►
Description
This webinar explored the current state of maternal mortality in the United States, potential strategies to decrease the disparities in maternal deaths, and examples of state legislative actions to reduce rates.
A
Good
afternoon
and
thank
you
for
joining
us
for
the
national
conference
of
state
legislatures
public
health
webinar
series,
our
webinar
today
is
titled
saving
moms
strategies
to
reduce
maternal
mortality
in
the
us.
My
name
is
tammy,
jo
hell
and
I'm
a
policy
specialist
in
ncsl's
health
program
and
I'll,
be
your
moderator.
For
today,
before
I
introduce
our
speakers,
I
want
to
review
a
few
housekeeping
items.
Today's
webinar
is
a
platform
for
information
exchange
and
engagement
over
the
next
60
minutes.
A
We
encourage
participation
through
our
chat
box,
so
feel
free
to
type
your
questions
and
answer
any
questions
in
the
chat
box
on
your
screen
to
begin
building
some
comfortability
with
the
chat
function
and
to
learn
who's
on
the
line.
Today,
I
invite
you
to
type
in
the
state
from
which
you're
calling
now
we
will
hold
a
formal
q.
A
after
presentations
are
finished.
Presenting
I
want
to
briefly
mention
the
resources
above
the
presentation.
You
will
see
a
couple
tabs
with
them
labeled
resources.
A
A
A
A
A
Then
ncs
sells
kind
win
will
provide
a
brief
overview
of
state
legislative
trends
from
the
last
few
years
before
we
hear
from
two
state
legislators
who
will
share
their
own
work
to
reduce
maternal
mortality
in
their
states,
we
will
then
hold
a
general
q.
A
for
all
speakers,
please
feel
free
to
type
your
questions
throughout
the
webinar
in
that
chat
box.
A
We're
here
today,
because
approximately
700
women
die
every
year
from
pregnancy-related
causes,
giving
the
united
states
the
highest
maternal
mortality
rate
among
similar,
wealthy
nations.
Research
has
shown
about
3
out
of
5.
Pregnancy-Related
deaths
are
preventable
and
there
are
significant
racial
disparities
in
maternal
mortality
rates.
A
A
Now
we're
ready
to
hear
from
our
presenters.
First,
we
have
a
national
overview
from
dr
elizabeth
howell,
chair
of
the
department
of
obstetrics
and
gynecology
at
the
university
of
pennsylvania's
pearl
pearlman
school
of
medicine.
Dr
howell's
research
focuses
on
the
intersection
between
quality
of
care
and
disparities
in
maternal
and
infant
mortality
and
morbidity
and
postpartum
depression
and
its
impact
on
underserved
communities.
B
Thank
you
very
much.
It's
a
pleasure
to
be
here
today
and
to
talk
to
you
about
maternal
mortality
and
the
u.s
maternal
health
care
crisis.
You've
already
heard
that
there
are
about
700
deaths
from
pregnancy-related
causes.
Every
year
in
the
united
states
our
rates
are
higher
than
all
other
high-income
countries.
Our
rates
have
actually
increased
over
the
last
decade,
while
other
countries
have
successfully
reduced
their
rates.
Yet
we
live
in
a
country
that
spends
has
the
highest
expenditure
on
health
care
as
compared
to
any
other
country.
B
But
a
big
part
of
the
reason
we
do
so
poorly
on
this
metric
are
the
large
racial
and
ethnic
disparities
that
exist
in
this
country.
They
are
long-standing.
The
black
white
gap
has
been
known
for
the
last
hundred
years
ever
since
it
started
to
be
documented,
and
this
slide
just
sort
of
shows
you
three
stories
of
women
that
died.
A
pregnancy-related
death
now
up
in
the
upper
right
hand,
corner
is
dr
shalon
irving.
B
Dr
irving
was
a
cdc
epidemiologist
and
she
had
her
first
child
delivered
from
a
cesarean
section
was
sent
home,
and
three
weeks
later,
she
died
from
complications
of
high
blood
pressure.
She
was
seen
four
or
five
times
by
health
care
providers
in
those
three
weeks,
yet
she
still
died.
On
the
left,
lower
hand.
Corner
is
erica
garner.
She
is
the
daughter
of
eric
garner
who
was
killed
by
the
new
york
city
police.
B
She
became
a
big
advocate
against
police
brutality.
She
died
three
months
following
childbirth,
from
a
heart
attack
and
on
the
lower
right
is
the
story
of
rosa
diaz,
who
was
featured
in
a
piece
by
propublica
where
they
were
talking
about
health
insurance
and
maternal
health
care
in
in
texas,
and
miss
diaz
actually
died
from
a
ruptured
ectopic.
She
did
not
have
health
insurance
and
she
delayed
seeking
care.
B
So
these
racial
and
ethnic
disparities,
as
I
mentioned,
are
long-standing,
and
this
is
data
from
the
cdc
showing
you
pregnancy-related
mortality
ratios
from
2007
through
2016.,
and
you
can
see
that
black
women
are
about
three
times
more
than
three
times
as
likely
to
die
as
compared
to
white
women
and
indigenous
women.
American
indian
women
are
over
twice
as
likely
to
die
from
a
pregnancy
related
cause.
B
So
let
me
take
a
moment
and
just
explain
some
of
the
definitions.
You
often
hear
us
talking
about
maternal
mortality,
we're
talking
about
a
death
that
has
occurred
within
42
days
from
a
pregnancy-related
cause
and
and
again
42
days
of
a
pregnancy.
This
is
this
measure
that
the
world
health
organization
uses
to
compare
countries
on
the
statistic
in
this
country
in
the
united
states.
B
We
often
at
the
cdc,
in
addition
to
measuring
maternal
mortality
measures,
something
called
pregnancy-related
mortality,
and
what
this
is
is
a
death
within
one
year
from
a
pregnancy-related
cause,
and
you
know
what
so
many
of
the
things
you
can
think
about.
Eclampsia
a
seizure,
a
stroke,
all
those
things
happen
and
then
may
result
in
a
death.
Those
are
pregnancy-related
causes.
B
When
we
talk
about
disparities,
it's
important
to
realize
that
we're
talking
about
a
social
justice
issue.
I
believe
it
was
margaret
whitehood
whitehead.
Excuse
me
in
the
early
1990s
who
was
talking
about
this
in
the
united
kingdom
and
and
talking
about
something
being
unjust
or
unfair.
Here
is
a
definition
from
a
a
professor
at
ucsf,
dr
braveman,
and
I
feel
I
I
find
it
quite
helpful.
Health,
equity
and
health
disparities
are
intertwined.
B
B
And
now,
if
you
compare
black
women
to
college
education
to
the
left
side
of
this
chart,
you
can
see
as
compared
to
a
white
woman
in
blue
with
less
than
a
high
school
education.
A
black
woman
is
about
1.6
times
more
likely
to
die
a
black
woman
with
a
college
education.
So
again,
this
goes
beyond
class.
B
So
what
are
some
of
the
causes?
You
know
overall
in
this
country.
Overall,
cardiovascular
disease
is
the
number
one
cause
of
pregnancy-related
deaths
for
all
races
and
ethnicities
right
now
overall,
but
I
wanted
to
show
you
this
slide,
because
I
think
we
have
to
dig
deeper
to
try
to
understand
what
are
the
major
causes
in
different
groups
so
that
we
can
come
up
with
solutions
to
address
these
issues
and,
as
a
slide
demonstrates,
you
can
see
that
cardiovascular
conditions
are
high
for
both
black
and
white
women.
B
Cardiomyopathy
preeclampsia
and
eclancia
things
related
to
hypertension
are
more
pronounced
for
black
women
and
for
white
women.
You
can
see
that
mental
health
conditions.
I
was
telling
you
earlier
about
suicide
and
the
growing
risk
from
overdose
opioid
deaths
in
it
from
pregnant
in
pregnant
women.
These
are
growing
in
the
country.
B
The
other
important
thing
to
note
about
not
only
to
think
about
the
causes,
but
the
timing
of
a
pregnancy-related
death
is
really
important
and
it
turns
out
that
about
a
third
of
these
deaths
occur
while
a
woman
is
pregnant,
about,
17
18
actually
occur
on
the
delivery
day,
but
52
of
these
deaths.
So
over
half
of
these
deaths
occur
from
in
the
postpartum
year
so
from
day
one
postpartum
all
the
way
through
12
months,
so
thinking
about
timing
is
critical
as
we
start
to
come
up
with
solutions
that
we
want
to.
B
You
know
utilize
to
address
this
issue,
but
you
know
for
every
maternal
death
over
a
hundred
women
suffer
severe
maternal
morbidity.
These
are
severe
complications
related
to
delivery
things
like
shock.
You
know
a
clot
embolism
eclampsia
seizures
having
a
hysterectomy,
because
a
woman
has
lost
so
much
blood
and
she's
hemorrhaged.
B
B
B
Now
the
cdc
and
others
have
shown
us
that
these
deaths
are
preventable.
These
case
reviews
have
been
instrumental
in
us
getting
a
better
understanding
of
the
contributing
causes,
and
we
know
that
over
60
percent
of
these
deaths
are
preventable.
Making
this
you
know
an
incredible
loss
and
tragedy
and
something
that
we
desperately
need
to
address
now.
I'm
a
health
services
researcher
and
I
wanted
to
sort
of
help.
You
understand
how
I
think
about
this
issue,
because
I
think
this
is
important
to
thinking
about
solutions,
so
there's
a
growing
recognition.
B
I
think
that
this
coveted
pandemic
has
really
brought
to
the
forefront
how
structural
racism
and
discrimination
really
underlie
a
lot
of
these
disparities
and
underlie
health
in
so
many
ways.
So
at
the
patient
level
we
can
think
about
age
and
education,
poverty
and
insurance.
We
can
think
about
knowledge,
belief
and
health
behaviors.
B
We
can
think
about
psychosocial
issues
such
as
stress
the
weathering
hypothesis,
the
idea
that,
because
of
chronic
discrimination,
women
have
black
women's
bodies,
age
quicker,
and
so
that
results
in
more
adverse
birth
outcomes
and
social
support.
We
can
think
about
community
and
neighborhood
factors
such
as
the
social
network,
crime,
poverty,
the
built
environment,
clinician
factors
such
as
knowledge,
experience,
our
own
biases,
implicit
or
explicit
cultural
competence
in
our
communication
skills
and
then
system
factors,
access
to
high
quality
care,
transportation
and
other
policy
level
factors.
B
B
So
it's
not
just
that
there
are
between
hospital
differences.
We've
done
additional
work
that
has
shown
us
that
a
black
woman
and
a
latinx
woman
in
new
york
city
has
a
higher
risk
of
having
a
severe
maternal
morbidity
as
compared
to
a
white
woman,
even
in
the
same
hospital
after
accounting
for
things
like
medical
insurance,
hypertension,
age,
obesity
and
those
kinds
of
factors.
B
B
In
addition,
we
need
to
think
about
that
postpartum
period.
Remember
I
told
you
that
over
half
of
these
deaths
occur
in
this
period
and
we
need
to
make
sure
that
we
give
women
the
access
to
care
that
they
need.
There
are
new
models,
such
as
patient
navigators
and
case
management
that
have
been
showing
a
lot
of
promise
in
this
area,
but
we
can't
forget
the
story
of
serena
williams.
B
B
B
B
So
I
want
to
end
by
just
walking,
through
some
of
the
policy
levers,
that
I
think
we
can
utilize
to
address
the
maternal
health
care
crisis,
and
there
are
so
many
conversations
going
on
currently
and
movement
on
a
number
of
these
fronts.
First,
the
extension
of
medicaid
to
12
months
postpartum
is
so
essential.
Remember
I
told
you
52
of
these
deaths
are
occurring
in
this
period
and
making
sure
that
women
have
access
to
health
care
is
essential,
especially
for
those
women
who
are
high
risk,
who
have
chronic
illnesses,
who
are
more
at
risk.
B
For
example,
women
with
high
blood
pressure
state,
maternal
mortality
review
boards
are
so
very
important.
We
have
learned
from
overseas
that
these
case
reviews
are
critical.
If
we're
ever
going
to
be
able
to
lower
the
rates
of
deaths
in
this
country,
you
learn
about
what
the
contributing
causes
are.
You
study
what's
preventable?
What's
not
and
it's
those
lessons
that
inform
how
we
move
forward
state
perinatal
quality
collaboratives
are
so
important.
They
provide
a
mechanism
for
quality
improvement.
B
They
often
have
both
a
maternal
and
an
infant,
a
component,
and
it's
a
way
for
some
of
the
standardized
bundles
that
I
was
talking
about
before
to
actually
be
implemented
in
hospitals.
It's
very
important
data
collection
and
reporting.
So
we
need
to
make
sure
that
hospitals
are
able
and
are
mandated
to
to
collect
self-identified
race,
ethnicity,
and
then
we
need
to
think
about
measuring
and
reporting
all
the
quality
measures
by
stratified
by
race
and
ethnicity.
So
we
can
understand
how
we're
performing
for
different
racial
and
ethnic
groups.
B
We
need
to
implement
bias
trainings
in
health
care
facilities.
We
need
not
only
address
implicit
bias,
but
we
need
to
think
about
strategies
around
explicit
bias.
We've
learned
so
much
in
the
healthcare
industry
and
healthcare
field
about
patient
safety,
and
we
can
use
many
of
those
lessons
around
patient
safety
to
build
a
culture
of
equity
within
our
facilities.
B
Doula
care.
You
know
there
have
been
a
number
of
studies
showing
us
that
when
doulas
are
involved,
there
are
less
interventions
during
delivery,
whether
that's
a
cesarean
section
or
other
other
interventions,
so
increasing
medicaid
coverage
for
doulas
is
an
important
tool
for
us
to
use.
Once
a
woman
has
a
cesarean
section
and
then
she
has
another
one.
She
starts
to
increase
her
risk
for
morbidity
and
becoming
one
of
these
women
who
experience
severe
maternal
morbidity.
B
We
need
to
integrate
maternal
behavioral
health
screenings
around
depression
antepartum
during
pregnancy,
postpartum
at
the
new
at
the
at
the
infant
healthcare
visits,
so
that
we
can
do
this
for
women.
We
need
to
also
be
thinking
about
screenings
around
substance
use
and
then
finally,
we
need
to
recognize
that
medicaid
expansion
that
having
access
to
prenatal
care
is
important
that
many
racial
and
ethnic
women
often
get
prenatal
care
in
the
third
trimester
or
or
later,
and
so
we
need
to
do
things
to
expand
access
to
antenatal
care.
B
A
A
The
poll
should
appear
on
your
screen
and
the
question
will
read.
I
am
aware
of
the
following
in
my
state:
please
feel
free
to
select
as
many
of
those
options
as
you
see
on
your
screen,
while
you're
selecting.
I
would
also
like
to
remind
you
about
the
audience
chat
box
feel
free
to
put
in
any
questions
throughout
all
of
our
presentations
today,
and
we
will
be
sure
to
address
them
here
at
the.
A
A
Wonderful-
and
it
looks
like
here
for
the
most
part
we
see
a
lot
of
folks
are
not
sure
what
they
have
in
their
states,
and
I
see
this
would
be
a
great
question
for
some
of
our
presenters
to
think
about
about
ways
that
you
can
find
this
information
out
in
your
state.
Although
I
will
say
we
do
also
see
folks
that
are
saying
they
see
the
maternal
mortality
review
committee
as
a
policy
option
within
their
state.
A
A
A
So
first,
a
number
of
states
have
passed
resolutions
to
bring
awareness
to
maternal
health
and
recognize
the
toll
of
maternal
mortality
in
their
states.
The
examples
included
here
range
from
calling
specific
attention
to
black
maternal
health
in
delaware
to
a
general
recognition
of
women
who
die
from
complications
of
pregnancy
or
childbirth,
such
as
in
pennsylvania.
A
A
A
A
For
example,
oklahoma
established
legislative
authority
for
its
maternal
mortality,
review
committee
and
added
a
requirement
to
look
at
quality
of
care,
lack
of
transportation
and
lack
of
financial
resources
specifically
and
vermont.
Revised
provisions
related
to
its
review
panel,
around
membership,
access
to
information
and
a
requirement
to
consider
health
disparities
and
social
determinants
of
health
in
their
reviews
on
the
theme
of
using
data
to
improve
care
states
also
address
maternal
healthcare
quality
through
perinatal
quality
collaboratives,
which
identify
healthcare
processes
that
need
to
be
improved
and
use.
A
New
jersey,
for
example,
recently
established
a
statewide
maternal
care,
quality
collaborative
to
coordinate
efforts
across
multiple
committees,
programs
and
healthcare
cooperatives
states
have
also
looked
at
maternal
healthcare
quality
through
actions
around
midwifery
practice
and
around
perinatal
provider.
Training
regarding
midwives
states
have
studied
and
explored
their
role
in
maternal
health
care
and
set
forth
licensure
and
standards
for
quality
training
and
scope
of
practice.
A
Other
efforts
to
ensure
high
quality,
prenatal
care
or
perinatal
care
include
those
to
reduce
racial
disparities
through
provider
training,
for
example,
california
and
maryland,
will
require
certain
perinatal
care
providers
to
complete
ongoing,
evidence-based
implicit
bias.
Training,
citing
that
implicit
bias
is
a
key
cause
that
drives
health
disparities
in
communities
of
color.
A
So
I
hope
these
quick
examples
were
helpful
in
providing
a
snapshot
of
recent
maternal
mortality
policy
trends.
You
can
browse
our
maternal
and
child
health.
Legislative
database
for
more
enacted,
builds
on
this
topic
check
out
other
ncsr
resources
and,
of
course,
reach
out
to
me
with
any
specific
questions
or
requests.
Thank
you.
So
much.
A
Thank
you
so
much
khan.
Next
we're
going
to
hear
from
two
legislators
who
will
share
their
work
on
maternal
mortality
in
their
states.
Representative
dempsey
is
joining
us
first
from
georgia
and
assemblywoman
salaj
from
new
york,
representative
dempsey
was
elected
to
the
georgia
house
of
representatives
in
2006
and
is
currently
the
chairwoman
of
the
appropriations
resource
committee
and
member
of
the
health
and
human
services
committee
among
others
you
so
much
for
joining
us
today.
I
will
let
you
take
it.
D
I
really
enjoyed.
What
dr
howell
presented
today
at
the
end
of
her
chat.
She
posted
nine
policy
levers
that
we
all
need
to
address
to
address
this
crisis,
and
I
just
want
to
talk
to
you
about
five
that
in
georgia,
particularly
we've
been
focused
on
the
first
work,
really
began
in
2014
with
the
establishment
of
the
maternal
mortality
review
committee.
It
did
come
about
through
legislation
and
also
through
appropriations
and
continues
to
be
a
part
of
our
budget.
It
was
part
of
the
2020
budget
that
we
have
just
finished.
D
The
committee
is
currently
reviewing
cases
from
20
2017
and
we'll
finish
reviewing
the
cases
from
2018
and
2019
by
the
end
of
2021..
Now
that
seems
like
we're
we're
working
backwards
and
trying
to
catch
up.
We
certainly
are,
but
that
will
help
us
reach
the
cdc's
goal
of
reviewing
deaths
within
two
years
of
the
date
of
that
death.
D
This
past
june,
we
also
implemented
interviews
with
family
members
or
other
close
contacts
that
would
give
us
some
more
information
information
that
doesn't
always
show
up
in
medical
records
alone
to
make
sure
that
we
are
really
examining
the
barriers
to
care
and
the
social
determinants
of
health.
Georgia
was
one
of
the
first
states
to
implement
this
policy
of
looking
deeper
beyond
what
medical
records
show.
D
So
that
is
the
first
one.
The
next
one
I
want
to
highlight
is
our
perinatal
psychiatry,
access
program,
peace,
p-e-a-c-e
for
moms
and
the
20
budget.
We
actually
appropriated
about
a
million
dollars
for
this.
It
is
the
psychiatry
access
program
that
provides
free,
rapid
consultations
between
obstetric
obstetric
providers
and
perinatal
psychiatrists
at
emory
university.
D
These
providers
are
receiving
training
and
consultation
on
how
to
screen
their
patients
for
depression,
anxiety
and
those
other
mental
health
conditions
and
how
to
manage
the
medication
that
is
involved
at
times
increasing
this
access
to
mental
health
care
for
pregnant
and
postpartum
women.
Women
is
particularly
important
in
georgia's
rural
areas,
and
so
working
in
this
manner
is
greatly
helping
address
those
concerns.
D
D
D
Georgia
is
this.
This
collaborative
is
leading
maternal
quality
improvements
in
54
birthing
hospitals
throughout
our
state.
It's
currently
implementing
the
alliance
for
innovation
on
maternal
health
and
patient
safety
that
bundle
for
obstetric
hemorrhage
and
severe
hypertension.
Those
are
two
of
the
leading
causes
of
maternal
death
in
our
georgia.
D
The
last
is
one
that
we've
taken
a
step
forward
on
and
that
I
hope
that
we
can
do
even
more
in
the
future.
We've
just
heard
about
how
important
the
months
following
delivery
are:
georgia
increased
their
postpartum
care
through
medicaid
for
six
months
wish
it
was
12,
but
six
is
better
than
where
we
were
from
2012
to
2015.
D
E
C
C
So
you
know
time
and
time
we
said
over
in
this.
In
this
webinar
women
in
the
united
states
die
from
pregnancy
related
causes
each
year
at
a
much
higher
rate
than
in
most
other
high
income
countries
and
the
mature.
The
mortality
rate
from
causes
related
to
pregnancy
and
childbirth
vary
across
the
different
states,
and
it
also
varies
across
different
regions,
a
state
like
new
york.
We
have
urban,
obviously
everyone
knows
of
new
york
city,
but
we
also
have
suburban
and
we
also
have
very
rural
areas.
C
Each
of
those
areas
have
their
unique
challenges,
especially
now
that
we're
living
within
a
pandemic.
The
challenges
are
even
greater
so
book
your
seatbelt,
I'm
quickly
going
to
highlight
some
of
the
stuff
that
new
york
state
is
doing
to
ensure
that
we're
bringing
high
quality
measures
that
are
enriching
and
also
providing
equity
in
the
care
of
birthing
people.
C
We've
passed
a
measure
in
2015
that
would
permit
pregnant
women
to
enroll
in
the
state
health
exchange
at
the
time
at
the
at
any
time.
Excuse
me,
anytime.
During
birth,
we
were
the
first
state
in
the
nation
to
make
pregnancy
a
qualifying
event
in
order
for
you
to
obtain
health
insurance
benefits
at
any
time
through
our
health
exchange.
C
So
just
for
fyi
life
events
can
include
a
change
of
residence,
birth
adoption,
marriage,
death
and
divorce
and
in
new
york
state.
Their
enrollment
period
is
from
october
to
december,
and
so
we
know
that
health,
insurance
or
health
coverage
for
a
woman
could
be
effective
as
a
a
special
way
or
effective
as
a
way
for
women
to
have
healthier
pregnancies
by
ensuring
they
have
access
to
prenatal
care
and
better
preparation
for
childbirth,
especially
when,
when
women
have
pre-existing
conditions,
timely
and
appropriate
medical
care
will
decrease
and
prevent
health
related
pregnancies.
C
C
The
savings
is
improved:
birth
outcomes,
child
development
and
school
readiness,
reductions
in
child
abuse
and
neglect
and
juvenile
crime,
and
these
are
outcomes
that
we
will
save
in
the
long
run
as
a
state.
As
you
know,
birthing
doesn't
come
with
a
manual
or
instructions
I
wish,
and
for
many
first-time
mothers
they're
not
familiar
with
some
of
the
symptoms
of
preeclampsia
or
or
heart
attack
or
any
of
this.
So
the
nurse
is
there
to
help
guide
them.
That's
a
resource
for
these,
these
young
women
to
reach
out
to
to
learn
or
to
ask
questions.
C
I've
heard
so
many
stories
of
women
who
reached
out
to
their
nurse
when
they
had
issues,
whether
it's
emotional
or
physical
and
the
nurse
was,
was
able
to
help
them
and
be
there
for
them.
A
second
great
resource
that
we
have
in
new
york
state
is
our
doula
program.
So,
as
said
before,
our
doulas
is
a
support
person
they're
there,
slowly
solely
for
the
mother
and
the
birthing
partner
in
the
the
months
leading
to
birth
during
labor
and
postpartum.
C
I
currently
sponsor
legislation
for
medicaid
coverage
for
doula
services,
about
43
percent
of
the
births
in
new
york.
State
are
financed
by
medicaid,
so
extensive,
reliable
research
shows
that
doula
care
is
a
high
value
model
that
improves
child
birth.
It
increases
the
quality
of
care
and
it
also
provides
a
cost.
Saving
so
the
legislature
and
the
executive
we're
exploring
ways
of
how
we
can
implement
this
program,
and
so
in
2008
we
actually
started
a
medicaid
pilot
program
to
cover
dealer
services.
C
The
medicaid
pilot
program
covered
labor,
supports
labor
support.
It
also
covered
home
visits
by
the
doulas
in
order
to
address
discrimination
or
inequalities
in
health
care
experienced
by
low-income
communities
and
communities
of
color.
The
doula
care
include
non-clinical
emotional,
physical
and
informational
support
before,
during
and
after
labor
and
birth,
and
it
was,
it-
was
covered
by
the
state's
medicaid
fee
for
service
plans
in
rural
areas
like
erie,
county
and
upstate
new
york.
C
We
are
seeing
positive
outcomes,
we
see
it
already
with
the
numbers
and
the
cost
analysis
has
found
that
doula
care
also
reduces
and
helps
avoid
unnecessary
medical
procedures
and
potential
complications
or
chronic
conditions
from
birth.
It
reduces
the
nicu
emissions
and
it
fosters
healthy
relationships
and
also
fosters
breastfeeding,
which
is
something
very
important
and
with
the
few
moments
I
have,
I
also
want
to
address
how
the
state
is
tackling
ways
to
eliminate
racial
disparities
in
maternal
mortality.
C
We
know
that
poverty
and
racism
are
public
health
crisis
and
united
states
has
the
highest
maternal
and
infant
mortality
rates
among
development
nation,
developing
nations,
especially
when
it
comes
to
african-american
women
and
so
women
across
the
spectrum
of
income.
Spectrum
of
all
walks
of
life
are
dying
from
preventable
pregnancy-related
complications.
C
So
you
know
it
it's
it's
birth,
it
shouldn't
be
legal,
it's
going
a
little
script,
you
know
it's
a
travesty
and
that's
something
that
we
as
a
state
have
taken
very
seriously.
So
we
create
a
task
force
on
maternal
mortality
and
we
are
using
a
comprehensive
initiative
to
target
that
and
we've
done
research
we
brought
experts
together.
C
C
It
will
also
expand
community
outreach
and
tackle
you
know
the
increase
in
access
to
prenatal
care,
so
the
task
force
met
back
in
2008
and
we
came
up
with
some
recommendations,
and
so
a
few
of
the
recommendations
are
establishing
a
statewide
maternal
mortality
review
board
in
statute,
which
we've
done.
We
also
design
and
implemented
a
comprehensive
training
and
education
education
program
for
hospitals
on
implicit
and
racial
bias.
C
We
also
launched
the
best
practice
summit
with
hospitals
and
obs
and
gynecologists
so
that
we
could
start
talking
to
them
about
implicit
bias
and
what
we
can
do
to
make
it
better
for
for
black
women.
We
we
provided,
and
we
are
looking
to
provide
scholarships
and
loan
forgiveness
for
women
who
are
interested
in
mimwifery
or
to
become
a
doula
and
there's
many
other
different
reports,
and
so,
if
you're
interested
in
that
report,
you
can
search
the
keywords.
C
New
york,
state,
maternal
mortality
and
racial
outcome,
task
force
and
you'll
be
able
to
get
the
complete
report
report.
It's
actually
excellent,
and
so
with
that.
I
thank
everyone
for
this.
This
great
conversation-
and
I
just
implore
you
to
keep
pushing
legislation,
keep
having
this
conversation.
It
shouldn't
be
a
trend.
E
E
E
E
Thank
you.
So
much
klein,
it
looks
like
you
have
provided
some
examples
here
of
resources
that
are
in
the
chat
box.
It
looks
like
only
a
few
states
have
enacted
at
this
point
for
efforts
around
postpartum
coverage
and
medicaid,
but
this
has
been
a
trend
in
recent
years
and
that
I
would
anticipate
with
kim's
approval
here
that
this
will
likely
be
a
trend
that
we'll
continue
to
see.
E
E
E
B
So
I'll
start-
and
I'm
sure
other
people
want
to
chime
in
here,
but
we
do
know
that
we,
we
think
that
covid,
that
when
you
are
pregnant,
if
you
get
severe,
you
may
get
more
severe
disease.
So
the
cdc
recently
came
out
with
a
report
suggesting
that
the
the
that
your-
and
we
know
this
in
pregnancy
in
general
right.
We
know
that
women
with
the
flu
who
are
pregnant,
often
get
sicker,
and
it
seems
right
now
with
the
information
that
we
have
so
far
that
there
is.
B
There
is
a
sense
that
pregnant
women
who
get
covet
disease
can
get
sicker
and
and
that
recent
report
from
the
cdc
showed
us
that
the
there's
not
as
much
data
there's
it's
a
bit
mixed
on
the
actual
birth
outcomes
associated
with
covet.
So
there's
some
some
thinking
that
there's
higher
rates
of
preterm
birth.
B
You
know
people
in
the
maternal
health
field
have
been
talking
about
for
years
right,
so
it
was
sort
of
it's
interesting.
It's
unveiled
it
for
the
rest
of
the
country,
but
sort
of
the
role
of
racism
and
how
it
impacts,
health
and
and
and
and
the
disparities
you
see.
We've
been
talking
about
and
sort
of
doing,
research
in
that
space
for
quite
some
time.
E
Thank
you
so
much
dr
howell
really
appreciate
that.
Next,
I
have
a
question
here
for
both
of
our
respondents.
Our
legislative
responders.
Excuse
me,
it
says
what
were
the
biggest
barriers
you
faced
in
passing
this
legislation
and
how
did
you
overcome
them?
Representative,
dempsey?
Let's
start
with
you.
D
D
C
And
I
just
I
definitely
agree
you
know.
Education
is
a
key
and
and
providing
colleagues
with
appropriate
education
on
the
this
topic
is
is
essential,
but
also
it's
the
financing.
You
know
everyone
every
legislator
wants
to
invest.
You
know
money
into
so
many
different
issues,
and
really
just
you
know,
advocating
and
being
aggressive
and
and
making
sure
that
we
invest
into
maternal
mortality
is
what
we
should
be
doing
as
a
a
country.
You
know
the
brain
science
is
there.
C
If
we
invest
in
the
first
thousand
days
of
life
and
even
the
first
five
thousand
days
of
life,
they
are
less
likely
to,
you
know:
go
into
illicit
activity,
they're
more
likely
to
stay
in
school.
So
you
know
it's
just
really,
educating
colleagues
and
just
advocating
to
ensure
that
you
know
you're
investing
that
money
into
you
know
our
youngest
americans.
E
I
would
also
like
to
highlight
that
today's
webinar
was
part
of
ncsl's
public
health
webinar
series.
There
are
three
left
in
the
series
picking
backed
up
in
january
for
a
complete
schedule,
links
to
recordings
of
previous
webinars
and
registration
details
for
upcoming
webinars.
Please
follow
the
link
on
the
slide
or
in
your
resource
document.
E
Finally,
I
would
like
to
say
one
more
big.
Thank
you
to
our
presenters.
We
greatly
appreciate
your
expertise
that
each
of
you
provided
and
again
to
our
sponsors,
the
cdc
and
the
maternal
and
child
and
health
bureau.
Thank
you
again
to
our
attendees
for
joining
today's
webinar.
As
a
reminder,
a
recording
of
the
presentation
slides
will
be
available
on
ncsl's
website
within
a
week.
If
you
have
any
questions
or
research
related
needs
to
maternal
mortality,
please
reach
out
to
kind
win,
have
a
great
day.