by Dozens of maternal health organizations and advocates are urging California’s surgeon general to suspend the rollout of a plan aimed at reducing maternal deaths. They say the recently announced initiative will not effectively address the crisis and “risks exacerbating existing inequalities.”
In a letter to The Times, representatives from organizations including the California Black Women’s Health Project, Black Women for Wellness and the California Nurse-Midwives Assn. criticized the plan for “unnecessarily burdening individuals” and failing to “explicitly identify and address racism as a root cause of maternal health disparities.”
The California Maternal Health Blueprint, unveiled in September, lays out strategies to try to reduce maternal mortality. Among them: Prompting Californians of childbearing age to fill out a new questionnaire to assess their risk of pregnancy complications, even before they become pregnant.
In their October 21 letter to State Surgeon General Dr. Diana Ramos, the advocacy groups said the Maternal Health Blueprint recognized racial disparities in maternal mortality rates but “did not base these disparities on the evidence showing that systemic racism was the driving factor.” .”
Asked for comment on the letter, the state surgeon general’s office issued a statement saying it was “committed to working with partners across the state… to improve maternal health outcomes, reduce maternal mortality and save the lives of California mothers and pregnant women. people.”
State data shows that black women in California have a maternal mortality rate that is more than three times that of white women. The Centers for Disease Control and Prevention has highlighted many factors, including health care disparities and underlying chronic conditions, as well as structural racism and implicit bias.
Studies have shown that inequality exists even for Black women who are affluent, prompting maternal health researchers to increasingly focus on racial disparities in health care, bias and discrimination experienced by patients, and the physical consequences of chronic stress due to persistent racism over time.
In an interview in September, Ramos said California’s previous efforts to prevent maternal deaths had focused on “health care,” allowing it to achieve “the lowest maternal mortality rate in the country.”
As it stands, California has a much lower number of deaths from pregnancy, childbirth, and their aftermath than other parts of the U.S., although maternal mortality has soared in recent years due to the COVID-19 pandemic. The state is presented as a model for its system of assessing maternal mortality.
“If we keep doing the same thing — just focusing on the care team — we will get the same results,” Ramos said in September, explaining why the recently announced plan emphasized making sure patients knew their risk level. “That’s why we involve the patient.”
The Maternal Health Blueprint sets a goal of having at least 50% of “individuals of reproductive age” across the state complete a questionnaire about their risk of pregnancy complications by December 2026.
In the letter objecting to the plan, the coalition of groups said that calling on people to complete such a questionnaire “gives the impression of personal guilt and/or that individual behavior is to blame, thus making the user burdened and the role of the system in creating problems is discredited. this crisis.”
The groups said they knew of no research supporting ‘personal risk assessment’ as a way to improve outcomes for people giving birth. The blueprint also does not clearly describe next steps or what will happen to the data, their letter argued.
Dana Sherrod, co-founder and executive director of the California Coalition for Black Birth Justice, said that “omitting mention of systemic racism puts the blame back on patients.” The only time the phrase “systemic racism” appears in the blueprint is in reference to the findings of another state report.
Sherrod said that even when other factors are taken into account, “black women still have worse outcomes.” For example, an analysis of maternal mortality in California found that black mothers with the highest incomes had worse pregnancy-related mortality than white mothers with the lowest incomes.
A much earlier study found that black women were not significantly more likely to suffer from preeclampsia, postpartum hemorrhage and other serious complications than white women. Yet black women with such complications were two to three times more likely to die from them than white women with these complications. such circumstances.
Even if “they are a healthy weight, educated, married – the things that should be protective – even if they do all these things, we still see poor outcomes,” Sherrod said.
The California plan also calls for medical facilities to use an existing screening tool to measure the risk levels of pregnant patients. Ramos told The Times that such screening could help determine where patients go for delivery, and ensure those at higher risk go to the facilities best equipped to support them.
However, the coalition warned that this could “further marginalize high-risk populations and divert resources away from struggling facilities, while at the same time overburdening higher-level facilities.” California is already facing “critical maternity care shortages” as labor and delivery units have closed, they pointed out.
“It’s already very difficult for many people to navigate the health care system and understand where to go to get the best care,” Sherrod said, “and this potentially makes that even more complicated.”
Coalition leaders are seeking a meeting with Ramos and first partner Jennifer Siebel Newsom, wife of Gov. Gavin Newsom, who announced the plan with Ramos in September.
Ramos’ office said in its statement Monday that since their initiative was launched, “Dr. Diana Ramos has met with several partners in maternal health and will continue to meet with others, including coalition members, to identify opportunities to collaborate.”
