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November 13, 2020

Rep. Pressley Discusses Racial Disparities in Maternal Health at U.S. Commission on Civil Rights Briefing

Video (YouTube)

WASHINGTON – Today, at a briefing held by the U.S. Commission on Civil Rights (USCCR), Congresswoman Ayanna Pressley (MA-07) discussed the growing racial disparities in maternal health and the urgent need to combat the Black maternal mortality crisis.

As a founding member of the Black Maternal Health Caucus, Congresswoman Pressley is committed to ending the Black maternal mortality crisis in America and affirming maternal health justice for all. Last May, she introduced H.R. 2602, the Healthy MOMMIES Act, to extend post-partum Medicaid coverage for pregnant people and expand coverage to include culturally competent and community based doula care. In March, she introduced H.R. 6129, the Justice for Incarcerated Moms Act, legislation to improve maternal health care and support for pregnant individuals who are incarcerated. 

In September, Congresswoman Pressley, along with Congresswoman Barbara Lee (CA-13) and Senator Elizabeth Warren (D-MA) introduced the Anti-Racism in Public Health Act to confront the public health impacts of structural racism through two bold new programs within the Centers for Disease Control and Prevention.

A full transcript of Congresswoman Pressley’s testimony at the USCCR briefing is below.

Transcript: Rep. Pressley Discusses Racial Disparities in Maternal Health at U.S. Commission on Civil Rights Briefing
November 13, 2020
U.S. Commission on Civil Rights

REP. PRESSLEY: Good morning and thank you for the opportunity to address the Commission and to discuss the stark racial disparities in maternal health across our nation. It is critical we understand that the maternal mortality crisis is part of the fight for healthcare justice. 

A safe pregnancy should be a right not a privilege. Every person should be able to experience their pregnancy without worrying if they will survive delivery, or make it to their child’s first birthday. 

Unfortunately, at alarmingly disproportionate rates, that is not the reality for pregnant people of color, especially those who are Black. Black women in particular face significantly more pregnancy-related health risks than any other ethnic group. As black women, we are four times more likely to experience life threatening complications or death during labor, delivery and the postpartum period. 

And while the Commonwealth of Massachusetts has one of the lowest maternal mortality rates in the nation, in my district, the Massachusetts 7th, we have some of the starkest health inequities and disparities. Predominantly Black neighborhoods in my district like Dorchester and Mattapan lead in low birth weight, pre-term birth and infant mortality. In Boston, a city in my district, pre-term birth is 50% higher among Black women compared to our white counterparts. 

This has been the status quo for the Black families I serve, and these challenges have only been exacerbated by the COVID-19 pandemic. The truth is, our current public health emergency has taken a significant toll on the mental health of pregnant people. Many pregnant or new mothers are isolating at home for safety and due to COVID-19 protocols. Many must attend hospital visit visits and even go through labor without their support team critical support systems linked to positive birth and postpartum mental health outcomes. 

The CDC reported that half of COVID positive infants were born pre-term, while Black, brown and indigenous communities are at least twice as likely to contract COVID, be hospitalized and die from the disease. 

The numbers are clear, we are trapped. We are trapped in an unconscionable cycle of harm that is needlessly robbing Black and brown communities of life, and we must act. 

As we work towards a COVID-19 recovery, we must reject the notion of simply returning to normal. We know that normal was unjust and unequal in the first place. Instead, we must work to expand access to quality health care and ensure every pregnant person is covered for 365 days after they give birth. This is common sense policy that will ensure our lowest income mothers are able to access comprehensive maternal care and save lives. 

But make no mistake, access to health care is only part of the battle. If we are truly going to address racial disparities and maternal health, we need to also confront systemic racism head on. Even Black women with access to health care, with the highest levels of education, with fame and fortune, experience severe maternal morbidity. When Black women seek care, they are pushed into the cracks of a racist health care system that too often ignores our pain our voices and discounts our lives. 

This is why introduced the Anti-Racism in Public Health Act with Congresswoman Barbara Lee and Senator Elizabeth Warren. Our bill would create a national center for anti-racism at the CDC, declare racism as a public health crisis, and further develop a base of practical knowledge to root out racism from our health care system. 

We need policies that expand access to care and ensure that that care is comprehensive, community-based and culturally humble, like the Healthy MOMMIES Act legislation I worked to introduce with Senator Booker from New Jersey, which would create strategies to improve access to pre- and post-partum community-based doula care, because the data tells us that all mothers have better health outcomes when they have doulas or midwives on their care teams. 

We must enact innovative and bold policy solutions that center scientific evidence and the lived experiences of all pregnant people. Combating the maternal mortality crisis requires work at every level of government, and in every institution.  And the work is worth it. Because Black and brown lives are worth it. 

Although it seems the nation is just now catching up to this irrefutable fact, Black women have always been critical to the functioning of our country’s democracy. We are saving and creating lives. We are raising and sustaining our families and communities. Black women continue to show up for this country, and we must fight for their lives with as much energy and urgency as they fight for the soul of this nation. Again, I appreciate the opportunity to speak on this urgent crisis. And I look forward to answering any questions you may have. Thank you.

CHAIR LHAMON: Thank you so much, Congresswoman. I’ll open for questions from my fellow Commissioners. Commissioner Adegbile?

COMMISSIONER ADEGBILE: Thank you. Thank you, Congressperson. That was very important testimony. And thanks for your leadership on these issues. I was wondering if you could help us understand a little bit about the federal architecture here. You mentioned some bills that you have been behind and sponsored and cosponsored, and I’m wondering if you could help us understand what limitations you may have perceived in the existing preventing maternal death act that caused you to think more broadly about additional federal interventions in these areas?

REP. PRESSLEY: Sure, well, I mean, the data the numbers are just sobering. They’re damning. You know, I should say, my paternal grandmother, I never had the blessing to know because she died in the 1950s, giving birth to my father’s youngest brother, sending my father and his five siblings into a downward spiral of great trauma and hardship. And the fact that my grandmother died in childbirth in the 1950s, and Black women are four times more likely to still die, really is just, you know, condemnation and confirmation of the embedded biases and systemic racism throughout our healthcare system. For too long, the pain of black women has been delegitimized. And so the US has the highest rate of maternal mortality in the developed world, despite spending more money on health care than any other country on earth. And the rate of maternal mortality in the United States has more than doubled since the 1980s. So again, Black women are nearly four times as likely to die. And within my district, which I represent, while the Commonwealth of Massachusetts has one of the lowest maternal mortality rates in the nation, we continue to see stark disparities in maternal outcomes and infant mortality across the state. The rate of infant mortality for black mothers is nearly double that of white mothers, predominately black neighborhoods like Dorchester and Mattapan, lead the district in low birth, preterm and low birth weight, preterm birth, and infant mortality. So you know, the confluence of all these things, and then against the backdrop of both this national reckoning on racial injustice and also, the pandemic, which has really laid bare these inequities and disparities, as we see with marginalized communities living under the comorbidities of structural racism, unequal access to health care, underlying conditions. So the maternal mortality crisis has the potential to only be exacerbated by this pandemic.

And so while we’re in the midst of this national reckoning on racial injustice, I think it’s critical that the first thing we do is acknowledge that there is racism in public health. And that is exactly why Senator Warren, Representative Barbara Lee, and I have introduced the Anti-Racism in Public Health Act of 2020. So what this would do, and I think this is a first step, and then I have you know other bills that support the work of that, but it’s to create a center for anti-racism at the CDC, to declare racism as the public health crisis that it is, to further develop the research base and knowledge of the science and practice of anti-racism. Because this is systemic, so we must be intentional and active in the dismantling of it. The center would be responsible for conducting research, collecting data, awarding grants, and providing leadership and coordination on the science and the practice of anti-racism in the provision of health care, the public health impacts of systemic racism, and the effectiveness of intervention to address these impacts. Now, two things I’ll lift up very quickly, that are interventions that have been proven to work is investing in our community health centers, we know that they are already proven in combating disparities, they do have those wraparound services, and they also operate with that cultural humility. The other is doula care. You know, these are non-medical persons professionally trained in childbirth, to support pregnant persons in childbirth, you know, in delivery. And there’s really growing evidence that the integration of professional doulas into the US maternity care system would result both in cost savings and increased cost-effectiveness. Professional doula care leads to fewer cesarean births, fewer adverse maternal outcomes, and that’s exactly why I’ve introduced the Healthy MOMMIES Act with Senator Booker, which would expand access to doula care.

COMMISSIONER ADEGBILE: Can I ask one quick follow up question. Under the MOMMIES Act is one of the issues that Medicaid coverage is limited? Is it limited to pregnancy services and doesn’t reach the postpartum pieces or what is your understanding of the gap that this act is trying to get to?

REP. PRESSLEY: Right. So what we’re trying to get to is that providing that full comprehensive of care throughout the entire postpartum period, rather than services that are only related to pregnancy. So what it does – the Healthy MOMMIES Act that I’ve introduced with Senator Booker – is that it requires the expansion of Medicaid’s pregnancy pathway coverage from 60 days to 365 days postpartum. So this is really common-sense policy that will save lives. This bill would also encourage state Medicaid programs to improve access to pre and postpartum doula care programs because again, the data tells us that all mothers have better health outcomes when they have doulas or midwives as a part of their care teams. And then, you know, again, against the backdrop of the pandemic, I want to also talk about the importance of access to telemedicine, which is also a tenant of our Healthy MOMMIES Act. Our bill explores ways that telemedicine can increase access to quality, socially distanced maternity care, and services.

COMMISSIONER ADEGBILE: Thank you, that point about postpartum seems very important. I mentioned in my opening remarks I alluded to Dr. Chaniece Wallace, who died two days after her pregnancy on October 22, in Indianapolis. And so I think that the risks clearly exist beyond the delivery time. And we know and you have alluded to the impact of that window. And so I thank you for it and for your leadership. Thank you, Madam Chair. And thank you. Congresswoman.

REP. PRESSLEY: Thank you, Commissioner, and thank you for bringing her into the room. It is so important that you know in the retelling of these very sobering statistics that we not lose sight of the fact that behind each of those statistics is a person, you know, who was loved and was a member of a family and a community. And so I thank you for bringing her into the room. Um, if you don’t mind, I would also just like to speak to a vulnerable population in the midst of the pandemic that I do not believe is getting enough oxygen, focus, or attention. And that is those that are pregnant and are incarcerated. We know that our county jails and our prisons are really petri dishes, for the virus to thrive because of mass incarceration, we have overcrowding. And so it’s virtually impossible to socially distance. And we have seen surges throughout the country. And it’s why I have been pushing for the decarceration of, of pregnant women because they are more vulnerable to contracting this. And I don’t believe that this should be, that being incarcerated should be a death sentence. And so while I continue to advocate for those that are medically vulnerable, to be released, I’m prioritizing in that those incarcerated women who are pregnant, I did also introduce legislation as a part of a broader Momnibus package with Representative Lauren Underwood, a Justice for Incarcerated Moms Act, which I’m happy to further unpack if there’s an interest in that as well.

CHAIR LHAMON: I’m certain there’s interest. And I’m also worried about time, so I just want to make sure that fellow Commissioners have an opportunity for questions. Commissioner Kirsanow, I couldn’t tell if you were raising your hand. No. Okay. Watching people’s screens, I’m going to ask my question, but I hope people will raise their hands if they have them as well. Representative Pressley, you compellingly describe the bills that you’ve introduced. And I and I know that you have a sort of one-two punch your focus on this and that in increasing access to health care for all people who will give birth and then also a focus on anti-racism in particular, as a way of addressing this issue. And I wonder if you could unpack a bit for us, how you know that we need to be focused specifically on systemic racism in health care delivery. For black women, in particular, in this area, we have received testimony on a variety of fronts about the causes of the disparities, and some of that testimony posits that racism is not the cause. And so I am interested in, in your view about why it is that you need to take both approaches in the legislative response.

REP. PRESSLEY: Well, the point is that racism is systemic, it is structural, and because it is structural, it shows up in all of our institutions. It shows up, it’s pervasive even in our policies, which, you know, what I consider to be policy violence, which has often been short-sighted or discriminatory, resulting in those comorbidities of structural racism and unequal access to health care. And so again, as we find ourselves in the midst of a pandemic, which has laid bare these inequities, disparities, racial injustices across all outcomes, including and especially health, you know, the way to reverse course, is to get to the root. And so the way to get to the root and to bring about systemic change is to first confront and acknowledge how embedded these biases are within our systems. Again, this is not about individuals this is about systems. And the data, you know, bears out that I know there have been some narratives, which lean very heavily on assumptions. But again, this has no ties to socioeconomic status, education level. And so the fact that whether you are low income or affluent, educated, non-educated, that if you are a Black woman, that you are still four times more likely to have your pain delegitimized when you express it, and to have those biases potentially result in not only complications but fatality.

CHAIR LHAMON: Thank you very much. And I now see that we are just past your time limit. So I so appreciate your giving us your time this morning. We’re grateful for you. And we’ll move on with the rest of the panel. Thank you very much.

REP. PRESSLEY: Thank you very much. Thank you all for your service. Take care.

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