►
Description
Docket #0396 - Hearing on black maternal health, racial and gender equity in the healthcare system in the City of Boston
A
My
name
is
Matt
O'malley
I'm,
the
district
6
city
councilor,
as
well
as
the
chair,
the
Boston
City
Council's
Committee
on
healthy
women,
families
and
communities.
We
are
here
today
to
discuss
docket
number
zero,
three,
nine
six
in
order
for
a
hearing
on
black
maternal
health,
racial
and
gender
equity
in
the
healthcare
system
in
the
city
of
Boston.
A
This
hearing
order
was
written
by
myself
as
well
as
city
councilor,
Kim,
Janey
and
I
want
to
thank
councilor
Jamie
for
her
unwavering
leadership
and
partnership
on
this
hearing,
as
well
as
all
the
incredible
work
she
has
done
and
will
continue
to
do
on
ending
the
racial
and
gender
equity
gap
in
the
City
of
Boston.
The
hearing
today
will
use
an
intersectional
lens
to
discuss
health
care
issues
specifically
impacting
black
women.
The
epidemic
of
maternal
mortality
and
morbidity
for
black
mothers
has
become
an
issue
that
is
persuade
her.
A
That
is
pervasive
throughout
the
country
for
black
women
who
are
affected
by
structural
inequality,
the
chronic
stress
of
poverty
and
racism
has
been
shown
to
have
a
deleterious
effect
on
health
outcomes
and
is
linked
to
persistent
maternal
health
disparities.
The
lack
of
trust
and
sense
of
fear
is
validated
considering
the
data
the
United
States
has
the
highest
rate
of
deaths
from
any
cause
related
to
or
aggravated
by
pregnancy,
compared
to
any
other
developed
country
for
black
women.
A
Massachusetts,
like
with
many
policy
issues
such
as
gun
reform
and
education,
does
lead
naturally
in
maternal
health.
Yet
there
are
the
same
type
of
disparities
in
our
state
and
in
our
city,
especially
when
it
comes
to
access
to
services.
The
Massachusetts
state
health
assessment
states
that
black
mothers
continue
to
have
the
least
access
to
prenatal
care.
The
number
of
black
mothers
suffering
from
the
symptoms
of
postpartum
depression
is
three
times
higher
than
for
white
mothers.
In
Massachusetts
we
have
some
great
anchor
institutions.
We
have
a
plethora
of
schools
and
universities.
A
We
have
other
educational
resources
and
research
resources
to
address
this
problem.
I'm
really
looking
forward
to
this
hearing
from
our
panelists
of
experts
to
introduce
the
conversation,
share,
best
practices
and
discuss
our
next
steps.
This
obviously
is
an
incredibly
important
issue,
an
incredibly
timely
issue
and
I'm
once
again
delighted
to
have
partnered
with
councilor
Kim
Janney
on
this,
so
that
we
can
truly
address
some
of
the
structural
in
indices
that
which
have
caused
this
and
solved
this
very
real
problem.
We're
also
joined
by
councillor
Eadie
Flynn
and
after
we
have
our
the
council's
opening
statements.
A
B
You
so
much
mr.
chair
I
am
very
grateful
for
the
opportunity
to
partner
with
you
on
this
very
important
issue.
I
appreciate
your
leadership:
Thank
You,
councillor,
Flynn
and
asabi
George
for
being
here
as
well
as
well
as
representative
Liz,
Miranda.
You've
heard
the
stats
very
staggering
stats
here,
I'm
thinking
back
to
when
you
and
I
introduced
this
hearing
order,
it
was
at
the
end
of
February
and
the
City
Council
was
celebrating
Black
History
Month,
and
for
this
particular
year
we
were
celebrating
black
women
and
black
girl,
magic
and
I.
B
Remember
thinking
at
that
time
that
so
many
of
us,
as
black
women,
have
to
kind
of
power
through
whatever
we're
going
through
it.
We
have
to
keep
going
if
we're
feeling
pain
if
we're
feeling
tired,
because
everything
rests
on
our
shoulders.
So
many
of
us
are
heads
of
our
own
households
and
even
myself
personally
I've
said
several
times:
I
don't
have
time
to
be
sick.
B
I,
don't
have
time
to
be
sick
and
I
will
just
keep
going
and
keep
going
and
I
bring
that
story
up,
because
we
refer
to
ourselves
as
being
magic
and
we
are
magic
and
it's
wonderful,
but
we
often
kind
of
take
on
the
attributes
of
being
superhuman.
And
it's
important
that
we
recognize
that
we
have
to
take
care
of
ourselves
and
make
sure
that
we
are
getting
the
care
that
we
need
and
that
we
are
speaking
up
equally
important.
B
B
C
Thank
You
counsel,
O'malley
and
Thank
You
councillor
Janey
fee
our
important
work
on
this
on
this
issue.
Both
of
you
have
been
real
leaders
on
the
City
Council
on
issues
that
are
impacting
the
most
vulnerable.
You
know
in
our
society.
I
also
had
the
opportunity
to
read
the
statement
from
a
previous
statement
from
congresswoman
Presley
and
representative
Liz
Miranda
and
I
would
like
to
acknowledge
their
excellent
work
as
well
on
public
health
and
in
maternal
health
related
issues
in
the
african-american
community.
C
I'm
also
interested
to
learn
about
these
strategies
in
changes
that
we
can
use
in
addressing
these
disparities
in
black
maternal
health,
whether
it's
addressing
structural
factors
like
racial
bias,
in
framing
policies
through
the
lens
of
racial
justice,
as
counsel
Janey
mentioned
or
addressing
the
service
side
of
this
issue's,
like
engaging
engaging
the
community
I
mean
get
to
learn
about
this
important
issue.
Prenatal
care,
postpartum
depression,
how
it
ties
into
the
larger
issue
of
public
health.
C
D
You,
chair
and
I
appreciate
the
sponsors,
the
lead
sponsors
in
their
effort
and
on
this
behalf,
I
just
want
to
reiterate
and
applaud
and
lift
up
this
effort
to
make
sure
that
all
of
our
residents,
especially
women
of
color,
are
getting
access
to
not
just
appropriate
physical
health
care.
But
mental
health
care.
D
Through
this
hearing
order
and
I
want
to
make
sure
that
we
also
appreciate
the
when
there
is
a
mental
health
crisis,
the
toxicity
it
creates
within
for
that
woman
for
that
mother,
but
also
for
the
family
and
the
impact
it
has
on
infant
mental
health
issues,
which
we
know
are
a
real
thing
as
I
just
want
to
lift
that
up.
I
want
to
applaud
this
effort
and
look
forward
to
hearing
the
presentations
from
the
panelists
today.
Thank.
A
You
councilor
ciebie
George,
appreciate
your
comments
and
your
great
work
as
well.
Some
brief
housekeeping
first,
her
name
was
mentioned
and
I
would
like
to
echo
and
thank
our
predecessor
and
our
congresswoman
Ayanna
Presley,
who
actually
founded
the
Committee
on
healthy
and
families
and
communities
upon
her
election
to
the
council
back
in
2010
or
joining
the
council
in
2010.
A
I
was
proud
to
have
been
her
vice
chair
for
the
last
number
of
years
and
I've
since
succeeded
as
chairman
when
she
left
us
for
Washington
DC,
but
this
has
been
an
issue
that
she's
been
working
on
and
focused
on
at
the
local
level
and
luckily
for
us
has
been
taking
that
same
fight
and
focus
at
the
federal
level
as
well.
This
is
a
public
hearing
and
it
is
being
recorded
and
broadcast
on
cable
television,
as
well
as
being
live
streamed
on
the
city's
website.
A
We
ask
all
folks
to
please
silence
your
cell
phones
and
other
devices.
If
you'd
like
to
have
some
conversations,
the
acoustics
aren't
great
so
we'd
ask
you
just
to
please
step
outside.
If
anyone
would
like
to
testify
that
hasn't
either
submitted
testimony
or
will
be
on
our
subsequent
panel.
There
is
a
sign-up
sheet
to
my
left
at
the
back
close
to
the
entrance.
Please
sign
up.
A
Obviously
she
cares
very
deeply
about
this
issue
and
wants
to
thank
our
sponsors,
bring
the
issue
forward
and
ascend
to
staff
to
review
the
committee's
report,
while
working
on
any
recommended
next
steps.
So,
having
said
that,
I'd
like
to
invite
representative
Liz
Miranda
from
the
fifth
Suffolk
District
to
please
join
us
in
offer
some
testimony
and
I'm
sure
she
will
reference.
A
E
E
Great
before
I
read
my
remarks
with
three
quick
stories
of
how
I
got
to
this
work.
I
was
elected
in
November
of
2018,
so
I've
been
serving
for
10
months
as
the
state
representative
of
the
Fed
Suffolk.
It
is
my
home.
It's
where
I've
lived,
my
entire
life
and
when
I
got
elected
I
knew
that
I
wanted
to
work
on
issues
that
would
deeply
impact
in
my
community,
and
so
I
came
to
this
work,
really
thinking
about
gun,
violence,
immigration
rights
and
other
issues
of
concern
and
the
criminal
justice
system.
E
My
first
week
on
the
job
I
got
a
presentation
from
March
of
Dimes,
which
essentially
told
me
that
there
was
a
crisis
and
it
was
particularly
impacting
my
community
and
we
looked
at
a
bunch
of
zip
codes
and
it
brought
down
my
heart
when
I
looked
at.
Most
of
the
zip
codes
were,
in
my
community
and
I
said
as
one
of
only
three
black
women
in
the
entire
legislature
of
two
hundred
members.
That
I
cannot
not
stand
for
us
right,
so
this
is
the
issue
that
I
championed.
E
Secondly,
through
this
work
you
know
often
we
are.
We
respond
to
our
traumas
in
our
lives
and
understanding
that
part
of
this
work,
as
I
watched,
my
sister
give
birth
to
a
21
week,
baby
that
did
not
survive
and
had
my
best
friend
hire
a
doula
and
her
last
trimester
because
of
complications
and
stress,
and
so
I
have
been
around
this
issue
both
personally
and
professionally,
and
it
draws
me
here
today
to
testify
dear
honourable
colleagues
on
the
committee
of
healthy
women,
families
and
communities.
E
My
name
is
Liz
Miranda
state
representative
for
the
fifth
Suffolk
again,
one
of
only
three
black
women
out
of
200
seats
and
I
think
that's
an
important
thing
to
note,
because
we're
we're
not
represented,
sometimes
we're
not
often
discussed
or
paid
attention
to.
It
is
critically
important
that
I
am
an
advocate
for
maternal
health
and
justice,
an
issue
that
has
been
negatively
impacting
this
country,
this
state
and
women
in
my
community.
E
My
district
contains
the
third
most
diverse
ZIP
codes
in
the
country
and
it's
the
most
minority
district
in
the
entire
Commonwealth
when
94
percent
people
of
color.
Although
it's
rich
in
diversity,
it
is
also
one
of
the
poorest
one
of
the
most
under-resourced
and
under
serves
communities
with
the
median
annual
income
of
about
$24,000
and
the
life
expectancy
of
my
dear
Roxbury
is
30
years
shorter
in
comparison
to
that
of
Beacon
Street
in
the
Back
Bay.
E
Just
a
few
stops
away
on
the
number
one
bus,
and
that
has
been
unacceptable,
as
my
district
is
pulling
itself
out
of
the
ashes
of
decades
of
poverty,
housing,
segregation,
food
insecurity,
environmental
justice,
injustice
and
lack
of
access
to
quality
health
care
facilities.
It
also
has
been
confronted
by
yet
another
public
health
crisis,
the
maternal
and
infant
mortality
for
black
and
brown
and
low-income
mothers.
All
of
these
systemic
issues
that
have
imposed
significant
burdens
and
trauma
and
pregnant
women
throughout
their
birthing
journey
has
led
me
to
understand
the
issue
more
deeply.
E
Our
zip
codes
are
literally
killing
us,
causing
us
to
have
more
unnecessary,
c-sections
having
later
term
births
underweight
children
and
have
led
to
high
rates
of
infant
mortality.
Research
on
maternal
health
has
focused
on
bandaging
the
effects
and
focusing
on
individual
women's
actions,
rather
than
addressing
the
largest
systemic
problem,
which
is
racism
which
has
led
this
research
and
will
continue
to
do
so.
If
institutions
like
government,
which
we
both
serve
in
our
not
held
accountable.
E
Black
women,
as
stated
earlier,
are
dying
at
an
alarming
rate
of
four
times
the
rate
of
white
women
during
their
birthing
journeys
and
in
some
cities
across
the
country.
It
is
high
as
eight
times
as
filmer,
a
former
Bureau
director,
dr.
Deborah
Allen,
stated
in
a
report.
Medical
conditions
alone
cannot
explain
these
inequities.
It's
partly
a
matter
of
poverty.
E
When
women
are
poor,
they
can't
buy
good
food,
live
in
warm
and
welcoming
homes,
get
enough
of
the
right
kinds
of
exercise
and
feel
safe
when
they
are
out
and
about
and
all
of
these
factors
impact
the
women
and
during
pregnancy
and
their
babies.
She
wrote
this
calls
for
access
to
high
quality
health
care
and
special
programs
to
support
women
at
risk
in
Boston,
and
specifically
many
of
the
zip
codes
in
my
district.
E
According
to
the
2016
20
2017
healthy
Boston
report
by
the
Boston
Public
Health
Commission
racial
groups
in
Boston,
experienced
inequities
in
a
number
of
outcomes
in
2015
Asian,
black
and
Latino
females
gave
birth
to
higher
percentages
of
lower
weight,
babies
at
10%,
12%
and
9%
respectively.
Then,
white
females,
which
were
at
6%
low
birth
weight
babies,
percentages
in
Boston,
were
8.6
percent
were
higher
than
the
state
average
of
7.5%.
E
Furthermore,
black
and
Latino
females
had
higher
percentages
of
preterm
births
at
11
percent
and
12
percent
and
10
percent
respectively,
compared
that
with
white
females
at
8
percent,
again
prematurity
percentages
in
Boston,
where
nine
point
five
percent
were
higher
than
the
state
average
in
percentage
of
8.4
percent.
Finally,
the
infant
mortality
rates
for
black
infants,
8.1
and
Latino
infants.
Nine
point
eight
were
higher
than
that
of
white
infants.
E
For
those
reasons,
it's
why
it's
been
important
and
critical
and
necessary
that,
as
the
woman,
that
I
am
in
the
House
of
Representatives,
I
have
filed
a
trio
of
three
bills:
one
on
racial
disparities
in
maternal
care,
one
on
doula
legislation
through
Medicaid
and
another
on
an
infant
mortality.
Review
for
the
city
of
Boston
I
also
have
now
become
a
new
commissioner
on
the
Ellen
story,
Commission
for
postpartum
depression,
because
we
understand
those
of
us
in
this
work
that
this
is
a
continuum
of
care
issue.
E
So
it
goes
for
pregnancy
all
the
way
to
postpartum
time
according
to
listening
to
mothers,
a
survey
of
nationally
representative
sample
of
us
women,
39
percent
of
black
non-hispanic
mothers,
30
percent
of
Hispanic
mothers
and
22
percent
of
white
non-hispanic
mothers
did
not
Dula
but
had
a
clear
understanding
of
doula
care
and
would
have
liked
to
have
had
that
care.
This
difference
across
races
is
significant.
Furthermore,
when
looking
at
payer
source
36%
of
mothers
on
Medicaid
or
CI
CH
IP
had
never
heard
of
a
doula
compared
to
that
of
19%
of
mothers
on
private
insurance.
E
This
difference
across
payor
is
also
significant.
Both
of
these
findings
show
that
there
are
clear
disparities
in
access
to
knowledge
of
doula
by
race
and
ethnicity,
but
also
by
who
their
insurance
provider
is
access
to
doula
care
is
such
a
program
and
a
beginning
of
filling
in
the
gaps
of
needed
policy
for
access
and
better
outcomes
in
maternal
and
child
health
in
our
Commonwealth
doulas
address
the
social
determinants
of
health.
They
also
provide
social
supports
of
women
and
help
improve
communication
between
low-income
and
reishi
racially
diverse
pregnant
women
and
their
health
care
providers.
E
Women
of
color
are,
at
the
most
risk
of
poor
outcomes,
yet
have
the
least
access
to
doula
care,
and
this
must
change.
My
trio
bills
will
help
to
save
the
lives
of
moms
and
babies,
who
look
like
me
will
improve
access
to
affordable
care
and
improve
the
birthing
journeys
of
many
families.
This
alone,
however,
is
not
enough
to
tackle
the
maternal
Justice
crisis
in
Massachusetts,
as
government
branches
need
to
work
collaboratively,
and
that's
why
I'm
here
today?
E
That's
why
I
also
support
congresswoman
Ayanna
Presley's
mommies
act
at
the
federal
level,
which
expands
Medicaid
coverage
to
include
more
maternal
health
services.
I,
don't
want
to
die,
I
want
any
of
the
women
in
our
state
city
or
my
neighborhood
to
die
while
giving
birth
or
to
die,
because
we,
as
public
officials
and
leaders
of
this
city
and
great
Commonwealth,
didn't
listen
and
didn't
do
something.
Did
he
make
access
to
care,
affordable
and
didn't
change,
how
we're
providing
care
to
our
most
vulnerable
citizens?
E
E
We
have
the
chance
to
be
the
state
in
the
nation
with
the
most
comprehensive
maternal
justice
legislation
from
city
to
federal
level
and
supporting
other
important
legislation
on
racial
disparities
and
postpartum
recovery
to
close
I
am
also
proud
that
we,
as
a
Commonwealth,
have
committed
five
hundred
thousand
dollars
to
the
health
policy
center
in
this
year's
budget.
To
study
this
crisis,
however,
we
can
and
should
do
more.
That
is
why
I'm
here
today
to
say
to
my
city.
E
A
Thank
You
representative
appreciate
your
terrific
work,
advocacy
and
being
with
us
this
afternoon.
Any
questions
for
my
colleagues
for
representative
Miranda.
Thank
you.
Thank
you.
Thank
you
very
good.
Thank
you.
I'd
like
to
ask
our
panelists
tonight.
Please
join
us
at
the
dais
Monica
Valdes
Lupi
executive
director
of
the
Boston
Public
Health
Commission,
dr.
Jeanette,
Callahan,
Clinical,
Instructor
and
pediatrics
okay,
dr.
Robin
Reid
assistant,
professor
of
Tufts,
University
School
of
Medicine
and
co-founder
and
president
of
the
collaborative
and
is
dr.
Audra
meadows
with
us
as
well
from
Brigham
and
Women's
Hospital.
Okay!
A
B
A
So
we
believe
dr.
Kalyan
may
be
joining
us
so
and
if
she
does
indeed
join
us,
she
will
join
the
panel.
Similarly
with
dr.
meddars,
who
is
dr.
Meadows,
who
is
enroute,
there's
also
some
testimony.
That's
been
submitted
from
the
Baystate
birth
coalition,
Emily
enesta
jones,
rory,
judy
nurse
again
and
eugene
de
Klerk,
doctor
de
Klerk,
who
which
we
will
make
sure
every
member
of
the
committee
receives
as
well
as
testimony
submitted
about
by
dr.
reed,
who
we
will
hear
from
presently
and
dr.
A
Nadia
maca
a
moot.
A
Onew
Gaga
from
Tufts
University
has
submitted
some
testimony
as
well,
which
we
will
share
with
all
members
of
the
committee
Monica.
Thank
you
for
joining
us
again,
executive
director,
Valdes
Lupi.
You
are
with
us
for
a
terrific
and
informative
and
not
dissimilar
hearing
earliest,
but
we
look
forward
to
you
opening
it
up
before
you
get
to
dr.
Reid
for
an
opening
statement.
So
welcome
great.
F
You
for
inviting
us
to
be
part
of
this
important
discussion
and
to
join
this
panel.
I
want
to
also
thank
councilor
Janie
for
co-sponsoring
this
hearing
and
also
councillors
Flynn
and
a
sabe
Jorge
for
your
leadership
on
a
lot
of
the
racial
justice,
health
equity
issues
across
the
different
work
that
we
do
under
Mayor
Walsh
and
his
administration.
Again.
My
name
is
Monica
Valdes,
Lupi
and
I'm.
F
The
executive
director
of
the
Boston
Public
Health
Commission
at
the
Commission,
were
committed
to
promoting
maternal
health
and
creating
equal
opportunities
for
families
to
have
healthy,
happy
babies,
and
this
is
part
of
our
larger
mission,
which
is
to
protect
and
promote
the
health
of
all
Boston
residents,
especially
those
who
are
most
vulnerable.
We
work
to
improve
maternal
and
infant
health
through
several
of
our
programs
that
strengthen
the
natural
assets
of
mothers,
their
families
and
their
communities.
F
We
measure
maternal
health
by
looking
at
several
different
data
points
and
thank
you,
representative
Miranda.
Thank
you
for
the
water
counselor
for
referencing
our
health
of
Boston
report.
We
have
an
entire
chapter
dedicated
to
maternal
child
health,
and
there
are
a
couple
of
different
data
indicators
that
I
just
wanted
to
highlight
for
the
councillors
that
we
look
at
when
we're
analyzing
and
considering
maternal
health.
F
The
first
is
around
infant
mortality
and
infant
mortality,
the
infant
mortality
rate
in
particular,
because
we
know
that
this
is
a
key
marker
for
paternal
and
child
health
that
has
been
used
to
gauge
social
and
economic
progress,
both
here
in
the
US
and
abroad
and
as
well
as
well
to
gauge
the
effectiveness
of
the
health
care
system.
The
second
data
point
that
we
look
at
is
around
maternal
mortality
rates,
which
are
also
known
as
pregnancy,
related
mortality
rates.
F
Nationally.
The
infant
mortality
rate
in
2017
was
5.8
per
1000,
while
Massachusetts
it
was
3.7
the
state.
The
Commonwealth
is
a
leader
in
in
addressing
infant
mortality
rates
in
Boston.
It
was
four
point:
five
significant
inequities,
though,
when
we
talked
about
it
this
morning
exist
in
infant
mortality
rate
across
racial
and
ethnic
groups,
both
nationally
across
the
state
and
in
the
city
in
the
city
in
2017.
So
this
is
an
update
from
some
of
the
data
that
rep
Miranda
had
shared
white
infants
in
Boston,
had
an
infant
mortality
rate
of
1.8%.
F
Despite
this
significant
disparity,
we
have
seen
progress
in
the
city
where
the
mortality
rate
for
black
infants
in
Boston
decreased
by
thirty
five
point:
three
percent
between
2006
and
2007
teen
we've
looked
at
maternal
mortality
among
Boston
residents
and
found
that
there
were
few
cases
over
time.
So
in
looking
at
a
17-year
period
from
1999
to
2015,
there
were
a
total
of
10
maternal
deaths
in
Boston,
and
three
of
these
were
among
black
mothers.
F
Other
important
markers
of
maternal
health
include
the
preterm
birth
rates
and
low
birth
weights,
where
we
continue
to
see
persistent
racial
gaps
in
the
city.
We
also
continue
to
grapple
with
the
causes.
Why
is
this
happening
in
terms
of
persistent
racial
inequities?
We
talked
earlier
this
morning
about
the
fact
that
in
the
city
and
in
the
Commonwealth,
we
have
near
universal
health
insurance
cover
coverage
and
multiple
access
points
in
the
city
through
our
hospitals
and
community
health
centers.
F
But
we
know
that
socio-economic
and
environmental
factors
play
a
huge
role
in
a
woman's
ability
to
have
a
healthy
pregnancy
and
healthy
outcomes
for
her
baby.
Racism
and
the
experience
of
discrimination.
Results
in
toxic
stress
and
evidence
shows
that
this
type
of
chronic
exposure
to
stress
leads
to
physiological
changes
during
a
woman's
pregnancy
that
can
be
really
detrimental
to
not
only
the
mom's
health
but
for
the
healthy
development
of
her
child
for
black
pregnant
and
postpartum
mothers
and
their
infants.
F
We
have
a
long
spin,
long-standing
grantee
for
the
Healthy
Start
initiative,
which
is
a
funding
that
we
receive
from
the
federal
health
resources
and
services
administration,
and
the
funding
supports
our
overarching
goal
of
reducing
the
racial
and
ethnic
inequities
and
infant
mortality,
and
specifically
focusing
on
the
gaps
between
black
infant
and
white
infant
death
in
their
first
year
of
life.
Our
service
area
for
this
grant
includes
our
neighborhoods
of
Roxbury
Dorchester,
Hyde,
Park
and
Mattapan,
where
the
black
infant
mortality
rate
is
10,
point
3
per
1000
a
through
Healthy
Start.
F
F
Another
program
that
we
run
out
of
the
child-
adolescent
Family
Health
Bureau,
which
supports
the
Healthy
Start
grant,
is
our
Father
friendly
initiative,
and
this
is
important
because
we
know
that
dads
need
support
and
resources
and
services
as
well
to
ensure
that
they
remain
engaged
and
connected
to
mothers,
their
children
and
their
families
and
communities,
and
so
this
is
something
that
we've
had
long-standing
in
the
in
the
Health
Commission
to
complement
the
work
of
the
Healthy
Start
initiative.
Another
program
that
we
fund
that
also
complements
the
federal
resources
we
use.
F
So,
in
this
last
session,
with
Mayor
Walsh's
support
we
filed
and
with
the
can,
the
Community
Action
Network,
we
were
able
to
introduce
a
bill
that
would
support
fetal
infant
mortality
reviews
or
the
femurs
in
Massachusetts,
so
having
this
system,
or
this
process
in
place
would
allow
a
community
to
be
driven
confidential
case.
Reviews
of
the
cause
of
individual
infant
deaths
to
help
communities
understand
what
were
the
underlying
causes
and
factors
so
that
we
can
work
to
address
and
advocate
for
policies
and
systems
change
at
the
local
level.
F
So
we're
working
hard
with
the
mayor's
office
to
continue
to
push
and
move
this
legislation
forward.
I
talked
earlier
this
morning
are
today
about
the
partnership
we
have
with
the
Boston
Housing
Authority,
and
that
program
was
started
with
director
McGonagall
and
that's
the
healthy
start
in
housing
programs.
So
this
has
been
a
seven-year
partnership
with
them
that
has
allowed
us
to
work
with
pregnant
women
who
are
homeless
or
at
risk
of
becoming
homeless,
to
have
expedited
access
to
BHA
housing.
F
Finally,
in
terms
of
pre-conceptual
health,
we
need
to
we
need
to
and
continue
to
provide
overall
wellness
services
and
help
and
support
to
women
to
access
comprehensive
reproductive
health
services,
because
we
know
that's
important
for
overall
maternal
health.
We
we
also
have
school-based
health
centers
that
are
embedded
in
our
high
schools
that
provide
support
service
for
young
women
at
six
boston,
high
schools,
and
these
are
public
health,
nurses
and
health
educators.
That
again
are
providing
information
and
resources
around
contraception
and
reproductive
health.
F
So
in
closing,
I
want
to
thank
the
counselors
again
for
allowing
us
the
opportunity
to
share
what
we've
been
doing
at
the
Commission
and
we're
really
looking
forward
to
working
with
you
in
the
upcoming
year
to
address
and
hopefully
improve
the
data
that
we're
seeing
in
terms
of
the
inequities
in
maternal
health.
Thank.
A
G
You
good
afternoon,
everybody
chair
mr.
O'malley,
MS,
Janey
and
other
members
of
the
council.
Thank
you
for
this
opportunity
to
speak
in
favor
of
this
hearing.
Maternal
health
and
improving
equity
for
the
residents
of
Boston,
the
Wellness
collaborative
which
I
represent,
is
an
interdisciplinary
nonprofit
block
think-tank,
an
education
organization
co-founded
by
three
black
women,
Jeannette
Callahan,
a
pediatrician,
Karen
Craddock
and
applied
psychologist
and
myself
an
internist.
The
Wellness
collaborative,
is
engaged
in
promoting
health
and
wellness
for
our
communities.
G
We
have
had
the
good
fortune
to
have
Councilwoman
Janie
speak
to
us
on
this
particular
topic
in
April
of
this
year
at
our
reimagining
health
care
forum
entitled
maternal
wellness,
a
conversation
with
our
brothers
and
sisters,
Massachusetts
has
long
had
a
maternal
mortality
and
morbidity
review
committee
and
with
improved
surveillance
and
assessment,
action
has
been
taken
to
do
a
decrease
overall
rates
of
death
and
disability
for
mothers
and
children.
However,
the
gaps
between
whites
and
blacks
remain.
G
Today's
focus
is
about
reviews,
reporting
and
remediation
that
are
needed
to
close
the
gap.
Women
over
the
age
of
35
and
those
under
30
are
2
to
3
times
higher
risk
than
white
women.
I
would
like
to
speak
to
the
ladder
young
women,
young
women
less
than
30
those
on
public
insurance
and
those
with
less
formal
education
and
more
social
strains
are
poor
prone
to
poorer
outcomes
and
higher
rates
of
depression
and
domestic
injury.
We
also
know
that
these
young
women
are
more
likely
to
have
preventable
medical
causes
of
mortality.
G
Why
is
that
providers
have
been
known
to
make
assumptions
about
their
patients,
whether
it
is
women
in
heart,
attacks
or
blacks
and
pain
tolerance?
Here
the
Assumption
may
be
that
a
young
person
has
no
troubles
is
healthy
needs
nothing.
They
can
just
push
it
out,
but
this
is
an
antiquated
myth,
perhaps
rooted
in
a
history
of
enslavement,
of
African
people
here
in
America,
the
psychosocial
stressors
stressors
of
marginalization
have
an
impact
on
black
women,
prenatal,
peripartum
and
parenting.
G
It
is
time
to
understand
that
young
black
women
need
to
be
supported,
assess
fully
for
risks
provided
appropriate
medical
monitoring
and
educated,
but
we
can
only
do
that
with
a
system
and
providers
that
vow
to
provide
trustworthy,
caring
and
be
accountable
for
shortfalls.
At
our
April
forum,
held
in
Roxbury,
we
learned
through
discussion
and
a
survey
that
buck
men
want
to
be
welcomed
into
the
discussion
care
in
support
of
maternal
and
child
health
from
before
conception
to
after,
regardless
of
marital
status
and
respected
for
their
status.
G
As
father,
we
learned
that
change
requires
breaking
the
silence
about
current
systems
and
welcoming
co-creation
of
a
new
model
of
maternal
care
and
caring
that
includes
community.
A
suggestion
was
made
to
rename
postpartum
depression
as
peripartum
depression,
which
requires
early
recognition
and
action,
including
the
90
days
postpartum.
This
includes
of
Obstetricians
and
PCPs
for
action
as
they
are
having
the
most
frequent
contact
with
the
mother,
rather
than
assuming
assuming
mommy
bliss
evaluating
for
depression
should
be
routine
at
every
pregnancy
visit,
just
as
asking
about
safety
at
home
has
become
routine
during
every
annual
physical
exam.
G
History
of
adverse
experience
and
treatment
and
discounted
preferences,
both
next-door
and
across
the
media,
have
created
an
environment
of
distrust.
Most
individuals
support
the
creation
of
a
community
cited
birthing
center,
with
high
quality
care
and
safety,
cultural
relevance
and
affiliation
with
more
than
one
Medical
Center.
Consideration
should
be
given
for
both
an
independent
center
or
a
joint
best
venture
between
medical
centers
insurance
coverage
of
doula
services
to
help
Shepherd
a
woman
through
the
unknowns
and
stresses
of
childbearing
are
strongly
recommended.
G
Studies
have
shown
that
incorporating
doulas
not
only
increases
Paytas
patient
satisfaction,
but
also
reduces
the
frequency
of
cesarean
sections
and
reduces
costs
like
to
a
thousand
per
live
birth.
This
was
published
in
birth
in
2016.
A
community
advisory
panel
should
be
developed
to
examine
next
steps
and
to
support
institutional
plans
for
advancements,
whether
conducted
at
the
level
of
the
Public
Health
Commission
or
at
the
level
of
each
healthcare
facility.
G
With
a
report
out
to
the
mayor
in
the
council,
within
one
to
two
years,
the
city
can
Commission
their
own
advisory
community
panel
for
research,
investing
or
or
use
existing
structures
for
providing
community
advisory
panels
for
research
and
investigation
such
as
chairs
the
center
for
community
health,
education,
research
and
service
again
I.
Thank
you
for
this
opportunity
to
speak
to
the
City
Council
on
this
very
important
topic.
Thank.
A
F
I
can
start
that
I
know
from
work
that
I
did
before
coming
back
to
Boston
I
worked
at
the
association
of
State
and
territorial
health
officials.
We
were
partnering
with
her
so
at
the
time
and
March
of
Dimes
and
some
of
our
colleagues
in
the
southeastern
states,
because
they
have
dramatically
higher
infant
mortality
rates,
had
used
models
where
they
had
group
prenatal
visits.
I
think
there
might
be
a
few
health
centers
in
the
city
and
I,
don't
know
dr.
Reed
if
you're
familiar
with,
but
I
think
there
might
be
I.
F
As
opposed
to
you
know
the
usual
model,
where
it's
a
one-on-one,
either
with
an
ob/gyn
or
a
nurse
practitioner.
If
that's
what
we're
looking
at
that
clinical
model,
where
you
women,
who
are
generally
at
the
same
stage
of
pregnancy,
go
into
their
prenatal
visits
together
as
a
group
and
that
way
they
are
their
own
cohort
of
sorts
that
they
can
talk
with
each
other.
F
G
A
Sounds
like
a
great
just
thinking
and
part
of
my
district
in
the
Mildred
Haley
housing
development.
There's
a
very
vibrant,
active
mothers
group
and
it
would
seem
a
great
opportunity.
I
mean
there
are
800
families
that
live
in
those
buildings.
To
sort
of
you
know
better
connect
and
work
and
build
that
community
sense.
For
those
do
we
offer
discounted
prenatal
vitamins
as
a
city
resource?
Is
that
something
we
could
do
they're
quite
expensive.
A
A
A
You
know
we
just
identified
one
or
two
sort
of
best
practices,
but
what's
something
that
that
is
just
shooting
for
the
stars
that
we
ought
to
be
figuring
out
how
we
can
leverage
the
resources
with
incredibly
the
best
health
care
system
in
the
country
in
our
backyard,
but
to
better
address
these
issues
of
sort
of
systemic
inequality
and
divergent
disparities.
I.
G
Would
say,
probably
low-hanging
fruit
actually
that
if
that
were
covered
by
health
insurance,
it
would
be
something
that
would
be
available
to
all
and
could
provide
more
comfort
in
trust
and
communication,
where
people
may
feel
inhibited
and
speaking
of
themselves
or
sharing
feelings
of
feeling.
Sad
or
depressed.
The
doula
can
help
bridge
that
so
I
think
that
would
be
very
cost-effective.
Absolutely.
F
Also
think
that
in
talking
with
the
staff
sort
of
those
additional
supports
like
child
like
child
care
and
transportation,
and
all
these
things
that
make
it
easier
for
families
to
living
wages,
to
just
improve
overall,
not
necessarily
within
a
specific
city
agency,
but
certainly
we
talked
this
morning
about
those
larger
societal
barriers
and
these
structural
barriers
that
have
created
the
conditions
where
it's
hard
to.
You
know
be
a
black
woman,
and
we
talked
about
some
of
the
data.
Dr.
F
Betancourt
was
talking
about
some
of
the
data
this
morning
in
terms
of
just
controlling,
even
controlling
for
socioeconomic
factors,
just
being
marginalized
and
experiencing
toxic
stress.
It
just
puts
it's
not
a
level
playing
field
for
black
women,
and
so,
if
there
were
other
things
that
we
could
think
of,
that
would
provide
additional
supports.
I,
think
that
would
those
would
be
opportunities,
not
necessarily
low
low-hanging,
fruit,
but
definitely
important
to
address
overall
health.
A
G
B
B
You
know
and
it's
a
quick
appointment.
Unfortunately,
our
healthcare
system
is
such
that
we
are
trying
to
turn
over
several
patients
in
a
very
short
period
of
time
and
the
doctor
said
a
B
and
C
and
for
me
I
always
have
lots
of
questions
and
that
I'll
say
well.
What
about
this?
Well,
the
doctor
didn't
say
that.
Well,
why
didn't
you
ask
question?
The
doctors
is
seeing
so
many
patients
with
a
very
short
window
of
time
and
so
I
guess
any
strategies
that
we
can
put
in
place
to
the
help.
B
Women
and
everyone,
but
since
we're
talking
about
black
maternal
health,
understand
here,
are
some
important
questions
to
ask
in
that
it
isn't.
It
is
okay
and,
in
fact,
necessary
to
kind
of
be
your
own
best
advocate
and
not
everyone
has
those
tools,
and
so
whatever
we
can
do
to
help
women
in
particular
and
develop
those
tools,
I
think
is
really
important,
especially
in
the
context
of
we
know.
We
live
in
a
racist
society.
B
We
know
that
it's
a
patriarchal
society
where
women
are
often
silenced
and
when
you
add
the
intersections
of
race
and
language,
they
may
even
be
more
silenced.
If
it's
a
woman
of
color
or
women,
an
immigrant
woman,
a
woman
who
does
not
speak
perfect,
English,
a
woman
who
may
have
less
education
I
mean
you
add
all
of
these
things,
and
then
we
see
the
results.
And
so
is
this
something
in
terms
of
this
group
appointments
or
just
maybe
it's
not
doctor's
appointments,
but
how?
B
Whatever
we
can
do
to
kind
of
create
these
safe
spaces
for
women
to
kind
of
share
their
experiences
and
understand
that
they
too
are
powerful
and
that
their
voices
matter
and
that
they
can
and
should
and
must
be
partners
in
their
own
health,
is
that's
something
that
you're
exploring
at
the
Commission
and
in
something
that
you're
exploring
with
the
collaborative.
So.
F
I
think
at
the
Commission,
the
one
thing
that
we
do
after
the
women
have
their
infants,
their
babies
is
the
Community
Action
Network.
We
just
had
a
celebration
annual
gathering
this
summer
at
Codman
square
and
to
me
one
of
the
things,
a
theme
that
came
across
the
different
tables
that
I
sat
with
was
the
fact
that
these
moms
many
of
them
were
young
moms,
but
there
were
also
older
moms
that
were
part
of
this
group
that
they
got
out
of.
It
was
the
sense
of
community
and
skills,
development
and
tools
to
do
that,
self-advocacy.
F
So
we
they
were
going
to
the
Statehouse
and
and
their
stories
and
being
able
to
find
their
voice
and
to
tell
their
stories
was
very
empowering
and
so
I
know
through
the
can.
I
do
think
that
they
help
them
with
navigating
care
and
being
able
to
ask
the
right
questions
and
those
postpartum
visits
and
you're
well
well.
Baby
you're,
well,
child
visits,
and
so
those
are
the
sorts
of
things
that
happen
after
the
pregnancies
through
the
Community
Action
Network
and
in
between
pregnancies
and
I'm
I
would
love
to
have
you
come
any
of
the
counselors?
F
B
G
The
reimagine
healthcare
poems
are
about
is
how
to
be
an
advocate
for
yourself
how
to
engage
with
your
doctor
and
with
government
to
create
change,
so
that
is
part
of
what
we
do
and-
and
there
are
other
organizations
around
the
city
that
specifically
focus
on
blacks,
women's
wellness
and
maternal
health
actually
nationally,
but
certainly
in
Boston
too.
So
that
is
our
goal.
In
addition,
we
look
we're
looking
to
see
if
we
can
create
other
things
and
leverage
technology.
G
So
we
know
a
lot
of
places,
provide
online
documents
and
tools,
so
we're
looking
at
those
and
identifying
which
ones
will
be
helpful,
see
if
new
ones
want
to
be
created
and
what
about?
What's
out
there
as
far
as
apps,
that
can
help
mom
or
online
forums
where
they
can
talk.
Although
we
tend
to
prefer
in-person
relationship
type
connections,
we
know
that
a
lot
of
people
are
using
technology.
B
F
B
Here
in
Massachusetts,
you
know
the
rates
are
better
than
in
the
rest
of
the
country,
yes,
but
we
still
have
kind
of
the
gap
between
black
women
and
white
women.
What
strategies
are
underway
that
we
need
to
know
about
or
should
be
under
way,
because
maybe
they
don't
exist
to
really
pinpoint
and
target
black
women
when
it
comes
to
these
disparities
that
we
see
so
and
I
asked
this
question,
because
often
in
Boston
and
in
Massachusetts,
we
we
focus
on
things
that
help
they
use
the
term.
B
You
know
the
tide
will
lift
all
boats
and
what
I'm
trying
to
get
at
is
that
you
need
kind
of
targeted
intervention
for
certain
groups.
It's
not
enough
just
to
say
everyone
will
have
better
access
or
opportunity,
but
how?
When
we
realize
that
these
gaps
are
in
place,
how
we
get
targeted
intervention
for
these
groups,
and
so
while
we
see
that
Massachusetts
may
be
doing
better
compared
to
other
states,
we
still
see
these
persistent
gaps
when
we
kind
of
peel
back
the
onion
look
at
different
ethnic
groups.
B
F
B
F
So
this
is
definitely
the
focus
of
the
Healthy
Start
initiative
funds
we
actually,
unfortunately,
our
grant
was
cut
by
nearly
50%.
This
is
a
federal
grant
that
we
and
they
made
it
competitive.
This
go-around
and
our
working
hypothesis
was
that
it
was
cut
to
provide
additional
resources
to
other
parts
of
the
country.
Thankfully
we
were
competitive,
but
instead
in
the
grant
I
believe
is
it
around
a
million
dollars.
F
Now
it
used
to
be
well
over
two
million
dollars
that
we
received
from
hersa
and
that's
specifically
looking
at
blacks
in
the
neighborhoods,
where
we
have
the
highest
infant
mortality
rates,
so
the
health
centers
that
compete
in
their
Boston
Medical
Center
as
part
of
the
program
they
compete
for
these
resources
and
so
Boden
Street
Codman
Square
Mattapan
Whittier
Street
in
Boston,
Medical
Center's
teens
in
Tots.
Clinic
are
the
service,
the
delivery
point
for
these
services
and
that's
specifically
focused
and
targeting
our
resources
and
attention
on
black
infants
and
black
moms.
G
Yeah
so
I
think
grant
support
is
important
for
all
of
this,
and
our
work
at
the
collaborative
is
FUBU
is
for
us,
it's
by
us
and
we're
looking
specifically
at
what
blacks
need
for
wellness
in
general,
we're
working
on
a
tool
to
do
an
assessment
that
would
include
the
social
determinants.
That's
a
little
different
than
what's
currently
being
promoted
and
a
little
bit
more
broad
and
scale,
but
definitely
more
specific
in
both
application
and
recommendations.
So
again
it
requires
funding,
but
I
think
it
will
make
a
difference
in
in
how
we
can
approach
things
right.
B
B
Obviously,
we
need
more
resources
to
tackle
these
problems,
but
if
you
could
offer
three
recommendations
for
kind
of
closing
the
gap
when
we're
talking
about
black
maternal
health,
what
would
they
be
three
to
five
if
you
have
them
that
we
really
should
focus
on
in
the
next
one
to
two
years
to
begin
to
close
this
gap?
If
you
each
want
to
offer
your
recommendations.
F
F
We
have
extensive
resources
both
on
the
clinical
side,
on
the
public
health
side
and
in
communities,
but
I
wonder
if
there
might
be
an
opportunity
for
the
mayor,
the
City
Council,
our
clinical
partners,
to
do
some
kind
of
inventory
to
help
us
better
map
out
where
these
resources
are
inside
no.5.
There
any
specific
gaps
across
the
lifespan,
from
birth
to
aging
and
I
think
that
that
is
something
that
I,
don't
believe,
I've
seen
and
knowing
what
the
resources
look
like
and
where
there
are
gaps
might
help
us
and
figuring
out.
F
G
Two
things
come
to
mind:
first,
I
think.
As
far
as
early
identification
of
mental
health
issues,
we
have
electronic
records
now
and
a
lot
of
things
are
templated
it'd,
be
very
easy
to
put
in
questions
that
providers
would
have
to
ask
along
somebody's
pregnancy
path
and
that
when
they
had
finished
their
obstetrical
care
and
come
back
to
primary
care
that
the
questions
continue
to
be
asked
that
the
ball
doesn't
get
dropped
so
I
think
that
would
be
an
easy
fix.
The
other
thing
is,
we
always
think
about.
G
G
B
Guess
and
my
final
questions
or
thoughts
as
I
wrap
up
my
questions
here,
we
talked
a
lot
about
supporting
families,
the
moms
themselves,
giving
them
the
tools,
the
right
questions
to
ask
the
support
systems
the
services.
What
can
we
do
with
the
providers
themselves
of
just
around
racism
and
addressing
implicit
and
explicit
bias
at
the
earlier
hearing?
And
thank
you
for
your
your
participation
on
that
that
panel
Monica,
one
of
the
panelists
I'm,
can't
remember
who
talked
about
training
for
for
doctors
and
healthcare
providers?
B
How
do
we
end
acknowledged
that
you
know
the
vast
majority
of
people
in
our
health
care
facilities
are
doing
good
work
and
are
working
hard
and
don't
believe
that
they
are
victims
of
implicit
bias
or
that
they
kind
of
perpetuate
that?
But
in
fact
we
know
that
this
is
happening,
and
so
what
more
you
know
beyond
helping
the
family
the
moms
themselves?
G
Recommendation-
and
it
doesn't
have
to
be
long
because
it's
building
on
existing
trainings
that
people
are
receiving
around
implicit
bias
and
cultural
sensitivity
as
opposed
to
cultural
competency,
so
I
think
there
could
be
many
modules
that
could
be
implemented
for
providers
just
to
reinforce
and
just
like
every
year
they
might
have
to
do
conflict
of
interest
statements.
It'd
be
good
to
do
updated
modules
about
current
trends
in
this
topic,
because
I
worry.
B
In
my
my
opening
statement,
around
being
kind
of
super
human
being,
very
tolerant
of
pain
and
and
so
oftentimes,
our
issues
are
dismissed
and
I
I
think
you're
right
that
we
need
an
ongoing
approach
to
kind
of
call
these
biases,
so
yeah
I
would
be
interested
in
any
any
concrete
recommendations
moving
forward.
But
I
do
want
to
be
mindful
that
I've
asked
several
questions
and
want
to
give
other
councillors
an
opportunity
and
then
hopefully
can
follow
up
with
each
of
you
individually.
I,
do
appreciate
your
your
testimony
here
and
all
the
work
that
you're
doing.
C
You
councillor
O'malley
and
Thank
You
councillor
Janey
into
the
panelists
for
your
informative
presentations.
Today,
I
just
had
a
couple
comments
and
questions.
I
know
it's
not
a
level
playing
field
for
african-american
woman
I'm
wondering
is:
is
there
a
disconnect
between
our
hospitals,
colleges,
universities
and
maybe
health
care,
centers
and
and
our
patient?
C
You
know
patients,
we
are
we
providing
our
patients
enough
support
and
care
from
these
great
institutions,
these
great
hospitals,
colleges
and
universities,
or
is
there
a
way
for
them
to
play
a
more
important
and
engaging
role,
especially
as
counselor
Jenny
mentioned
doctors
can
be
over?
You
know
you
can
have
an
appointment
in
ten
minutes
and
you
don't
get
an
opportunity
really
to
ask
the
right
questions,
but
is
there
an
opportunity
for
someone
to
kind
of
also
step
in
and
work
closely
with
the
patient
and
in
the
hospital
in
the
health
care
center?
C
G
Think
there
are
efforts
to
provide
navigators
and
case
managers
to
help
support
patients,
so
I
think
they
are
trying
to
do
something
in
that
effort.
I
think
what
has
happened
in
health
care
is
there's
been
so
much
consolidation
and
we
have
these
mega
institutions
now
that
it
still
becomes
a
challenge
for
individuals
to
know
how
to
advocate
for
themselves
in
them
and
even
when
they
do,
they
sometimes
feel
that
they're
not
being
heard
or
sidelined
so
understanding.
G
How
then
to
go
to
the
next
level,
whether
it's
through
an
Ombuds
person
or
or
a
facilitator,
to
help
smooth
communications?
It's
a
place
where
I
think
we
could
do
better,
but
there's
years
decades,
centuries
of
history
here
where
Trust
has
been
lost,
and
so
it's
about
rebuilding
trust
too
I
will
always
tell
you
that
I
think
we
need
to
see
more
diversity.
You
know
so
that.
C
G
F
Agree,
I
think
there
are
examples
when
we
visited
community
health
centers
I'll
talk
about
that
experience
and
the
city
that
there
are.
There
are
several
health
centers
that
we've
been
to
that
try
to
help
their
patients
better,
navigate
things
beyond
just
the
clinical
services
by
four,
for
example,
by
bringing
a
housing
specialists
on-site
there
on
certain
days
of
the
week,
because
that's
something
that
they
know
that
you
know,
especially
in
the
health
community
health
centers,
that
the
patients
are
grappling
with
or
the
displacement
and
housing
challenges.
F
There's
some
health
centers
that
are
doing
a
lot
of
work
in
this
space
around
transportation
and
really
coming
at
it
head-on
in
terms
of
these
barriers
that
make
it
difficult
for
their
patients
to
access
care.
So
I
think
that
I
think
there's
always
room
for
improvement.
But
those
are
a
couple
of
examples
that
I
can
think
about
that
we've
seen
in
our
in
our
health
centers
do.
C
Do
we
follow
up
with
the
with
the
mothers
that
deliver
a
child?
Maybe
the
child
is
a
low
birth
weight,
but
do
we
follow
up
with
that
mother
for
a
period
of
time,
maybe
maybe
ten
years,
knowing
that
there's
a
maybe
a
complicated
pregnancy
or
a
low
birthrate?
But
do
we
follow
that
and
child
over
several
years
to
make
sure
that
that
mother
gets
the
medical
care
she
needs?
She
gets
the
social
service
assistance
she
may
need
in
his
is.
F
G
But
certainly
with
the
new
ACO
models
that
are
accountable
care
organizations
that
are
looking
to
provide
services,
there
is
improvement
in
that
area
and,
of
course,
we're
hoping
that
that's
gonna
have
a
big
impact,
we'll
have
to
see,
but
I
think
there
is
a
need
for
that
part
of
again
is
the
design
of
the
healthcare
system,
where
you
go
from
the
obstetrician
to
the
primary
care
to
the
pediatrician.
So
different
people
are
overseeing
different
things,
unlike
in
the
old
days
when
there
was
a
family
practice
doctor
who
took
care
of
the
whole
family.
G
H
G
C
G
C
A
There
may
be
additional
questions
from
the
panel
and
then,
if
anyone
else
who
hasn't
signed
up
and
would
like
to
speak,
we'll
take
you
in
the
second
round
of
public
testimony,
but
for
initial
public
comment,
I'd
like
to
invite
Emily
enesta
from
the
Baystate
Birth
Coalition
and
Christina
gable,
a
doula
to
please
join
us
at
the
two
standing
podiums
up
here
and
then
those
are
the
only
two
individuals
who
have
indicated
they
would
like
to
testify.
If
anyone
else
would
like
to
please
sign
up
on
the
signup
sheet
to
the
back
left,
but
Emily.
I
I
Problem
hi,
my
name
is
Emily
enesta
I'm,
a
Boston
resident
and
one
of
the
founders
of
the
Bay
State
Birth
coalition.
Boston
is
a
great
city
for
medical
care
we
have.
As
was
mentioned,
we
have
top
research
hospitals,
no
shortage
of
providers
and
institutions
to
save
lives.
When
we
have
a
medical
crisis,
however,
pregnancy
and
childbirth
are
not
medical
crises.
Pregnancy
is
a
normal
state
for
the
human
body,
and
childbirth
is
a
normal
physiologic
process,
while
in
some
cases
medical
intervention
is
helpful
or
necessary.
I
Overuse
of
medical
interventions
in
childbirth
has
not
led
to
healthy
mothers
and
babies.
So
we're
here
I'm
here
to
say
that
we
need
policy
is
an
investment
in
expanding
access
to
midwives
growing
and
diversifying
our
midwifery
workforce
and
establishing
freestanding
independent
and
midwife
led
birth
centers
such
as
the
neighborhood
birth
center
project,
which
is
a
project
led
by
black
women
who
are
Boston
residents,
looking
to
establish
a
birth
center
in
embalm
the
city
of
Boston,
while
Massachusetts
is
generally
a
health
care
leader,
we
ranked
in
the
bottom
one-third
of
states
for
midwifery
care
integration.
I
Despite
the
evidence
of
significant
benefits
from
the
holistic,
the
relationship-based
midwifery
care
I
was
hearing
you
councillor,
Janie
talk
about
short
appointments.
When
you
see
an
out-of-hospital
midwife,
a
typical
prenatal
appointment
can
be
up
to
an
hour
long
if
the
client
wants
it
and
you
have
continuity
of
provider,
extensive
postpartum
support
and
so
forth,
so
that
care
the
benefits,
include
fewer
neonatal
deaths.
This
is
just
when
you
integrate
midwives
into
the
system:
fewer
neonatal
deaths,
fewer
preterm
births,
fewer
low
birth
weight,
babies,
fewer
c-sections
and
higher
breastfeeding
rates.
I
An
excerpt
from
that
article,
which
was
referring
to
a
study
in
The
Lancet
in
2016,
said
maternity
care
that
is
too
much
too
soon,
including
unnecessary
cesarean
sections
induced
labor
and
routine
episiotomies
may
cause
harm,
raise
health
care
costs
and
contribute
to
a
culture
of
disrespect
and
abuse.
Midwifery
practices
can
help
to
cut
down
on
some
of
these
unnecessary
interventions
and
also
improve
mothers
and
babies
outcomes.
Yet
many
women,
and
in
particular
women
of
color
lack
access
to
midwives
that
was
from
the
globe
article
last
month.
Thank
you.
H
So
my
name
is
Christina
gable,
I
work
for
the
March
of
Dimes
foundation
here
in
Massachusetts,
but
I'm
coming
here
today,
as
my
role
as
a
private
citizen
and
also
as
a
birth
doula.
So
I'd
like
to
address
some
of
the
comments
that
were
brought
up
earlier.
That
I
think
I
can
try
to
help
answer.
First.
I
want
to
say
that
dr.
meadows
sends
her
regrets
she's,
unfortunately
not
able
to
come.
Do
it
due
to
a
last-minute
issue,
but
she
has
sent
in
on
email
her
testimony.
H
So
I
wanted
to
start
by
saying
you.
It
was
asked
earlier
whether
these
resources
have
been
mapped
so
Rose
Molina
is
a
provider
in
the
Boston
community,
working
with
Anna
Langer
at
Harvard
to
map
these
resources
in
the
community,
they're
literally
doing
a
needs
assessment
through
Ariadne
labs,
of
which
resources
exist
for
moms
in
Boston.
I
also
would
like
to
address
the
low
the
quote.
You
know
low
numbers
of
maternal
mortality
in
our
city.
H
So
what
could
happen
is
they
might
have
preeclampsia
their
pregnancy
and
go
on
to
have
hypertensive
issues
after
pregnancy
that
can
very
much
threaten
their
life?
Another
one
is
just
a
tional
diabetes,
which
puts
them
at
risk
of
type
2
diabetes
after
pregnancy
and
in
one
of
our
medical
centers.
That's
working
to
improve
screening
after
pregnancy
for
just
for
diabetes,
because
there's
so
much
at
risk.
Only
30%
of
those
women
are
getting
followed
up.
Screening
for
diabetes
once
they've
once
their
pregnancy
and
birth
has
happened.
So
we
can
easily
see
how?
H
So
I'd
like
to
hold
that
up
as
a
possible
solution.
It
was
asked
earlier
about
group
prenatal
care
and
my
colleague
at
centering
pregnancy,
at
which
centering
Health
Institute
is
headquartered
here
in
Boston,
we're
very
lucky
for
that.
We
have
five
group
prenatal
care
sites
within
the
Boston
Limits
one
at
Boston,
Medical
Center,
one
at
Bowdoin,
one
at
Dimmick,
one
at
Mattapan
and
one
at
Whittier.
So
actually
we're
quite
we're
quite
lucky
in
that
sense,
and
March
of
Dimes
is
also
looking
to
spread
group
prenatal
care
at
additional
sites.
H
So
to
your
point
earlier,
yes,
implicit,
bias,
training
always
and
in
any
part
of
healthcare
is
useful,
but
we
also
need
a
focus
specifically
on
what
that
looks
like
in
maternity
care,
because
many
black
women
are
getting
ignored
and
neglected,
even
when
they
know
something's
wrong
and
even
when
they've
said
something's
wrong
and
that's
what's
particularly
troubling,
and
what
representative
Liz
Miranda
has
been
so
vocal
about.
It's
not
that
women
don't
know
it's
not
that
they
don't
speak
up.
It's
that
we're
not
listening
and
that's
a
huge
problem.
H
It
was
asked
earlier
about
data
linkages
and
if
we
follow
women,
so
we're
really
lucky
here
in
the
state
of
Massachusetts
to
have
a
system
where
we
can
link
Hospital
data
when
a
woman
is
pregnant
to
discharge
out
outpatient
data
and
we're
one
of
the
few
states.
That
really
has
those
linkages
set
up
but
they're
expensive,
and
it
takes
a
lot
of
time
and
resources
to
do
that
on
a
state
level.
H
So
I
would
say
you
know,
committing
more
resources
to
data
linkages
is
a
way
that
we
can
follow
these
families
well
into
early
childhood
and
then.
Finally,
my
last
point
is
I'm
coming
here
as
a
doula
today,
and
not
because
I
want
to
promote
that
doulas
can
solve
all
these
problems,
but
because
we
have
a
unique
opportunity
with
doulas,
and
that
is
you
know
right
now,
for
for
better
for
worse
the
way
that
our
maternity
care
system
is
it's
very
high
volume.
H
You
know
a
lot
of
women
do
have
choice
around
where
they
deliver,
but
you
might
go
into
the
liver
and
because
of
the
way
that
group
practices
are
set
up
or
on
call
and
shifts,
and
so
on
and
so
forth.
You
might
not
have
the
provider
that
you
saw
in
prenatal
care.
You
might
have
one
to
two
nurses
and
I
think
what
doulas
do
is
just
introduce
more
autonomy
into
the
birth
experience
that
you
are
choosing
someone
from
your
community
who
understands
you
culturally,
who
shares
your
same
race.
H
H
Education
I
mean
all
those
things
you
know
so
there's
career
opportunity,
but
there's
also
community
opportunity,
and
should
we
put
the
burden
on
community
to
solve
these
issues?
No,
we
shouldn't,
but
we
should
look
to
the
community
and
draw
from
the
community
for
the
solutions
and
that's
where
I
see
dual
as
being
a
big
part
of
that
I'm.
Happy
answer
any
questions.
H
B
H
So,
there's
a
lot
of
kind
of
rhythms
that
we've
fallen
into
into
the
maternity
care
system.
Some
are
out
of
convenience.
Some
are
efficiency.
Some
are
evidence-based.
Some
are
not.
Some
are
medically
indicated,
as
we
heard
earlier.
Some
are
not,
but
what
we,
what
we
as
doulas
see
a
lot
is
patients
not
being
offered
the
consent
for
things
that
that
are
considered
routine
so,
for
instance,
like
doing
a
vaginal
check
to
see
how
much
someone
is
dilated.
H
That
can
be
a
very
traumatizing
for
experience,
experience
for
someone
who
comes
into
the
delivery
room
with
a
history
of
sexual
assault
and
abuse,
or
rape
or
other
traumas.
So
sane,
simple
things
like:
are
you,
okay
with
me
doing
this
right
now
or
I'm
about
to
do?
Xy
and
z?
Are
you,
okay
with
that?
You
know,
I
see,
I,
see
that
quite
a
lot
in
pregnant
and
practicing
with
all
demographics
of
women
I
want
to
be
clear
that
this
is
a
systems
issue.
H
It
disproportionately
affects
women
of
color,
I,
truly
believe,
but
I've
also
seen
really
horrifying
disrespect
among
women
across
the
board.
So
you
know,
does
a
doula.
What
does
a
doula
do
in
that
situation?
She
witnesses
what
happens
because
then,
when
women
come
to
say
you
know,
I
was
mistreated
or
something
happened
to
me
and
I
don't
feel
like
I
had
my
consent,
that
dual
is
another
witness
in
the
care
system.
That
can
then
say.
H
Yes,
I
saw
that
too
and
I
perceived
it
the
same
way
you
know,
so
we
have
to
have
these
systems
in
place
where
women
can
then
go
back
and
process
their
trauma,
mental
health
being
especially
important
there,
but
we
also
have
to
have
systems
in
place
where
we
can
elevate
those
experiences
and
say
yes,
this
is
happening
in
our
maternity
care
system
and
I.
Think
doulas
can
serve
as
witnesses
to
some
of
the
things
that
were
seen
and
that
are
happening.
So
thank.
A
J
Very
brief-
and
you
just
introduced
me
and,
as
you
said,
I'm
with
the
mass
PPD
fund
and
we're
a
new
nonprofit
working
to
raise
awareness
and
increase
services
around
perinatal
mental
health
in
the
state
and
I
also
serve
with
rep
Miranda
on
the
postpartum
depression.
Commission
I
was
really
happy
to
hear
and
everybody's
remarks
the
mental
health
side,
because
that
is
our
focus
and
as
with
many
of
these
other
issues,
the
disparities
issue
is
more
prevalent
on
the
mouth
side
and
we
also
see
a
lack
of
services
on
that
side.
I'm.
J
So
we're
working
on
that
and,
of
course
it's
not
just
postpartum
depression,
but
as
Christina
mentioned,
the
disparities
issues
around
birth
can
often
result
in
trauma
and
then
you're
dealing
with
other
mental
health
issues
around
that.
So
we're
brand-new.
But
we
have
a
couple
of
projects
in
the
city
of
Boston.
I
was
also
happy
to
hear
the
councilor
mention
the
importance
of
groups
and
social
support
and
we're
looking
to
build
some
partnerships.
We
have
a
couple
of
projects
around
that.
We've
also
worked
with
the
healthy
baby,
healthy
child
program.
J
I'm
postpartum
support
international
and
I'm
working
with
some
of
those
clinicians
coming
to
a
national
training
and
I'd,
also
just
like
to
encourage
working
in
partnership
with
some
of
the
leaders
at
the
state
level
in
the
national
level
are
actually
right
here
in
Massachusetts
and
I
want
to
draw
your
attention.
There
was
a
Globe
magazine
article
around
medical
mistreatment
and
african-american
women,
and
a
number
of
the
leaders
in
Massachusetts
on
the
mental
health
side
wrote
a
letter
to
the
editor
around.
Let's
not
forget
the
mental
health
side.
I
can
pass
this
along
on.
J
A
B
You
know
I
I,
recognized
too,
that
this
issue
starts
long
before
a
woman
as
seeking
prenatal
care
and
it
becomes
this
vicious
cycle.
So
if
you
were
a
child
who
was
born
with
low
birth
weight,
who
had
different
health
challenges
because
of
that
low
birth
weight
and
now
you're
an
adult
who's
having
your
own
child,
it
just
becomes
this
vicious
cycle.
So
obviously
there's
a
lot
more
work.
B
We
need
to
do
to
not
just
decrease
mortality
rates
for
black
women
for
all
women,
but
we
really
have
to
make
sure
that
we're
pinpointing
and
targeting
certain
populations
to
make
sure
that
we're
we're
doing
more
for
them
and
providing
the
the
needs,
the
services
that
they
actually
need.
You
know
recognizing
the
the
intersection
of
womanhood
and
blackness
and
as
it
pertains
to
doing
more
for
all,
which
is
the
lifting
the
all
boats
model.
B
You
know,
I'm,
always
mindful
that
that
rising
tide,
if
you
don't
have
the
supports
that
you
need,
if
you
don't
have
kind
of
that,
wraparound
help
and
in-circle
that
rising
tide
can
tip
your
boat
over.
So
it's
not
enough
to
just
say
that
they
will
lift
all
boats,
but
you
need
the
actual
supports
in
place.
B
That's
okay
with
you,
because
I
this
for
me
has
been
a
wonderful
opportunity
to
learn
more
and
I.
Thank
you.
Dr.
Reid
I.
Remember
the
meeting
that
we
had
here
and
coming
out
to
speak
to
to
your
group,
there's
so
for
me:
learning
more
and
I'm
a
mom
I'm,
a
black
mom
and
I've
been
through
and
I
guess
a
high-risk,
pregnancy
myself,
but
there's
a
lot
more
as
elected
officials.
B
So
I
want
to
take
off
my
black
mom
hat
and
use
my
elected
official
hat
to
really
kind
of
target,
some
concrete
things
that
we
can
do
in
the
city
of
Boston.
That
will
help
us
address
not
only
the
implicit
bias
but
the
explicit,
biased
and
also
arming
black
women,
with
the
tools
that
they
need
to
ensure
that
they
will
get
the
health
care
that
they
deserve,
and
so
I'm
grateful
for
this
opportunity
to
partner
with
my
dear
friend
and
colleague,
councillor
Matt
O'malley,
as
well
as
the
amazing
panelists.
B
A
If
perhaps
we
agree
to
refile
this
legislation
in
January
and
rather
than
doing
a
hearing
again
go
right
into
a
working
session
and
I
would
even
argue
that
I
think
it
would
make
sense
to
have
a
series
of
working
sessions
in
community
health,
centers
I
know.
One
thing
you've
done
exceptionally
well
is
bring
the
council
to
the
community,
while
this
is
a
great
building
and
sort
of
centrally
located,
sometimes
it's
better
to
meet
folks
where
they
live
literally
and
figuratively.
A
So
perhaps
you
could
do
that
work
with
you
work
with
other
panelists
but,
most
importantly,
work
with
all
the
advocates
and
interested
parties
here,
because
there
is
a
lot
of
work
to
do
and
just
talking
about
the
issue
makes
sense.
I
had
no
idea
of
these
statistics
before
we
started
doing
some
work
and
there
was
a
fair
amount
of
media
on
it,
which
is
good,
obviously,
but
just
having
these
conversations
not
losing
sight,
as
some
of
our
panelists
had
mentioned
about
the
mental
health
aspect
as
well.
How
that's
so
important
to
it
dr.
A
Reid,
mentioning
father's
and
including
them
in
the
conversation
is
something
that's
vitally
important
as
well
and
I
think
we
can
be
a
safe
space
to
sort
of
talk
about
that.
Look
at
some
best
practices
and
figure
out
some
strategies
going
forward.
It
could
be
as
simple
as
having
a
resolution
in
support
of
some
of
the
legislation
offered
by
a
representative,
Miranda
or
some
other,
obviously
congressman
Presley.
You
know
supporting
her
efforts
at
the
federal
level,
but
we
can
make
some
very
minor
policy
changes
that
I
think
will
be
impactful
so
I.
A
G
F
A
Thank
you
very
much,
and
we
have
one
more
this
person
who
indicated
they
would
like
to
testify:
Lee
Graham
Lee.
If
you
could
please
join
us
up
here
and
then
Lee
will
be
our
final
person
offering
testimony
unless
anyone
would
like
to
say
otherwise
speak
now
or
forever
hold
your
peace.
Seeing
none
Lee
the
floor
is
yours.
Thank.
K
You,
my
name,
is
Lee
Graham
and
I
work
with
dr.
Rose
Molina
at
Ariadne
labs,
so
I
just
wanted
to
thank
the
person
who
mentioned
the
work
that
Rose
is
doing
and
tell
you
just
a
little
bit
more
about
some
of
the
work
that
Ariadne
is
doing.
We
are
on
the
I'm,
a
member
of
the
delivery
decisions
initiative
and
we
work
to
improve
child
birth
outcomes
in
the
u.s..
K
We
do
a
lot
of
work
in
health
systems
trying
to
reduce
cesarean
section
rates,
as
well
as
increase
autonomy
for
birthing
patients
in
communication
and
some
of
the
issues
that
you
guys
really
talked
about.
But
one
of
the
new
initiatives
that
I'm
actually
working
on
at
Ariadne
is
to
collaborate
with
cities
around
what
cities
need
that.
The
tools
that
folks,
like
you,
need
in
terms
of
data
and
evidence
and
process
and
capacity
to
really
be
able
to
respond
to
maternal
health
issues
like
we've
been
talking
about
today.
So
that's
something
it's
a
brand-new
initiative.
K
We've
just
launched
it,
but
it
sort
of
dovetails
nicely
with
the
work
that
that
dr.
Molina
is
doing
here
in
Boston
and
we're
really
trying
to
think
about
what
do
cities
as
platforms
for
improving
maternal
well-being.
What
do
you?
What
do
you
guys
need
to
really
be
able
to
take
action
around
this
issue?
So
would
love
to
keep
talking
and
just
thanks
so
much
for
having
this
hearing
today.
Thank.
A
A
If
you
haven't
left
it
with
us
already
and
we'll
make
sure
that
everyone
is
kept
in
the
loop
for
subsequent
working
sessions,
it
likely
would
be
after
the
first
of
the
year,
but
I
think
just
knowing
that
my
colleague
and
I
were
excited
about
getting
things
really
planned
and
working
ahead
of
time.
So
thank
you
all
for
that.
I
have
no
further
conclusion.