.
“We’ve started some policies over the last five to 10 years to try to address that, and we’ve had better results than other states,” Skinner said. “However, even California started to fall behind and across the country we started to see infant mortality and maternal mortality and complications from poor health increasing.”
Skinner also noted that there were a variety of organizations that helped formulate the law.
“This year’s bill really built on the past work of health organizations and advocacy groups like Black Women for Wellness. Also, groups trying to fight poverty — March of Dimes, Planned Parenthood — just a very broad coalition concerned about this came together and said California needs to do more,” Skinner said.
Paris Maloof-Bury, certified nurse-midwife and president of the California Nurse-Midwives Association, said statutory funding is needed to create a better midwifery education program.
“The part of the bill that directly affects midwives is workforce development and creates a placeholder for a stream of funding for midwifery education programs and that’s for all types of midwifery education,” Maloof-Bury said. “In our state we have three universities [CSU Fullerton, San Diego State and UCSF] that have midwifery education programs, two are for certified nurse midwives and one is for registered midwives and this bill creates a stream of funding for those programs.
Midwives are healthcare professionals who help mothers during the birthing process and after childbirth. Midwifery centers offer a variety of resources for mothers that involve prenatal care, gynecological exams, as well as labor and delivery support.
Maloof-Bury said better representation among midwives from all communities will help serve new mothers from different backgrounds.
“Bringing in more midwifery students and aspiring midwives of color and helping them return to communities that face the highest rates of racism and health care disparities, as well as bring midwives to underserved communities in general,” Maloof-Bury said.
To implement these training programs for midwives, California has set aside $6.7 million from the general fund of the state budget. The money will primarily be used for the implementation of the California Pregnancy Associated Review Committee (CPARC).
The Legislature’s analysis of the bill explains that the CPARC will be overseen by the California Department of Public Health (CDPH) and will conduct thorough investigations into infant mortality cases in the state. CPARC will be responsible for working more closely with families who experience a maternal death and will review medical records, death certificates and other relevant reports.
To get a better understanding of death rate information in the state, counties will be required to report all infant deaths to their local health departments annually. Health departments will then have to investigate at least 20% of cases in the county and report the causes of death of those infants.
While there’s no definitive reason why many Black and Indigenous mothers are dying at disproportionate rates, Senator Skinner said environmental factors could be to blame.
“When we look at the concentration of where a lot of our black community and some of our other communities of color live, it can often be in areas where pollution, air, water and contamination of floors are higher, which have less access to basic medical services and less access to healthy food,” Skinner said.
The final piece of the law concerns doulas: New mothers in the Medi-Cal program will soon be able to use doula services for 12 months postpartum. The new law obliges the State to report on the implementation of this benefit.
Doulas are trained to provide support and counseling to pregnant women during, before or after labor. Doulas are often used for emotional support and offer a wide variety of practices to help ease the labor process for pregnant women through emotional support, touch, and massage.
“I think it was really helpful to have someone who had attended a lot of births because my husband hadn’t been there so he didn’t intuitively know what to do, so she would be reassuring,” Carolyn said. Bernstein, nurse practitioner at Kaiser Permanente. “It reduces anxiety. It’s easy to be anxious during labor, because you don’t know what’s going on, and the doula was just a very grounded force and helped reassure and most importantly helped my husband help me.
Bernstein said her birth took 24 hours and her doula stayed with her for 12 of those hours. She added that she thinks first-time mothers who have no experience with the labor process should have a doula.
“I think making doula care more accessible to all women [is important]. I know I paid cash for my Doula, which limits other women’s access,” Bernstein said. “I was lucky because I gave birth in Berkeley, California, so there are a lot of midwives but not everyone.”