A Systematic Policy Review of Black Maternal Health-Related Policies Proposed Federally and in Massachusetts: 2010–2020

Abstract

Background: Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due to programs and policies available to pregnant people. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable (3).Methods: Using Massachusetts as a state-level comparison to national policies, we searched the US Congress and Massachusetts legislative databases for maternal health policies from 2010 to 2020. We screened 1,421 national and 360 Massachusetts bills, following set inclusion/exclusion criteria. Data analysis included (1) assessment of bill characteristics, (2) thematic analysis, and a (3) quality appraisal following an adapted model of the analytical framework for evaluating public health policy proposed by the National Collaborating Centre for Healthy Public Policy. Additionally, our data analysis identified the level of racism (internalized, interpersonal or institutional) that each policy addressed.Results: From 2010 to 2020, 31 national and 16 state-level policies were proposed that address maternal health and racial disparities. The majority of policies addressed racism at the institutional level alone (National: N = 19, 61.3%, Massachusetts: N = 14, 87.5%). Two national and two Massachusetts-level policies became law, while two national policies passed only the House of Representatives. Our critical appraisal revealed that the majority of unintended effects would be neutral or positive, however, some potential negative unintended effects were identified. The appraisal also identified 54.8% (n = 17) of national policies and 68.8% (n = 11) of Massachusetts with positive impact on health equity.Conclusions: There has been an increase in policies proposed addressing racial disparities and health equity in maternal health over the last 10 years. Although half of national policies proposed showed positive impact on health equity, shedding light on the work the U.S. is doing on a federal level to confront the Black maternal health crisis, only two policies made it to law, only one of which addressed racial disparities directly and had a positive impact on health equity.

Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity

“…48 Further, there is legislative momentum toward building awareness and competence among health care professionals to combat racism and discrimination in obstetric care. 49 Our results raise the hypothesis that hospital learning collaboratives focused on optimizing organizational practices and policies, increasing clinician and © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc.…”

“…48 Further, there is legislative momentum toward building awareness and competence among health care professionals to combat racism and discrimination in obstetric care. 49…”

Structural interventions that affect racial inequities and their impact on population health outcomes: a systematic review

“…Policies that address systemic barriers encountered by different racialized groups may be more effective than those applied to broader populations, as suggested by Assari, 2018, who proposes that the intersection of race, socioeconomic status and gender shape exposures to risk and protective factors [ 78 ]. For example, findings of a policy analysis by Carvalho et al, 2021, support a targeted approach, reporting positive impacts on health equity by policies directly addressing Black maternal health [ 79 ]. The studies included in this review that targeted specific populations were also more likely to show positive effects on inequities, for example DACA for Hispanic populations in the USA [ 55 , 60 ] and the Indigenous Land and Sea Management Programs in Australia [ 66 ].…”

Innovations and Opportunities in Care for Black Mothers and Birthing People

“…While individual states are making strides toward action, federal-level policy will be imperative to impact change nationally. To that end, the most common theme of recent proposed bills was expanding federal funding for maternal health research 66. This expansion of rigorous research will allow for identification of systemic issues in local communities and subsequently inform more targeted implicit bias interventions.…”

“…To that end, the most common theme of recent proposed bills was expanding federal funding for maternal health research. 66 This expansion of rigorous research will allow for identification of systemic issues in local communities and subsequently inform more targeted implicit bias interventions. At the time of writing, the Black Maternal Momnibus Act of 2021 has been introduced by members of the Black Maternal Health Caucus and has presently been passed by the House.…”