The National Association of County and City Health Officials (NACCHO) appreciates the opportunity to partner with the What to Expect Project on the #BumpDay campaign to raise awareness about the unacceptably high levels of preventable deaths among Black birthing people.

According to the Centers for Disease Control and Prevention’s National Vital Statistics System, the 2018 maternal mortality rate was 17.4 maternal deaths per 100,000 live births, placing the United States significantly behind other developed countries. A wide racial and ethnic gap exists between Black women (37.1 deaths per 100,000 live births), white women (14.7) and Hispanic women (11.8).^[1] Further data illustrates that Black women are three to four times more likely to die from pregnancy or childbirth-related causes than white women.^[2] This disparity persists across income and education levels and can be attributed to a number of intersecting factors, including historic racial discrimination in housing, healthcare and other systems that have placed Black birthing people in neighborhoods with poor built environments and little to no access to quality prenatal and postpartum care.[3]^,[4] These factors, among others, create the intersection of chronic stress, sexism, and racism that places Black women at greater risk for adverse birth outcomes.^[5] This disparity is especially heightened as a result of COVID-19 protocols that have limited in-person prenatal and postpartum care, which is critical to identifying conditions such as pre-eclampsia and establishing trust between provider and patient.

According to NACCHO’s 2016 National Profile of Local Health Departments, the majority of local health departments (LHDs) provide services to support the health of mothers and children, including Women, Infants, and Children (WIC) services (66%), home visits (60%), and family planning (53%). Few LHDs provide other direct clinical services to mothers and children, such as obstetrical care (8%), prenatal care (27%), and well child clinics (29%).[6] Due to LHDs frequent interaction with preconception, prenatal, and postpartum patients, as well as strong relationships with community partners, they are well situated to address inequities in Black birthing outcomes through the following strategies:

WIC Service Provision, Home Visits, and Family Planning

• Utilize appointments to assess and document the experiences of Black people in their prenatal and postpartum journey, identify gaps, and foster areas of improvement
• Link community members to needed maternal health services and assure the provision of adequate, culturally responsive healthcare when otherwise unavailable
• Provide community members with educational material and resources on healthy birthing specific to Black people to increase self-advocacy and overall knowledge

LHD Stakeholder Partnerships

• Expand maternal mortality review board to monitor, track and investigate instances of severe maternal morbidity to account for near instances of death and to develop recommendations to prevent future deaths
• Collaborate to create and disseminate materials on Black maternal health (e.g., birthing while Black infographics)
• Work to provide more birthing resources for Black moms (e.g., access to birthing classes)
• Facilitate culturally responsive training, training in racial bias, and training in providing quality care to Black people, Indigenous people, and people of color

LHDs with Clinical Services Provision

• Identify a birthing advocate who liaises between LHDs and medical providers to support the needs of the birthing person and the provider and to ensure that patient needs are met
• Require culturally responsive training for healthcare professionals
• Identify diverse OBGYNs, doulas, and nonclinical professionals to serve as additional resources for Black moms

It is equally imperative for LHDs to keep informed and respond to federal, state, and local policy efforts that impact Black maternal health outcomes, such as the Mothers and Offspring Mortality & Morbidity Awareness (MOMMA) Act (H.R. 1897 and S. 916.), which would expand pregnancy-related Medicaid coverage to cover the full postpartum period, and the Black Maternal Health Momnibus Act of 2020 (H.R. 6142). We encourage LHDs to collaborate with their state health departments to advocate for policies that expand access to equitable health coverage in their jurisdictions.

The role of LHDs is pivotal in advancing public health and ensuring that all people are safe, healthy and whole, including Black birthing people. In addition to the aforementioned opportunities to improve Black birthing outcomes, LHD’s support of national campaigns such as #BumpDay, which brings awareness and support to birthing journeys, is the first step in reducing Black maternal mortality in the U.S.

References

[1] Hoyert, D., & Miniño, Arialdi, Division of Vital Statistics. (2020). Maternal mortality in the united states: Changes in coding, publication, and data release, 2018 National Vital Statistics Reports, 69(2). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69_02-508.pdf

[2] Creanga, A.A., Syverson, C., Seek, K., & Callaghan, W.M. (2017). Pregnancy-Related Mortality in the United States, 2011-2013. Obstetrics & Gynecology, 130(2), 366-373. Retrieved 14 April 2020

[3] Boteach, M., Vallas, R. & Schultz, E. (2016) A Progressive Agenda to Cut Poverty and Expand Opportunity. Washington: Center for American Progress. Retrieved at https://cdn.americanprogress.org/wp-content/uploads/2016/06/03081022/RoadmapOpportunity-report.pdf

[4] Peiyin Hung et al. (2017) Access to Obstetric Services in Rural Counties Still Declining, with 9 Percent Losing Services, 2004-2014,” Health Affairs 36 (9): 1663-1671.

[5] Novoa, C. & Taylor, J.(2018) Exploring African Americans’ High Maternal and Infant Death Rates. Washington: Center for American Progress. Retrieved at https://www.americanprogress.org/issues/early-childhood/reports/2018/02/01/445576/exploring-african-americans-high-maternal-infant-death-rates/.

[6] National Association of County and City Health Officials. (2017). 2016 National profile of local health departments. Retrieved from http://nacchoprofilestudy.org/wpcontent/uploads/2017/10/ProfileReport_Aug2017_final.pdf