September 17, 2020
Dear Leader McConnell and Leader Schumer:
As the nation continues to navigate through the COVID-19 pandemic, one of the greatest challenges has been accessing routine, preventive, and essential health care services, including maternity care. Vulnerable and historically marginalized populations are further disadvantaged, as the pandemic has exacerbated health disparities across the board. We encourage you to build on past bipartisan efforts to ensure that pregnant, childbearing, and postpartum people on Medicaid are supported, by extending pregnancy-related Medicaid to one year postpartum and improving access to respectful, accountable maternity care by expanding Medicaid coverage of midwives, community birth settings, community-based doulas, peer childbirth educators, and lactation support.
As you know, the United States faced a maternal health crisis prior to the pandemic, with the U.S. reporting the highest maternal mortality rate of any high-resource country. Approximately 700 women die each year as a result of pregnancy or childbirth complications, and the majority of these deaths are preventable. Additionally, Black, American Indian, and Alaska Native women are about three times more likely to die from pregnancy-related causes than white women. While data is still being gathered to determine the full impact of the pandemic on maternity care, the experiences that families are reporting of isolation, mom and baby separation, and fear are concerning. Given Medicaid’s role in supporting vulnerable families and paying for 43% of births in the U.S, expanding and enhancing the program is a critical piece to addressing these two colliding public health crises.
Therefore, we request a legislative solution in the fourth stimulus package that would ensure that women and birthing people have access to comprehensive Medicaid coverage for the entire first year postpartum. Legislative action must also be taken to ensure coverage of respectful maternity care models and to create policies that foster a culture of equity, dignity, respect, and empowerment in health care systems. In all of these solutions, people most harmed by systems of care must have their voices and their experiences centered.
Data demonstrates that the extension of postpartum Medicaid coverage would save lives, improve health outcomes, and reduce health care costs over time. In some states, more than 50% of pregnancy-related deaths occurred after 60 days postpartum. These deaths are the canaries in a coal mine – countless women suffer trauma, severe mental health, and morbidity during this vulnerable phase of life from 42 days to 1 year postpartum. Further, it is estimated that the second six months of Medicaid coverage costs about 30 percent less than the first six months of coverage in a year.
The provision of anti-racist, culturally congruent, and respectful maternity care is essential to addressing the nation’s shocking maternal health inequities. One in six women reported experiencing mistreatment and disrespectful care while giving in the United States. Through training, accountability measures, and legal guarantees, maternity care providers and health care systems can begin to be accountable to the people and communities they serve, center patients as experts in their care, and honor patients’ rights to make decisions about their own bodies.
Expanding access to midwives, community birth workers, community-based doulas, peer childbirth educators, and lactation support through Medicaid coverage is also critical to ensuring that every pregnant person is able to give birth safely and with dignity. As stated in a recent National Academies of Medicine report, midwives and community birth are evidence-based alternatives to in-hospital birth that provide birthing people with respectful maternity care. Community-based perinatal support services, like doula care, lactation support, and peer childbirth education, provide emotional, informational, systems navigation and support that improve outcomes, center the voices of childbearing people, and link clients with a variety of support services to take a holistic approach to maternal health. Further, a recent study showed the importance of matching patients with physicians of the same race, adding to a growing body of work that shows over and over the importance of racial concordance – and when not available for families, the importance of having support from doulas and community birth workers that is concordant.
Expanding and adequately funding Medicaid is one of the most important ways that we can support pregnant and birthing people and improve postpartum health. Comprehensive Medicaid coverage, for the full postpartum year and for respectful, accountable maternity care, is essential to ensuring that everyone is able to give safely and with dignity. This is especially true for BIPOC, who are disproportionately affected by poor access to maternal health care and by the consequences of the COVID-19 pandemic.
Thank you for your support of policies to improve maternal health and health care. Expanding Medicaid coverage for postpartum care is critical to improving health outcomes for mothers and birthing people and ensuring that respectful, accountability maternity care is accessible to all.
March for Moms
Every Mother Counts
National Birth Equity Collaborative