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From YouTube: Committee on Public Health and Human Services 10-15-2019
Description
The Committee on Public Health and Human Services of the Council of the City of Philadelphia held a Public Hearing on Tuesday, October 15, 2019, at 2:00 PM, in Room 400, City Hall, to hear testimony on the following items:
190040 Resolution authorizing the Committee on Public Health and Human Services to hold hearings on the increase in maternal mortality among African American women in Philadelphia.
Committee on Public Health and Human Services
Chair: Councilmember Cindy Bass (8th District)
Vice Chair: Councilmember Maria D. Quiñones Sánchez (7th District)
A
Good
afternoon,
good
afternoon,
this
hearing
is
called
to
order.
This
is
the
public
hearing
of
the
City
Council
Committee
on
Public
Health
and
Human
Services.
The
purpose
of
this
meeting
is
to
hear
testimony
on
resolution
number
one:
nine,
zero,
zero,
four
zero.
The
members
of
the
committee
and
attendants
are
myself
and
Councilman
bill
Greenlee,
and
we
expect
others
to
be
joining
us
throughout
the
course
of
this
hearing.
And
now,
if
we
could
have
the
clerk
read
the
title
of
resolution
number
one:
nine:
zero,
zero,
four
zero.
B
D
You,
madam
chair
I,
just
want
to
say,
I
think
this
is
an
important
hearing
and
because
I
was
one
that
did
not
know
about
this
issue.
I
remember
many
years
ago
the
wife
of
one
of
the
Philadelphia
Flower
hockey
players
died
in
childbirth
and
I
thought
that
was
so
terribly
rare,
but
I'm
hearing
that
among
certain
segments
of
our
community,
unfortunately,
it's
not
rare
so
I
think
that's
very
important
I'm
interested
to
hear
some
of
the
background
on
this.
Thank
you,
madam
chair.
Thank.
A
A
C
State
representative,
Morgan
Cephas
of
the
192nd
legislative
district,
so
I
first
want
to
thank
the
committee,
the
chairwoman
and
Councilman
Greenlee
for
having
a
targeted
conversation
about
an
issue.
That's
honestly
plaguing
the
entire
country,
and
we
have
a
series
of
stakeholders
here
today
that
have
been
in
this
space
longer
than
I
have
so.
As
elected
officials.
We
always
like
to
lean
on
experts
when
it
comes
to
this
of
subject
matter,
to
come
up
with
policy
recommendations,
legislative
recommendations
and
just
provide
us
answers
from
their
perspective
because
they
are
on
the
ground.
C
And
so
what
do
we
need
to
do
on
the
local
state
and
federal
level?
So
again,
I
am
state
representative,
Morgan,
Cephas
and
I
served
the
192nd
legislative
district
in
West
Philadelphia,
as
we
sit
here
today
to
address
the
daunting
issue
of
maternal
mortality.
I
want
to
tell
you
about
miss
leshawna
Gilmore,
a
34
year
old
woman
from
my
district,
who,
like
too
many
women
and
far
too
many
black
women
died
while
giving
birth.
Just
this
past
summer,
the
pet.
C
This
past
June
leshawna
celebrated
her
34th
birthday
and
just
over
a
month
later,
on
July
26.
This
very
healthy
young
woman
went
into
labor.
She
made
her
way
to
the
hospital
to
experience
what
was
supposed
to
be
a
joyous
occasion:
the
birth
of
her
precious
baby
girl,
but
leshawna
didn't
survive
the
delivery.
C
Unfortunately,
her
story
is
just
one
of
far
too
many
tragic
stories
of
women
in
Philadelphia
and
across
our
state
and
country
who
have
succumbed
to
this
crisis.
Her
death
has
especially
left
a
void
in
the
life
of
her
now
2
month-old
baby
girl,
who
must
now
go
for
a
lifetime
without
her
mother
lashauwn
and
many
women
leshawna
and
many
women
like
her,
are
more
than
a
statistic.
The
harrowing
reality
is
that
she
leaves
behind
a
ten
year
old
son
and
again
a
two
month
old
daughter
and
mr.
C
guilt
of
Edward
Gilmore
lost
a
daughter
and
miss
Stephanie.
Gilmore
lost
a
sister.
Her
family
who
joins
us
here
today
or
will
be
joining
us
soon,
is
a
reminder
of
this
reality
and
that
we
are
far
from
any
form
of
solution.
Our
city,
our
state,
our
nation,
our
mothers,
our
families,
our
mr.
crisis,
this
great
nation
of
the
United
States,
has
one
of
the
highest
maternal
mortality
rates
in
developed
nations
higher
than
some
undeveloped
nations.
The
u.s.
C
loses
approximately
22
women
per
100,000
live
births
each
year,
whereas
neighboring
Canada
has
a
rate
of
7
per
hundred
thousand
in
the
US.
The
rates
of
maternal
mortality
are
three
times
as
higher
for
black
women
as
compared
to
white
women.
Maternal
mortality
disproportionately
affects
women
of
color,
even
when
controlling
for
factors
of
Education
and
income
levels
and
I.
Repeat
that,
because
oftentimes
when
we're
having
this
conversation,
some
people
like
to
equate
the
statistics
to
the
environment
that
that
individual
is
is
living
in.
C
But
we
know
with
listening
to
just
the
story
of
Serena
Williams,
who,
more
than
likely
can
afford
better
health
care
than
all
of
us.
Combined
still
had
challenges
with
her
pregnancy,
the
Centers
for
Disease,
Control
and
Prevention
reports
that
31%
of
the
deaths
with
maternal
mortality
occurred
during
pregnancy.
C
16%
occurred
during
the
day
of
delivery
and
a
majority.
I
repeat:
a
majority
of
the
deaths
happened
during
the
postpartum
period,
representing
51
percent
of
the
deaths.
What
we
do
know
is
that
our
mothers
are
dying
again.
We
also
know
that
black
women
and
women
of
color
are
at
greater
risk
of
maternal
death,
regardless
of
education,
level
and
social
economic
status.
Because
of
what
we
know,
we
must
remain
committed
to
addressing
the
core
factors
of
this
issue,
including
the
heart-wrenching
racial
disparities,
implicit
bias,
mental
health
and
substance
abuse
disorder
and
access
to
care.
C
Over
the
past
several
months,
in
conjunction
with
Philadelphia
women's
Commission,
with
the
leadership
of
our
executive
director,
we've
been
able
to
have
a
series
of
panel
discussions,
we've
hosted
several
public
policy
hearings.
We've
listed
testimony.
We've
listened
to
testimony
from
medical
professionals
advocates
effective
women
families.
We've
had
conversations
with
all
of
the
delivery
hospitals
in
the
city
of
Philadelphia
and
again
under
the
leadership
of
Jovita
Hill
from
the
Philadelphia
women's
commission.
C
C
Just
last
month,
Governor
Tom
Wolf's
announced
a
CDC
grant
funding
award
funding
award
for
the
Pennsylvania
maternal
mortality
review
committee,
which
supports
the
Philadelphia
review
committee,
and
we
were
able
to
secure
2.25
million,
and
last
month,
I
stood
together
with
the
Philadelphia
Department
of
Health,
as
they
announced
a
million
dollars
in
funding
from
the
firt
Merck
Foundation
for
mothers
for
the
maternal,
without
maternal
mortality,
review
committee
in
the
city
of
Philadelphia,
which
I'm
sure
other
representatives
here
will
speak
about
today.
Now
the
experts
will
talk
to
you
about
again
the
statistics.
C
The
advocates
will
tell
you
more
about
the
disparities.
The
practitioners
will
provide
insight
as
to
what
can
be
done
better
and
the
victims
will
share
their
tragic
story.
I
am
here
to
tell
you
that,
for
us,
legislators
and
policymakers,
the
time
is
now
to
do
that.
To
do
all
that
is
in
our
power
to
save
the
lives
of
mothers
and
for
the
sake
of
our
families.
Conversation
after
conversation
leads
us
to
the
same
recommendations,
it's
time
for
us
to
help
move
those
recommendations
and
actions
and
results.
C
That
will
have
an
immediate
impact
on
the
individuals
that
we
serve
here
in
Philadelphia.
So
with
that
I
come
with
recommendations,
of
course,
so
one
of
those
recommendations
would
be
to
require
implicit
bias
and
cultural
competency,
training
for
all
students
in
the
medical
schools
in
the
city
of
Philadelphia
and
all
students
that
access
our
hospitals
in
the
city
of
Philadelphia
to
require
that
training.
C
And
how
can
we
fill
the
gaps
and
fill
the
challenges
that
exist
with
those
dollars
and
with
you
know,
strategic
thinking,
but
one
thing
that
it
often
doesn't
do
is
fund
the
actors
that
are
on
the
ground
trying
to
move
the
needle
high
council,
women
that
are
on
the
ground,
trying
to
move
the
needle
in
the
populations
that
they
serve.
So
I
look
at
a
potential
line
item
a
grant
program,
possibly
to
go
to
organizations
like
maternal
mortality.
I
mean
not
my
turn.
C
The
mortality
like
different
organizations
that
you'll
hear
before
this
council
in
this
body
that
have
innovative
strategies
that
they're
implementing
and
they
just
need
the
resources
on
the
order
to
scale
so
like
I,
meant
the
maternity
care
coalition.
Some
of
the
practices
that
they
have
the
last
piece
I
would
always
recommend
is
just
so
continuously
ask
the
question:
what
else
can
we
do
and
how
can
we
be
creative
in
our
responses?
So
I
again
think
this
legislative
body
for
taking
up
this
issue?
C
There
is
a
report
coming
out
that
reflects
our
numbers
here
in
the
city
of
Philadelphia,
for
maternal
mortality
and
I
can
tell
you
across
Pennsylvania
that
our
rates
are
increasing
and
one
of
the
newest
issue.
Well
not
new,
but
one
of
the
more
prevalent
issues
in
our
rates
now
is
a
substance
abuse
disorder.
C
So
when
you
think
of
the
opioid
crisis
and
how
it's
impacting
our
mothers,
they
are
indeed
impacted
and
some
of
the
legislative
pieces
that
we
are
considering
up
in
Harrisburg
one
is
to
expand
Medicaid
to
cover
up
to
a
year
postpartum
right
now.
It
only
covers
mothers
that
qualify
for
Medicaid
that
are
pregnant
up
to
six
weeks
right
now,
so
we're
asking
for
it
to
be
covered
up
to
a
year.
The
second
piece
is
again
similar
to
lawyers.
C
They
have
continued
legal
education
requirements,
so
we
would
add
implicit
bias,
implicit
bias,
training
to
continued
medical,
professional
education
requirements.
So
that's
the
second
piece.
A
third
piece
is
to
make
maternal
morbidity
a
reportable
event
right
now.
It's
just
maternal
mortality
and
far
too
many
mothers
are
still
having
complications
and
a
maternal
morbidity
is
what
essentially
represents
Serena
Williams
and
her
challenges
that
she
had.
The
last
piece
would
be
to
ensure
that
doulas
were
both
certified
and
able
to
be
reimbursed
by
insurance
companies
as
well
as
Medicaid.
One
of
the
things
I'm.
C
A
firm
believer
in
is
that
if
we
expand
the
healthcare
footprint
to
incorporate
a
lot
more
women
into
the
healthcare
profession,
then
I'm
hoping
that
we
could
see
a
lot
less
deaths.
So
I
again,
thank
you
for
having
this
conversation.
I
look
forward
to
any
questions
that
you
might
have
and
again
how
we
can
partner
on
a
local
and
state
level
to
really
move
this
needle,
not
just
in
the
Commonwealth
of
Pennsylvania,
but
with
with
in
Philadelphia
as
well.
Thank
you
thank.
A
A
Information
that
you
provided
about-
lishchyna,
yes,
leshawna
leshawna
leshawna,
really
took
me
back
and
reminded
me
of
my
own
experience
during
childbirth,
and
you
know,
as
a
woman
of
color
here
in
Philadelphia,
who
had
access
to
excellent
medical
care
and
who
had
prenatal
care
still
I
found
myself
in
a
very
scary
situation
and
having
preeclampsia
and
that
you
know
it's
it's
funny,
because
I
heard
recently
in
the
last
few
months,
or
so
that
Beyonce
actually
happy
yeah,
you
know
preeclampsia
as
well.
It's
like
everybody
wants
to
be
Beyonce,
except
from
that.
A
No,
but
nobody
wants
to
have
preeclampsia
and
what
a
horrifying
and
terrible
experience
it
really
was,
and
you
know
just
thinking
fast
forward
of
you
know
the
moment
when
I
realized
just
going
backwards.
The
moment
that
I
realized
that
this
is
something
like
I
might
not
be
here.
I
mean
I
just
gave
birth
to
a
baby,
and
I
might
not
be
here
to
care
for
that
child
and
how
incredibly
frightening
you
know.
A
A
You
know
I
just
thank
God
that
I
had
excellent
medical
care
from
the
folks
down
at
Pennsylvania
Hospital,
but
I
also
recognize
that,
even
with
that
excellent
health
care,
there's
still
a
lot
of
women
of
color
who
are
still
very
much
adversely
affected
and
who
are
not
being
able
to
pull
through,
and
we
would
need
to
ask
ourselves
why.
Why
is
this
happening
so
I
want
to
thank
you
for
your
testimony
and
open
up
that
anyone
else
have
questions
okay.
A
B
E
Afternoon,
chairman
woman
bass,
members
of
the
Public
Health
and
Human
Services
Committee,
thank
you
for
inviting
me
to
testify
on
this
very
important
issue
of
maternal
mortality
in
forints
of
resolution
number
nineteen
zero
zero
four
zero
I
am
an
obstetrician
and
gynecologist.
The
medical
director
of
obstetrics
at
Temple
University
Hospital
I
serve
as
an
associate
professor
at
a
fo
b
GYN
at
the
Lewis
Katz
School
of
Medicine.
E
As
you
know,
Temple
University
Hospital
and
the
Lewis
Katz
school
medicine
are
located
in
North
Philadelphia
and
some
of
the
most
socially
economically
challenged
areas
in
the
city
of
Philadelphia
and
Commonwealth
Pennsylvania.
In
turn,
this
leads
to
challenging
comorbidities
in
healthcare
that
can
lead
to
mortality.
Additionally,
our
Episcopal
attempt
campus
treats
many
opioid
overdoses
daily
and
is
located
in
the
community
with
a
highest
opioid
mortality
rate
in
the
city
as
a
result
of
the
socioeconomic
medical
challenges.
Many
of
our
obstetric
impatient
face.
E
They
are
too
significantly
increased
risk
for
maternal
mortality,
medically
the
highest
rates
of
maternal
mortality
caused
by
cardiovascular
disease,
hypertensive
disease,
thromboembolic
events
and
sepsis.
These
issues
are
being
addressed
by
national
state
and
local
guidelines
for
emergent
treatments
and
continued
care
participation
in
the
Pennsylvania
perinatal
quality,
collaborative
strengthen
these
protocols
to
provide
guidance,
education
and
further
treat
and
prevent
medical
issues.
However,
there
are
many
comorbidities,
such
as
obesity
and
diabetes,
that
directly
contribute
to
maternal
mortality
that
are
not
always
addressed
by
these
initiatives.
E
Access
to
nutrition
services,
affordable
healthy
food
options
and
our
food
options
and
diabetes
and
overall
health
literacy,
education
in
Philadelphia
must
be
improved.
Residents
also
need
access
to
latest
technologies
for
hypertension
and
diabetes
management,
which
have
been
proven
to
reduce
morbidity
and
costs.
In
addition
to
the
cost
of
many
medications,
in
particular,
insulin
can
be
prohibitive
for
patients
who
are
on
and
underinsured
providing
additional
funding
for
these
initiatives
will
help
to
decrease
morbidity
or
mortality
in
Philadelphia
mothers
and
other
residents.
The
opioid
crisis
is
also
associate
with
a
highest
mortality
rate
in
the
city.
E
As
I
said
earlier,
our
fiscal
campus
is
located
in
the
center
of
the
crisis
to
address
this
issue.
Temple
Health
has
worked
diligently
to
establish
a
multi-pronged
and
integrated
approach
to
substance,
use,
disorder,
treatment
and
education,
but
multidisciplinary
task
force
have
come
together
to
offer
medication,
assisted
treatment
and
counseling
to
prevent
a
one-size-fits-all
approach
to
addressing
this
complex
public
health
crisis.
E
Additionally,
however,
there's
also
no
well-defined
risk
that
accounts
for
the
increased
rate
of
maternal
mortality
among
african-american
women,
including
those
who
are
not
disadvantaged
social.
Economically,
there
are
theories
there.
This
may
be
due
to
an
overall
stress
women
of
color
experienced
throughout
their
lives.
E
Studies
have
shown
adverse
childhood
experience
or
a
scores
are
higher
among
the
communities
surrounding
Temple
University
Hospital
than
any
other
area
in
the
city,
as
well
as
for
women
of
diverse
racial
backgrounds.
As
such
adverse
childhood
experience
affects
all
aspects
of
care.
We
provide
evaluation
of
the
ACE
scored.
The
Temple
University
Office
of
Diversity
has
started
programs
to
evaluate
a
scores
and
implement
trauma-informed
care.
Dr.
E
Cathy
Reeves
is
set
to
discuss
this
later
in
the
hearing
as
a
result
of
childhood
trauma
mistrust
and
of
traditional
medical
services,
lack
of
child
care,
transportation
of
the
Daley's
of
life,
many
bears
existe,
maternal
health
care
and
education
in
Philadelphia.
It
is
clear
that
additional
maternal
health
services
are
needed
throughout
the
city
to
build
trust
and
break
down
barriers.
E
This
includes
investment
in
community
health
workers,
patient-centered
obstetrical
care
and
continuation
of
Medicare
for
women
beyond
the
postpartum
period,
as
justice
start
to
prevent
mortality,
we
a
Prettyish
a
city
councils,
commitment
to
addressing
maternal
mortality
among
our
patients.
We
serve.
We
again
thank
you
for
holding
this
hearing
to
discuss
this
important
issue
and
I'm
happy
to
answer
any
questions
you
might
have.
Thank.
A
F
Osler
Mehta
good
afternoon,
chair
and
bath
in
the
Public
Health
and
Human
Services
Committee
I
am
dr.
Osler
Mehta
women's
health
policy
advisor
for
the
Philadelphia
Department
of
Public
Health,
and
a
practicing
ob/gyn
in
Philadelphia
in
this
role.
I
am
the
I
serve
as
a
co
facilitator
for
the
Philadelphia
maternal
mortality
review
team
I'm,
a
member
of
the
Pennsylvania
maternal
mortality,
review
team
and
I'm.
The
policy
chair
for
the
Pennsylvania
perinatal
quality
care
collaborative.
Thank
you
for
the
opportunity
to
provide
testimony
for
resolution
number
one:
nine:
zero,
zero.
F
Four
zero,
which
authorizes
council
hearings
on
the
increase
in
maternal
mortality
among
african-american
women
in
Philadelphia,
the
rate
of
pregnancy,
related
mortality
in
the
United
States
has
more
than
doubled.
In
the
past
30
years,
the
city
of
Philadelphia
has
seen
an
increase
in
maternal
mortality
that
follows
these
national
trends.
In
order
to
address
this,
the
Philadelphia
Department
of
Public
Health
Medical
Examiner's
Office
and
the
Greater
Philadelphia
maternal
health
community,
created
the
first
county
level.
F
Maternal
mortality
review
team
in
the
United
States
in
2010,
the
maternal
mortality
review
team
brought
together
six
labor
and
delivery
hospitals
in
the
city.
Now
there
are
five
with
the
closure
of
Hahnemann
University
Hospital,
along
with
city
based
agencies
and
non-governmental
organizations,
to
develop
a
more
accurate
method
of
identifying
and
track
the
number
of
pregnancy
related
and
pregnancy
associated
deaths.
F
As
representative
Morgan
Cephas,
already
defined
a
pregnancy
related
death
is
defined
as
a
death
which
occurs
during
or
within
one
year
of
the
end
of
the
pregnancy,
from
any
cause
related
or
aggravated
by
the
pregnancy
or
its
management.
A
pregnancy
associated
death
is
one
that
occurs
during
that
same
time
period,
regardless
of
cause.
The
multidisciplinary
review
of
each
case
helps
identify
the
systematic
shortfalls
that
women
of
childbearing
age
face
and
gaps
and
community
resources.
F
Over
the
course
of
over
30
meetings,
the
Philadelphia
maternal
mortality
review
team
has
gained
knowledge
and
insight
about
maternal
morbidity
and
mortality
by
reviewing
over
200
pregnancy
associated
deaths
of
Philadelphia
residents,
based
on
aggregated
surveillance,
data
from
deaths
that
occurred
from
2010
to
2011,
airy
numbers.
30%
of
the
deaths
of
these
deaths
were
categorized
as
pregnancy.
F
Related
of
the
pregnancy
related
deaths,
40%
were
attributed
to
cardiomyopathies
or
other
other
cardiovascular
conditions,
25%
to
embolisms
15%
to
infection
and
10%
to
hemorrhage
black
non-hispanic
women
account
for
41%
of
Philadelphian
women
of
childbearing
age
and
white
non-hispanic
women
account
for
35%.
However,
black
non-hispanic
women
have
accounted
for
75%
of
Philadelphia's
pregnancy
related
deaths
from
2010
to
2012,
Aion
Hispanic
women
have
accounted
for
15%.
F
The
Philadelphia
and
maternal
mortality.
Dataset
has
thus
far
revealed
that
40%
of
all
reviewed
deaths
had
diagnosed
by
the
diagnosis
of
mental
health.
History
and
60%
have
had
a
previous
and/or
current
substance
use
disorder.
Overdose
related
deaths,
which
have
risen
dramatically
in
as
general
population,
has
likewise
risen
rapidly
among
pregnant
and
postpartum
women,
whereas
25%
of
reviewed
maternal
deaths
between
2010
to
2016
were
due
to
accidental
drug
intoxication.
That
percentage
has
increased
to
38%
of
reviewed
maternal
deaths
from
2017
and
18.
The
Philadelphia
maternal
mortality
review
team
released
its
first
citywide
surveillance
report
in
2015.
F
The
report
documented
Philadelphia's,
significant
maternal
health
challenges
and
included
evidence
informed
recommendations
to
reduce
maternal
deaths
and
methods.
To
track
progress,
while
there
is
no
formal
system
in
place
to
move
these
recommendations
forward,
the
maternal
mortality
review
teams,
maternal
health
partners,
developed
collaborative
teams
to
begin
addressing
recommendations,
successes
include
the
creation
of
a
centralized
revert
referral
system
for
home,
visiting
services,
which
is
currently
in
its
implementation
phase.
F
A
prenatal
labs
sharing
agreement
to
facilitate
health
information
exchange
among
all
delivery
hospitals,
Medicaid
reimbursement
for
immediate
postpartum,
long-acting,
reversible,
reversible
contraception
and
a
citywide
educational
program
focused
on
screening,
brief
intervention
and
referral
to
treatment
for
substance
use
disorder
and
pregnancy.
Though
progress
has
been
made,
more
investment
is
needed
to
scale-up
and
develop
innovative
interventions
to
improve
the
way
in
which
women
are
cared
for
during
pregnancy
and
after
they
give
birth.
F
The
Philadelphia
maternal
mortality
review
team,
in
collaboration
with
the
health
Federation
of
Philadelphia
applied
for
and
recent
recently
received
funding
from
the
merck
for
mother's,
safer
childbirth,
cities
initiative.
The
funding
support
will
allow
the
maternal
mortality
route
review
team,
along
with
its
partners
to
more
effectively
implement
evidence,
informed
interventions
to
strengthen
surveillance
and
reporting
improved
clinical
care.
Integrate
community
voices
in
developing
innovative
solutions
address
racial
disparities
and
maternal
health
outcomes,
an
increased
community-based
support
for
childbearing
women
through
development
of
a
Community
Action
team.
F
This
team
will
implement
formal
initiatives
that
specifically
address
maternal
mortality,
identified
contributors
to
maternal
mortality
in
Philadelphia
cardiovascular
disorders
and
over
drug
overdoses,
as
well
as
poor
case
coordination,
a
prenatal
and
postnatal
care
among
perinatal
providers
and
associated
social
service
agencies.
In
particular,
this
team
will
focus
on
activities
that
aim
to
reduce
significant
rate
of
racial
disparities
and
maternal
mortality.
Thank
you
very
much
for
the
opportunity
to
address
you
today.
I
am
happy
to
answer
any
questions
you
may
have
thank.
A
G
G
Many
things
were
said
today
prior
to
myself,
sitting
here
and
I
want
to
echo
the
request
and
ask
of
Representative
Cephas.
It's
not
that
we
don't
know
what
is
going
on
and
it's
not
as
if
we
don't
want
to
help.
We
are
handcuffed
and
our
patients
have
to
navigate
obstacles
that
are
seemingly
impossible,
though
there's
legislation
to
allow
patients
to
access
health
insurance,
navigating
the
opportunities
to
achieve
health
insurance
are
vast,
difficult
and
cumbersome.
When
asked,
why
didn't
you
get
insurance
I
couldn't
get
a
day
off
of
work?
I
had
a
stand
in
this
line.
G
I
needed
this
piece
of
paper.
The
doctor
wouldn't
fill
this
out.
It
seems
that
that
insurance
is
available.
It
is
but
obtaining
the
insurance
is
very
difficult,
and
then
you
have
patients
who
maybe
suffer
from
health
literacy.
That
is
our
responsibility,
navigating
a
system
that
I
personally
would
struggle
to
navigate
and
then
they're
labeled
as
no
prenatal
care
and
they're
stigmatized,
because
they
didn't
care
about
their
pregnancy
and
when
asked
that
is
absolutely
not
the
case.
The
case
is
I.
G
Had
children
at
home,
I
couldn't
get
there,
I
couldn't
get
through
the
system,
and
that's
that's
honestly
where
it
starts,
but
it
doesn't
end
there.
We
know
intimate
partner.
Violence
is
a
major
contributor
to
the
fault
of
our
society,
but
to
young
women
of
color
who
are
pregnant.
We
see
it
every
day
and
the
sad
part
is
because
of
concerns
that
they
have
hell.
They
may
be
perceived,
they
say.
Oh
I
fell
down
the
stairs.
Oh
I
tripped
on
the
curb
it's
our
responsibility
to
dig
deeper
and
find
solutions.
G
The
problem
that
we
have
is
when
we
find
the
solutions,
the
opportunities
for
intervention
for
human
partner
violence
are
limited
at
best
and
certainly
not
reimbursed.
So
we
must
rely
on
grants,
philanthropy
or
just
doing
the
right
thing
to
help
patients.
We
at
Einstein
deliver
3,000
babies
a
year.
The
statistics
will
tell
us
in
urban
settings
no
different
than
my
colleagues
here.
More
than
50%
of
those
patients
suffer
for
some
from
some
form
of
intimate
partner
violence.
We
have
one
counselor
three
days
a
week,
not
enough
not
enough.
G
G
Same
can
be
said
for
substance
abuse.
We
know
the
patient's
suffer
some
from
substance
abuse.
They
want
help.
Where
can
they
turn
for
help?
There's
nowhere
to
turn.
There
are
limited
resources,
they
have
psychiatric
disorders.
They
know
they
have
psychiatric
disorders,
so
we
know
these
psychiatric
disorders.
We
know
what
medications
they
need
we're
obstetrician
gynecologists,
who
are
not
psychiatrists,
trying
to
get
an
appointment
with
the
mental
health
physician
in
this
city.
No
matter
what
your
insurance
is
is
at
minimum.
G
A
three-week
wait,
wait,
oh,
but
you
can
go
to
the
crisis
center
and
be
seen
immediately.
No
one
wants
to
do
that
and
that's
not
an
excuse,
nor
a
reason
to
go
to
a
crisis
center
and
that
that
would
further
put
delays
on
patients
who
actually
need
to
be
in
the
crisis.
Center
Einstein
has
one
of
the
lowest
rates
of
maternal
mortality
in
the
entire
country,
and
it
is
not
because
we
have
different
drugs
or
different
surgery.
G
It's
because
we
have
taken
the
time,
like
my
colleagues
here,
to
invest
in
the
resources
that
are
need
to
identify
the
social
disparities
of
health
and
address
them
immediately.
It's
because
we
have
taken
the
opportunities
to
to
change
how
we
train
the
residents,
you
don't
say
to
a
patient,
you
don't
have
chest
pain.
Do
you
because,
what's
your
gonna
say
yes
I?
Do
she
thinks
that
you
want
her
to
say
no?
Well,
you
can't
ask
the
question
that
way,
because
you
won't
identify
the
problem.
G
We
have
to
be
able
to
teach
our
patients
how
they
can
be
self
advocates
for
their
own
health
care
and
the
health
care
of
their
families.
We
want
to
them
to
learn
how
to
navigate
the
system.
The
question
that
we
are
here
to
ask
is:
how
can
we
partner
together
to
move
the
process
forward
to
educate
patients
to
improve
healthcare,
lettis
literacy,
to
allow
them
to
advocate
for
themselves?
G
G
People
often
will
say
in
the
literature
supports.
We
should
have
providers
who
look
like
the
patients
they
care
for,
and
we
need
to
do
a
much
better
job
at
a
medical
school
level
at
a
college
level
of
enabling
people
who
look
like
the
people
they're
going
to
care
for
to
enter
the
medical
field,
it
may
be
as
a
doula,
a
midwife,
an
advanced
practice
provider
or
a
physician
all
are
important.
It's
a
health
care
team,
but
we're
not
going
to
solve
this
by
just
change
one
thing
or
that
one
or
small
little
item
over
here.
G
A
Thank
you
for
your
testimony.
I
agree
with
you
I
think
that
there
has
to
be
a
real
cultural
culture
shift
in
terms
of
the
way
we
approach
healthcare,
particularly
when
it
comes
to
women
of
color
and
women
of
color,
who
are
living
below
the
poverty
line
who
are
really
struggling
and
who
need
someone
to
you
know
to
advocate
on
their
behalf,
and
we
are
their
advocates.
We
stand,
you
know
just
as
people
who
are
interested,
whether
you're
a
woman
of
color
or
not.
A
A
Health
institutions
here
in
the
city
of
Philadelphia
different
hospitals,
I've
noticed
that
when
I
went
to
I
think
it
was
Fox,
Chase,
Cancer
Center.
We
had
a
roundtable
discussion
and
we
were
talking
about
cancer
and
particularly
among
african-american
American
community,
and
one
of
the
things
that
I
learned
is
that
there
is
only
about
3%
of
cancer
research
that
is
dedicated
towards
African
Americans,
and
why
is
it
that
cancer
is
so
much
more
aggressive
within
African
Americans?
A
And
so,
when
you
look
at
you
know
when
you
look
at
that,
and
you
take
that
statistic
and
that
information
and
you
look
across
the
board
at
the
other
things
that
affect
the
african-american
community
and
the
Hispanic
community
health-wise.
You
have
to
look
at
those
things
and
say
you
know
across
the
board.
What
is
the
amount
of
research
and
work
that
is
going
to
affect
this
issue
across
the
board?
So
I
just
say
that
to
thank
all
of
you
for
the
work
that
you're
doing
and
being
vigilant
and
steadfast
or
this
issue.
H
You
and
I
want
to
take
a
moment
and
thank
representative
Morgan
cephus
for
her
work
in
this
and
understanding
that
there
was
a
role
both
at
the
city
in
the
state
level.
So
congrats
on
a
conversation
and
I
know,
councilman
bundle,
Reynolds
ground
would
say
it's
a
long
journey
on
some
of
these
issues.
But
if
you
stay
focused
and
steadfast,
you
know
we
can
get
some
work
done.
One
had
a
couple
of
questions:
who
is
the
Philadelphia
much
maternal
mortality
team?
F
Yeah,
so
it's
a
multidisciplinary
team,
dr.
mola,
actually
sits
on
it
and
it's
a
number
of
different
stakeholders
from
community-based
organizations,
as
well
as
representatives
from
different
areas
of
the
both
Health
Department.
We
have
people
from
insurance
companies
that
are
represented
there.
We
have
doctors
midwives
and
not
it
not
just
OBGYNs,
but
we
have
cardiologists
on
the
team
critical
care,
physicians,
so
multi
destroying
the
medical
community
as
well.
Is
it.
H
Let
me
strongly
encourage
you
to
include
some
of
the
women
who
have
this
experience.
I.
Think
one
of
the
things
that
we've
learned
when
you
hear
these
some
of
these
terms
evident
evidence
informed
interventions
when
you
hear
about
best
practices
going
back
to
what
counsel
and
bass
was
saying,
study
by
whom,
for
whom,
right
and
I
think
it's
hugely
important,
that
I'm
I'm
strongly
encouraged
by
how
you've
outlined
and
articulated
what
what
the
goal
of
this
Community
Action
Team
is.
But
I
strongly
encourage
you
from
day
one
to
have
the
women
who
experiences.
H
F
As
I
outlined
in
my
testimony,
we
have
specific
initiatives
that
are
already
happening
in
the
city
and
so
where
some
of
that
funding
will
be,
the
funding
that
we're
receiving
from
mark
will
be
to
bolster
already
existing
initiatives,
and
then
some
of
the
funding
will
go
towards
actually
creating
this
Action
Team.
The
leadership
structure,
the
governance
structure,
as
well
as
a
sustainability
piece
of
it,
so
that
after
the
funding
is
gone,
we
can
still
continue
the
work.
So.
H
F
So
this
action
team
is
really
a
is
the
action
arm
of
the
review
team.
So,
let's
say
the
review
team
reviews
cases
that
come
up
with
recommendations
in
the
past.
These
recommendations,
we're
hoping
that
an
advocate
or
somebody
that
somebody
that's
already
working
on
this
in
the
community
will
take
that
up
and
do
that.
So
this
will
more
structural
eyes
it
so
that
we
say:
okay
like
these
are
the
things
that
are
going
on
right
now.
How
can
we
do?
F
How
can
we
move
forward
these
recommendations
in
a
more
streamlined
fashion,
so
people
on
this
action
team
will
be
already
members
community
members
that
are
working
in
you
know
these
different
aspects.
So,
if
we're
thinking
about
prenatal
care,
we
already
have
a
collaborative
of
all
the
labor
and
delivery
hospitals
that
meet
monthly
as
the
leadership.
The
nursing
leadership,
as
well
as
the
physician
leadership
of
each
of
the
hospitals.
F
H
F
The
funding
is
going
to
go
towards
increasing
doula
access
in
the
city.
It's
going
to
go
towards
increasing
access
to
family
planning
services,
we're
one
with
substance,
use
disorder.
We're
also
going
to
be
developing
a
model
to
implement
screening
brief
intervention
and
referral
to
treatment
that
hospital
systems
can
then
easily
implement
whether
it's
in
the
prenatal
care
side
of
it,
whether
it's
in
the
hospital,
so
that
we're
catching
these
women
that
has
substance
use
disorder
earlier
we're
also
going
to
be
doing
implicit
bias,
training
to
our
maternal
health
community.
F
It
starts
with
the
residents
and
the
hospitals,
all
the
physicians
and
nursing
leadership,
or
not.
We
nursing
nurses
that
are
on
the
ground,
as
well
as
implicit
bias,
training
for
community-based
organizations
that
they've
not
yet
done
so
so
those
are
three
there's
gonna
be
more
oh
and
then
one
of
the
bigger
ones
is,
as
I
alluded
to,
that
our
pregnancy
related
mortality
when
it
comes
to
is
the
highest
causes
of
cardiovascular
disorders.
F
So
I'm
pen
medicine
actually
made
an
app
called
heart,
safe
motherhood
and
has
been
we've
been
implementing
that
in
our
health
system
for
over
a
year
and
it's
shown
to
improve
hypertension
or
high
blood
pressure
surveillance
in
the
immediate
postpartum
period.
So
basically,
it's
this
interactive
app
that
women
are
enrolled,
that
our
qualifying
are
enrolled
in
the
program
and
then
they
sort
of
talk
with
this
app
and
they
text
in
their
blood
pressures.
And
if
it's
out
of
a
range
that's
within
normal,
then
they
get
that
that
number
gets
directly
to
a
high
risk
physician.
F
Who
will
then
talk
to
that
patient
directly
and
manage
that
so
the
outcomes
of
that
so
traditionally,
prior
to
this
app
people
that
are
diagnosed
with
high
blood
pressure
during
pregnancy
or
in
the
immediate
postpartum
period,
we
recommend
them
to
come
back
in
like
two
days
or
a
week
for
a
blood
pressure
check
and
that
blood
pressure
check
visit
is
very
unattended,
so,
like
less
than
20,
less
than
30
percent
of
people
really
attend
that.
So
our
data
is
shown
with
this
app.
F
H
Don't
we
alluded
and
I'm
glad
to
hear
that
again,
I'm
interested
around
how
how
we
change
people's
lives
and
behaviors
and
preventive
medicine-
and
you
know,
I,
had
this
conversation
with
Bill
Ryan
the
other
day,
because
Einstein
has
become
an
important
place
for
some
of
our
opioid
work
and
an
addiction
we've
mentioned
Hahnemann,
closing
les
hospitals
who
are
going
to
be
doing
this
work?
What,
if
anything,
are
we
doing
to
accommodate
how
folks
are
going
to
move
within
the?
What
is
it
six
hospitals
left,
five
five
who
are
gonna
be
doing
this.
I
F
So
I
trained
at
hundreds,
I'm
very
familiar
with
hanaman,
so
we
as
a
collaborative
so
again
mattias
it's
on
this
collaborative
as
well.
The
labor
and
delivery
leadership
group,
as
well
as
all
the
chairs,
were
very
collegial
and
have
once
we
knew
that
Hahnemann
was
closing
the
hole
all
of
OB
leadership
met
with
the
health
department
and
we
came
together
and
decided
how
patients
were
gonna,
be
diverted.
F
What
was
going
to
happen-
and
you
know
in
the
interim
in
regards
to
exchange
of
information
like
health
information
slots,
were
opened
up
at
all
the
other
hospitals
for
prenatal
care,
and
you
know
we
just
sort
of
like
an
open
communication
about
how
that
was.
Gonna
work,
a
lot
of
those
patients
because
of
the
generosity
of
Jefferson.
F
E
Has
also
put
an
outreach
out
to
reach
out
to
the
patients
at
the
health
districts
we've
provided
additional
appointments,
so
some
of
the
patients
who
have
barriers
to
care
and
transportation
and
things
like
that
to
get
to
Jefferson.
Since
we
geographically
located
near
some
of
the
health
districts,
we've
accepted
those
into
our
practice.
We've
accommodated
them
that
way.
How.
H
Have
we
been
able
to
get
around
some
of
the
health
care
reform
issues
with
the
fact
that
we
have
UPMC
and
health
partners
in
the
medicaid
market
house
how's?
That,
because
I
know
that
when
that
transition
happened,
we
had
a
lot
of
patients
who
were
defaulted
into
a
different
plan?
How
you've
been
able
to
work
around
that?
For
this.
G
So
first
allowed
me
to
say
that
Philadelphia
is
unique
in
many
ways,
but
one
of
the
areas
specific
to
this
conversation
that
is
very,
very
empowering
is
that
all
of
the
delivering
hospitals,
all
the
chairs
and
all
the
directors
of
waiver
and
delivery.
We
meet
quarterly
or
monthly
in
a
collaborative
fashion,
to
come
to
confirm
and
affirm
that
the
care
that's
provided
at
all
the
hospitals
is
equal.
It's
not
a
competitive
place
for
us.
It's
a
safety
place
and
I
think
we
could
capitalize
on
that
already
existing
infrastructure.
G
The
answer
to
your
specific
question
is
we
don't
care
what
insurance
patients
have
we
don't
care
what
country
they
came
from?
They
walk
in
the
door
and
they
get
the
care
that
they
deserve,
and
we
don't
deal
with
it
to
be
very
honest
with
you.
Does
that
make
administration
happy
all
the
time?
No,
no.
H
G
G
G
There
was
work
done
with
senior
leadership,
both
at
Health,
Partners
and
Jefferson
to
create
circumstances
that
would
enable
patients
to
not
have
to
deal
with
that
question
and
to
allow
Jefferson
to
have
emergency
opportunities
to
accept
health
partners
for
these
specific
circumstances,
and
so
I
think
that
in
the
end
the
community
really
rallied
and
it
was
really
heartwarming.
To
be
honest,
it's
a
terrible
that
Hahnemann
closed,
but
the
response
at
least
I
can
speak.
We
all
here
can
speak
to
the
obstetrical
community
obstetrical
community.
G
It
was
actually
fantastic
of
how
we
tried
and
were
able
to
successfully
accomplish
creating
the
system
to
allow
the
crisis
that
was
supposedly
going
to
happen.
Never
to
be
seen
and
I
do
have
to
just
name
dr.
Baxter
sitting
behind
us.
He
is
the
obstetrical
director
at
Jefferson
and
I
think
that
he
did
I
know
that
he
did
a
significant
amount
of
work
around
this
time
to
create
the
seamless
opportunities
for
not
only
for
the
physicians
but
for
the
patient's,
a
Trachsel
to
seek
a
safe
place
to
have
care.
Thank.
H
H
Just
the
back
office
finance
people
that
are
the
problem
I
just
want
to
make
sure
that,
as
we're
doing,
this
work,
we're
cognizant
of
the
fact
that
all
those
those
those
dots
haven't
been
connected,
I
still
find
myself
intervening
many
times
around
Brown
this
stuff
and
in
this
world,
in
this
space
of
where
women
will
have
children,
is
hugely
important,
especially
poor
women,
who
don't
always
have
all
those
options,
so
we'll
be
looking
at
that,
and
we
appreciate
all
the
work
that
you
do.
Thank
you.
A
J
Yes,
yes,
comments
and
a
couple
of
questions.
Let
me
start
where
a
Councilwoman
Sanchez
left
off
and
that
is
to
acknowledge
and
recognize
and
say
thank
you
for
the
work
that
you
do
for
the
tiniest
little
people
among
us,
children
who
hopefully
make
it
beyond
their
first
birthday.
So
when
we
know
that
the
United
States
ranks
55
out
of
225
countries
and
I
think
the
number
is
2.5,
black
children
are
more
likely
to
not
survive
than
there
than
there
are
non
African,
American
or
white
counterparts
I.
J
For
me,
it
begs
the
question
of
coordination
of
effort,
which
you
spoke
to
briefly
talk
to
David,
jasmine
and
so
to
hear
that
you
have
quarterly
meetings,
is
reaffirmed,
reassuring,
although
councilman
Sanchez
point
is
equity
and
assurance
of
equity
and
delivery
of
services.
Is
that
a
goal?
So
that's
my
first
question
and
and
where
is
that
exemplified
or
illustrated
that
that's
a
goal
that
is.
G
The
goal
the
goal
is
to
identify
best
practices,
specifically
I
can
speak
to
several
years
ago.
It
was
noted
that
if
women
presented
with
symptoms
of
preterm
labor
that
just
doing
a
regular
physical
examination
was
not
adequate,
but
by
doing
ultrasound
to
check
the
cervix
and
the
length
of
the
cervix
was
optimal,
but
not
every
labor
and
delivery
was
able
to
do
that
based
on
resource
availability
or
education,
but
through
this
collaborative
we
made
that
a
priority,
and
we
ensured
that
each
labor
and
delivery
obstetrical
unit
had
the
ability
to
do
the
same
thing.
I.
J
Say
so,
who's
the
glue,
I'm
learning,
who
the
glue
is,
who
is
holding
the
glue
together
like
who's
responsible
for
making
sure
those
quarterly
meetings
happen
on
those
meetings
happen
on
a
quarterly
basis
because
of
what's
what's
what
matters
is
partnerships
and
partnerships
because
government
it's
not
doing
well,
let
me
say
the
feds
are
not
where
they
should
be
and
requires
the
state
and
us
to
step
up
so
who's,
making
sure
that
these
meetings
happen.
If
we
want
to
arrest
this
decline
or
this
increase
and
incline
and
the
number
of.
J
J
J
F
So
we
coordinated
so
that
at
that
time
there
were
six
labor
and
delivery
hospitals
and
oftentimes
women
will
go
to
one
hospital
for
prenatal
care
and
then
go
elsewhere
to
deliver,
and
so
there's
sometimes
a
delay
in
getting
access
to
records
nice
and
you
can
imagine
in
an
OPG
like
in
an
obstetrical
time.
It's
sometimes
like
the
delay
is
not
not
good
enough,
because
things
happen
very
quickly,
so
we
streamlined
the
records
exchange
in
the
lab
exchange.
F
F
That
have
come
from
that
group.
We've
also
shared
best
practices
amongst
the
groups,
so
that
you
know
we're
looking
at
our
hemorrhage
protocols,
we're
looking
at
our
emergency
response
to
things
like
shoulder
dystocia,
which
is
when
the
shoulder
gets
stuck
in
the
birth
canal
during
delivery.
So
there's
been
a
lot
of
sharing
of
in
formation
in
that
respect
and
then
bringing
it
back
to
our
institutions
so
that
we're
all
sort
of
on
the
same
page.
F
When
it
comes
to
those
types
of
emergency
situations,
we
also
have
looked,
and
then
this
is
that's
where
that
the
hypertension
app
that
I
was
talking
about
the
high
blood
pressure
app.
That
was
shared
by
pet
like
the
pencil,
the
pen,
that
system
their
hospitals,
so
that
now
we
have
the
funding,
we're
gonna
operationalize
that
and
all
the
other
delivery
hospitals.
So
all
of
us
will
have
that
same
monitoring
system.
So.
J
J
Thank
you
for
lifting
this
issue
back
on
the
radar
screen
when
I
came
here
twenty
years
ago,
we
were
discussing
this
issue
so
to
see
that
it
has,
and
and
and
based
on
what
I've
read,
there's
been
a
decline,
but
now
there's
an
uptick
again.
So
how
help
us
understand
at
least
update
us
on
where
the
state
might
be,
or
should
be
when
it
comes
to
funding
so.
C
The
state
I'm
not
sure
if
you
were
here
they've,
been
going
after
some
federal
resources
as
well
to
support
their
review
committee
too,
so
they
were
awarded
2.5
million
from
the
federal
government
just
this
year
at
Governor,
Tom
wolf.
We
also
just
recently
established
a
review
committee,
so
Philadelphia
has
really
been
leading
the
way
in
this
space
in
a
lot
of
ways.
C
C
C
So
we
still
have
a
lot
of
work
to
do
on
the
state
level
and
some
of
the
things
that
I
recommended
was
one.
We
need
a
line
item
on
the
state
level
to
support
the
review
committee
as
well
as
report
organizations
on
the
ground
and
review
committees
like
Philadelphia,
so
they
can
do
that
work
as
well.
So
currently
we
do
not
have
that
in
the
Commonwealth.
The
second
piece
and
some
other
states
are
looking
to
do
this
as
well.
C
We
are
16th
in
the
nation
when
it
comes
to
maternal
mortality
deaths,
but
our
neighbor
in
New,
Jersey
I,
feel
like
it's
forty,
fourth
and
they've,
so
other
states
have
been
taking
the
deeper
dive
passing
legislation
to
address
this
issue.
So
some
of
the
pieces
that
we're
considering
now
is
expanding
Medicaid
coverage
for
pregnant
women
past
the
original
six
weeks
up
to
a
year,
because
again,
majority
of
the
deaths
are
happening
during
the
I
feel
like
we
call
it
the
fourth
period,
the
fourth
trimester
I'm
trying
to
get
the
lingo
myself.
C
So
that's
one
of
the
areas
of
interest.
Some
other
states
have
passed
legislation
to
certified
doula
care
require
insurance
companies
to
reimburse
doulas
California,
naturally,
is
always
leading
the
way
on
all
these
things.
They
are
requiring
their
medical
institutions
providers
practitioners
to
take
on
implicit
bias,
training
to
address
some
of
the
racial
disparities
that
we
have
within
this
space.
So
I
mean
there
are
other.
You
know,
councilman
green
just
actually
talked
about
it
this
morning,
not
reinventing
the
wheel
and
looking
at
best
practices.
C
Harrisburg
and
I
think
the
media
likes
to
you
know
portray
that
we
mirror
Washington
DC
with
our
Republicans
in
Harrisburg,
but
there
are
some
issues
that
we
really
align
around
and
we
actually
had
a
Republican
white
male
from
York
County
passed
legislation
to
establish
the
review
committee
in
Pennsylvania.
So
this
is
one
of
the
issues
that
we
are
able
align
around
and
hopefully
we'll
see
some
traction
in
a
upcoming
legislative
session.
I'd.
J
Like
to
offer
up
for
consideration
when
you
come
up
with
recommendations
at
the
end
of
those
reviews,
because
too
often
you
stay
here
long
enough,
you
see
all
these
reviews,
you
see
a
document
producing
than
it
sits
on
the
shelf.
So
the
hope
is
that
this
serious
implementation
from
around
the
recommendations
and
dr.
J
David
Jasper's,
spoke
I
think
very
eloquently
to
how
medical
schools
need
to
get
in
the
one
at
the
circle
at
the
table,
because
they
have
a
role
in
building
or
growing
professionals
in
that
space,
so
that
you
can
have
those
who
are
who
need
the
service.
You
have
people
around
them,
delivering
the
service
and
so
that
that
takes
real
coordination
at
the
higher
ed
level,
yeah
and
leadership
as
well.
To
ensure
that
that
happens.
That
should
not
go
unrecognized
in
this.
The
statement
that
dr.
Jasper
made
it.
L
J
C
One
of
the
reasons
why
we're
going
to
go
after
the
Medical
Review
Board
in
the
Commonwealth
of
Pennsylvania,
to
require
as
continuing
legal
education.
Well,
you
know
how
lawyers
have
continuing
legal
education.
Well,
so
do
individuals
in
a
medical
field,
so
we
want
to
require
there
to
be
implicit
bias,
training
and
you
know
just
bringing
up
this
issue
as
a
requirement
of
annual
education
for
those
professionals.
The
opioid
issue
has
been
something
that
has
been
incorporated:
mental
health
issues.
So
why
not
this
issue
as
well
agreed.
J
B
That
has
a
lot
to
do
with
Pennsylvania
and
other
types
of
health
care
issues
that
are
going
on,
but
it
is,
it
is
heightening
and
I
think
one
of
the
things
that
I
do
recognize
is
that
the
hospital
is
coming
together
in
a
quarterly
fashion
and
making
sure
that
the
care
of
the
patients
you
see
is
it's
an
important
issue,
but
I
think
what
I'm
most
concerned
about
is
the
patient's.
You
don't
see
and
I.
B
One
of
the
questions
that
I
would
have
is
that
as
part
of
that
quarterly
meeting
as
part
of
the
Department
of
Public
Health,
who
is
actually
doing
an
analysis
of
who
doesn't
come
through
the
door.
So
we
know
that
there
were,
for
example,
50,000
emergency
room
patients
a
year
coming
through
Hahnemann
Hospital.
There's
issues
about
location.
This
goes
beyond
who's
coming
in
through
your
er
and
why
they're
coming
through
them,
but
I
wonder,
is
the
Department
of
Health
taking
proactive
measures
to
evaluate
the
impact
of
the
loss
of
care.
B
Whether
people
in
general
are
are
less
likely
to
seek
attention
because
of
the
decline
in
in
a
particular
hospital
or
in
terms
of
access
to
a
particular
maternity
ward
and
whether
you're
doing
more
kind
of
on-the-ground
understandings
of
what's
happening
because
I
think
a
lot
of,
especially
when
it
gets
to
pregnancy
and
women's
health
care
needs
in
particular
because
of
the
regularity
of
it
and
the
requirement
for
it
to
be
so
regular.
It's
it's
hard
for
people
who
don't
have
a
continuity
of
care
to
get
used
to
like
us.
B
You
know
a
systemic
approach
for
care
that
you
traditionally
have
when,
or
you
know,
the
best
kind
of
care
that
you
would
have
if
you're
going
through
pregnancy
and
other
kind
of
reproductive
needs
that
many
women
face.
So
is
someone
kind
of
from
the
Department
of
Health
taking
a
proactive
effort
to
look
at
the
impact?
Not
how
are
other
systems
treating
people
as
they
come
through
the
door
which
I
assume
should
be
in
equal
measure
and
I'll.
B
F
So
I
guess
I'll
say
that
when
we
met
so
Hahnemann's
delivery
makeup
is
that
a
portion
of
their
deliveries,
a
majority?
Well,
a
majority
of
their
deliveries
came
from
the
Philadelphia
health
centers
in
convenient
conjunction
with
their
women's
care
center
and
so
the
Philadelphia
health
center,
which
is
about
800
deliveries.
In
that
time
period
they
were
warmly
handed
off
to
the
same
providers,
but
at
Jefferson,
and
so
there
was
a
sort
of
the
same.
It
would
be
in
the
same
way
that
they
would
have
gone
to
hanaman.
F
It
was
mainly
just
it
was
sort
of
all
diverted
there
with,
of
course,
there
being
some
patients
that
maybe
not
didn't
want
to
deliver
at
Jefferson
that
were
then
warmly
handed
off
to
other
institutions.
As
for
the
post,
it
just
closed.
It
was
two
months
ago,
so
I
think
that
we're
not
going
to
have
as
much
good
data
to
like
retrospectively
look
back
and
see
what
the
impact
of
that
closure
was.
I.
Think
that
that's
something
that
we
are
is
on
the
radar
too.
F
F
F
It
would
be
that
same
concept,
so
your
doctors
wouldn't
be
at
Jefferson,
etc,
and
so
the
other
two
health
centers
are
staffed
by
Einstein
and
hubs
Yeah
right,
Einstein,
your
hub,
and
so
those
are
left
the
same
way
that
they
were
before.
But
the
six
that
were
being
that
delivered
at
would
technically
deliver
to
Einstein
were
then
diverted
to
Jefferson,
basically
because
the
providers
were
there
so.
F
B
Know
like
I
guess,
I
would
say
this
thoughtfully,
but
you
know
they're.
The
Hahnemann
had
an
accessibility
aspect
to
it.
That
I
think
we
have
heard
anecdotally,
has
not
always
a
place
at
other
hospitals
and
other
places
of
care
and
I
think,
especially
for
women
who
are
about
to
give
birth
very
personal
journey
and
an
incredibly
intensive
one.
As
someone
who
gave
birth
three
times,
you
know
like
that.
Need
for
personal
access
of
care
is
deeply
important.
B
Actually
I'm
gonna
hold
on
that,
but
I
do
want
to
go
back
really
quickly
and
just
say:
I
appreciate
that
summary
as
well,
but
really
want
to
emphasize
that
it's
not
about
the
closure
of
hanaman.
It's
about
the
defining
access
to
care
to
OBGYNs,
to
certainly
one
of
6
maternity
wards
closing
all
across
the
city
and
to
lack
of
access
to
culturally
competent
and.
B
Anti-Racist
care
in
working
with
women
in
particular,
and
women
of
color
trans
women,
LGBTQ
families.
All
of
that
all
of
that
really
matters,
and
so
the
health
department's
role
in
analyzing,
the
landscape
of
care
right
now
could
not
be
more
important.
So
I
know
that
you,
you
know,
I
really
just
want
to
underscore
how
important
I
think
it
is
for
the
Department
of
Health
to
undertake
a
serious
citywide.
Look
at
women's
access
to
care
overall,
wait
times:
accessibility,
feelings
of
inclusivity!
Welcome!
B
'no
set
go
beyond
just
like
walking
their
way,
not
just
based
on
the
clients
who
walk
their
way
into
the
rooms,
but
really
on
women
who
are
giving
birth
period,
so
so
I
would
I
just
want
to
emphasize
that
this.
The
other
area
that
I
wanted
to
talk
about
in
relation
to
how
I
feel
like
giving
birth
is
such
a
personal
journey
is
to
ask
especially
for
Temple
and
Einstein.
What
is
your
relationship
with
doulas
in
particular
and
community-based
doulas?
B
How
do
you
have
like?
Do
you
support?
Do
you
provide
programs
that
not
only
support
training
but
ensure,
like
quality
wages,
access
to
care,
a
partnership
that
can
be
more
formalized?
I
know
a
lot
of
amazing
practitioners
who
are
doulas,
who
struggle
for
accessible
wages,
who
can't
get
appropriate
training
who
sometimes
have
not
always
felt
super
welcome
at
some
of
the
major
institutions
and
yeah
so
I.
E
Think
the
the
the
issue
with
having
doulas
and
community
health
workers
is
that
we
need
funding
and
temple
hospital
doesn't
really
have
funding.
We
have
to
rely
on
our
community
other
services
like
maternity
care,
coral
coalition.
If
we
have
the
patient
the
people
available
they're
more
than
welcome
to
come,
but
we
don't
have
the
money
to
employ
duelers.
We
don't
have
the
money
at
this
point
to
employee
community
health
workers.
E
The
em
cos
don't
really
provide
a
way
for
us
to
build
the
insurance
companies
for
these
supports
either
we
have
asked-
and
it
have
gone
to
different
health
insurance
companies
to
say
we
need
to
get
this.
This
kind
of
network
established,
but
we
really
don't
have
it.
We
don't
have
access
to
our
own
community
in
their
location,
people
we
don't
have
access
to
doula.
So
we
don't
have
access
to
community
health
care
because
there
isn't
the
funding.
So
we
will
have
to
go
through
other
other
community
systems
they're
available.
E
G
The
good
news
is
that
everyone
in
this
room's
voice
was
heard,
and
at
least
one
of
the
medicaid's
Keystone
first
will
reimburse
and
actually
employees
doulas
and
are
accessible.
But
it's
it's.
It's
not
the
perfect
scenario,
but
it's
better
than
zero.
So
a
great
the
perfect
world
is
that
the
dual
and
company
is
the
patient
throughout
the
prenatal
care
and
also
is
at
home
with
the
with
the
patient
as
when
the
family
as
well.
B
Yeah
I
mean
I,
think
I'm
going
to
go
even
a
step
further
than
that.
You
know
as
part
of
the
Merck
collaborative
partnerships,
implicit,
racial,
implicit
bias,
training
as
part
of
it
right.
Is
there
like
a
public
review
of
racial
diversity
amongst
the
doctors
and
hospital
care
practitioners
themselves,
like
do
the
hospitals
have
to
evaluate
their
own
diversity
numbers?
Yes,.
B
Think
you
said
like
a
really
beautiful
thing
about
how
doulas
are
really
increasingly
seen
by
community
members
is
just
being
what
a
really
great
sign
that
they're.
They
feel
like
they're,
getting
the
care
that
they
need,
and
so
it's
more
a
question
of
like.
Do
you
see
the
possibility
for
partnerships
not
do
have
to
have
one
right
now,
but
our
hospitals
increasingly
open
to
it.
I
know
it
costs
money
I'm.
B
But
we
are
talking
about
a
wider
initiative
and
part
of
the
Merck
collaboration.
Could
you
know
and
how
our
dual
is
being
seen
as
really
a
part
not
just
like
a
not
just
like
a
charitable
inclusion
of,
but
as
a
real
effort
to
invest
in
both
by
the
city
of
Philadelphia,
but
also
by
our
universities?
I
would.
E
Say
that
doulas
are
essential,
I
think
community
health
workers
are
essential
and
also
something
called
patient.
Centering
care
when
we
actually
bring
prenatal
care
to
our
patients
rather
than
have
our
patients
to
us
are
all
things
that
we
are
all
committed
into
trying
to
improve
access
to
care,
because
we,
especially
those
of
us
in
North
Philadelphia,
understand
that
there
are
huge
barriers
that
are
out
of
our
patients
control.
So
we
need
to
come
to
them
and
help
to
give
them
the
support
of
duelists.
E
B
M
M
M
Thank
You
representative
for
your
leadership
on
this
issue.
I
know
when
we
spoke
on
a
panel
last
week.
You
may
reference
to
talking
to
Senator
Casey
about
this
issue
and
also
you.
There
were
some
legislation
that
was
done
in
California
regarding
implicit
bias,
training,
I'm
curious
if
there's
been
any
other,
any
studies
that
have
been
done.
I
saw
looking
at
some
of
the
other
testimonies
for
some
of
the
panelists
today
that
there
is
a
basically
a
city
or
county
level.
Maternal
maturity,
review,
team,
yeah.
K
M
And
I'm,
reflecting
on
the
work
that
my
former
boss,
councilmember
and
task
I
did
regarding
sits,
and
this
issue
seems
to
not
really
but
there's
not
really
a
I
want
say,
use
the
word
cure,
but
his
number
of
heavens
are
being
taken
to
address
this
issue.
I'm.
Have
there
been
any
entities
on
at
the
national
level
that
are
doing
some
funding?
I,
see
that
see
if
it
I
was
gonna
receive
about
a
million
dollars
for
a
study,
but
it
seems
to
be
at
this
usually
a
much
larger
issue.
Yeah.
C
C
C
That
was
a
resource
coming
from
coming
to
Philadelphia
through
Merck
the
pharmaceutical
company,
but
you
also
have
the
CDC
that
has
actually
issued
grant
to
a
series
of
states
in
Pennsylvania
was
one
of
them,
so
we
received
2.5
million
to
go
towards
our
review
committees
and
20%
of
that
will
be
going
to
Philadelphia
because
we
run
our
own
review
committee.
I
think
you
know
it's
a
great
thing
to
have
grants
and
I
feel,
like
the
health
department
says
this
all
the
time
it's
great
to
have
grants
it's
great
to
have.
C
The
federal
government
acknowledge
this
with
this
2.5
million
dollar
investment,
but
we
do
need
to
talk
about
sustainability
in
long-term
impact,
with
funding.
One
of
the
things
with
the
Commonwealth
of
Pennsylvania
that
we're
working
on
is
to
ensure
that
there's
a
line-item
dedicated
to
this
work,
at
least
on
the
Commonwealth
level.
C
That
has
given
the
local
review
committee
that
the
ability
to
have
that
action
arm,
so
things
are
moving
into
the
right
direction,
but
again
I
still
stress
I,
don't
think
you
were
here.
We
did
just
recently
have
a
constituent
of
mine
just
passed
away
her
family's
here
today.
She
just
passed
away
in
June
due
to
her
pregnancy.
So
we
are
by
no
means
out
of
the
woods
with
this
issue
and
again,
the
infusion
of
dollars
and
support
is
great,
but
we
need
to
start
thinking
about
sustainability.
You
know.
M
Dynamic
having
the
nation's
first
Hospital
and
a
number
of
other
institution
that
have
been
around
a
long
time
that
we
can
really
take
the
leadership
with
having
our
teaching
institutions
really
have
nets,
have
an
implicit
bias,
training
as
part
of
their
medical
program
and
also
working
with
national
partners.
I
did
reach
out
as
a
file.
Our
conversation
last
week
reached
out
to
my
sister,
who
is
a
former
president.
The
student
National
Medical
Association
is
very
active
in
National
Medical
Association.
M
C
Imagine
do
feel
like
Philadelphia
again,
we
are
uniquely
placed
because
we're
working
all
together
and
because
we're
at
Ed's
and
meds
town
that
we
really
can
be
a
leader
in
this
space,
if
we
just
you
know,
make
sure
that
we're
working
in
a
collaborative
way
using
best
practices
that
works
and
covering
those
gaps
that
exist.
Thank.
A
Thank
You
councilman,
and
thank
you
so
much
for
being
here
for
your
testimony,
has
really
provided
valuable
insight
and
will
help
us
as
we
come
up
with
for
public
policy
on
this
issue.
So
I
just
really
want
to
say
thank
you
so
much
to
everyone
who
has
testified
thus
far
and
I'd
like
to
have
the
clerk
call
forward
the
next
panel,
but
also
asset
the
next
panel,
be
as
brief
as
possible.
A
C
K
K
Thank
you
for
the
opportunity
to
talk
with
you
today
about
the
maternity
mortality
crisis.
As
we
are
all
too
aware,
the
United
States
rates
of
maternal
mortality
are
the
highest
and
the
developed
world
and
have
been
rising
since
the
1990s.
To
the
point
that
today,
a
woman
who's
giving
birth
is
more
likely
to
die
in
childbirth
than
was
her
mother.
K
Black
women
are
at
least
three
to
four
times
more
likely
than
white
woman
to
die
around
childbirth.
We
all
know
this
and
we
know
in
Philadelphia
the
city's
maternal
mortality
review
team
has
reviewed
more
than
160
pregnant
pregnancy
associated
deaths
in
Philadelphia
of
residents
between
2010
and
2011
accounted
for.
74
percent
of
Philadelphia's
pregnancy
related
deaths,
while
white
non-hispanic
women
accounted
for
15%
I
currently
serve
as
the
senior
associate
dean
for
health,
equity,
diversity
and
inclusion
at
temples,
school
of
medicine
and
I
am
a
practicing
pediatrician.
K
We
have
done
a
lot
of
work
in
the
pediatric
realm
around
something
called
trauma-informed
care.
There's
been
a
lot
of
conversation
around.
What
many
policymakers
feels
needs
to
be
done
about
the
mortality
crisis.
We
haven't
really
been
talking
about
a
trauma-informed
approach.
There's
been
discussion,
a
lot
of
discussion
around
unconscious
bias,
training,
maternal
child
medical
homes,
expansion
of
Medicaid
services
to
improve
access
to
prenatal
care
and
extend
eligible
postnatal
care,
and
all
of
these
things
have
incredible
merit.
K
Pennsylvania
has
been
moving
very
quickly
towards
creating
what
has
become
known
as
trauma-informed
practices,
we're
seeing
it
in
our
schools.
We've
passed
laws
to
require
it
in
our
schools.
We
see
it
in
mental
health
spaces
we're
working
with
the
police
and
with
criminal
justice
programs
just
to
name
a
few.
So
what
would
that
look
like
if
we
tried
to
apply
that
to
pregnancy
care?
K
First,
just
as
a
quick
review
since
1998,
we
have
known
that
children
who
experience
significant
trauma
during
childhood
are
more
likely
to
suffer
from
heart
disease,
diabetes,
autoimmune
disease
addiction
and
mental
health
disorders,
they're
more
likely
to
suffer
from
the
majority
of
social
determinants
of
health.
We
talk
about
every
day
at
places
like
Temple
and
Einstein,
and
what
used
to
be
hanaman.
There's
economic
struggle,
less
opportunity
for
education,
less
access
to
good
food
in
many
other
forms
of
marginalization
and
impression.
K
Medicine
defies
trauma
as
events
trauma
events
as
anything
in
which
an
individual
experiences
witnesses
or
is
confronted
with
an
actual
or
threatened
death
or
serious
injury.
This
includes
what
an
individual
may
feel
threatened
or
afraid
for
their
safety.
So
this
can
be
lots
of
different
things
right.
This
can
be
children
who
suffer
physical
abuse,
sexual
abuse,
emotional
abuse,
witness
trauma
in
one
of
the
schools
that
were
working
in
today.
We
know
that
65%
of
our
seventh
graders
personally
know
somebody
who
has
been
injured
through
gun
violence.
K
Our
children
witnessed
this
each
and
every
day
it
may
be.
Someone
in
the
household
who
has
the
substance
used
to
someone
who
has
a
mental
illness.
Someone
who's
incarcerated,
one
out
of
three
of
our
black
men
in
North
Philadelphia
are
currently
or
have
been
incarcerated.
It
can
mean
feeling
unsafe
being
in
the
foster
care
system
being
hungry
suffering
from
poverty.
K
K
We
know
that
any
adult
who
has
experienced
four
or
more
of
these
events
during
childhood.
They
have
twice
the
rate
of
cancer
as
other
individuals.
There
are
three
times
more
likely
to
have
heart
disease.
There
are
four
times
more
likely
to
have
COPD
or
asthma
there's
six
times
more
likely
to
suffer
from
addiction,
and
if
there
a
score
is
six
are
higher.
Their
average
life
span
is
20
years
shorter.
Where
we
sit
right
now
in
North
Philadelphia,
the
average
lifespan
for
our
population
is
68
years.
K
K
K
So
what
do
we
know
about
this?
What's
what
can
the
science
tell
us
on
how
we
should
try
to
move
forward?
So
imagine
you're
in
a
forest
and
a
bear
is
chasing
you.
Your
body
is
very
smart.
You
will
make
adrenaline,
you
will
make
cortisol.
It
will
all
be
about
you
running
away
from
the
bear
you're
not
going
to
be
thinking
about
how
to
solve
a
problem.
K
You're
not
going
to
be
thinking
about
how
to
make
an
appointment,
you're
not
going
to
be
planning
ahead
for
anything
you're
just
going
to
be
trying
to
survive,
and
that
works
great.
If
you're
in
the
forest
and
a
bear
is
chasing,
but
what
happens
if
this
bear
comes
home
every
night?
What
happens
if
the
child's
brain
is
bathed
in
cortisol
and
adrenaline
all
the
time?
K
We
know
that
this
changes
their
their
physiology.
We
know
that
even
as
adults,
if
we
check
inflammatory
markers
in
their
blood
they're
going
to
be
abnormally
high,
we
know
that
if
we
do
PET
scans
on
their
brains,
they're
going
to
be
different,
they're
going
to
have
the
parts
of
the
brain
that
are
all
about
survival
and
all
about
immediate
response,
be
much
more
prominent
than
areas
of
their
brain
that
are
about
planning
and
taking
part
in
everyday
social
life.
K
But
all
of
this
is
not
lost.
We
can
reverse
some
of
these
changes.
There
is
evidence
that
if
we
use
a
trauma-informed
resiliency
based
approach,
we
can
make
we
can
see
these
changes
in
the
brain
and
these
changes
in
the
blood
tests
be
reversed,
and
we
also
know
that
if
we
don't
do
that
and
weari
traumatize
people,
we
make
that
situation
work.
K
So
what
would
an
ob/gyn
office?
That's
trauma-informed!
That's
a
trauma-informed
space,
look
like
well!
First
and
foremost,
it
has
to
be
a
space
that
sees
the
person
in
front
of
them,
the
mother,
as
a
patient
who
may
have
had
bad
things
happen
to
them,
not
as
a
bad
person,
not
as
someone
who's
non-compliant
to
what
they
can
do.
K
So
so
what
would
it
look
like
if
we
created
a
trauma-informed
OB
clinic,
so
we've
all
experienced
healthcare?
So
imagine
a
mother
of
three
who
was
pregnant.
She
comes
to
an
academic,
Medical
Center
she's,
a
single
parent.
She
has
to
bring
all
three
of
her
children
with
her.
She
walks
four
blocks
to
get
to
the
bus.
Then
she
takes
two
buses
she's
20
minutes
late,
the
front
desk
staff
is
overwhelmed
overworked
and
tired.
They
know
they
have
to
see
her.
They
fit
her
in,
but
their
whole
day
is
behind.
So
she
sits
in
wait.
K
She
waits
for
over
two
hours.
She
has
her
kids
with
her
the
entire
time.
There's
no
place
for
her
kids
to
be
their
kids.
They
make
a
lot
of
noise
again.
The
staff
is
looking
at
her.
She
feels
they're.
Judging
her
parenting
skill.
She
finally
gets
in
to
see
the
doctor.
She
has
hypertension
she
had
hypertension
at
the
last
visit.
They
gave
her
medication.
She
couldn't
get
the
medication
filled
because
that
certain
medication
wasn't
on
her
manage
Medicaid
plan.
The
practitioner
is
really
worried
about
her
and
her
child
you're.
K
Putting
your
child
at
risk
says
the
practitioner,
the
mother,
here's
a
second
sentence
in
her
head
and
we
may
need
to
get
social
services
involved
because
maybe
you
aren't
worthy
to
have
these
children
she's
keenly
afraid
that
that's
how
they're
seeing
her
her
ace
score
is
six.
She
has
suffered
all
the
effects
that
go
along
with
that
when
it
comes
time
for
her
next
appointment,
she
doesn't
go.
She
stops
going
all
together,
she's
afraid
she
will
lose
her
children.
She
will
be
confronted
with
all
that
she
is
unable
to
do.
K
The
providers
really
wanted
to
help
but
they're
overwhelmed.
They
don't
have
the
capacity
to
help
we're
not
set
up
for
that.
We're
set
up
to
do
really
well
in
suburbia
for
women
who
have
lots
of
resources.
What?
If
the
experience
looked
different?
Let's
say
we
didn't
have
a
clinic
that
booked
a
patient
every
15
minutes
that
we
had
group
visits
for
women
that
were
planned
around
the
bus
schedule.
Maybe
10
to
15
women
from
the
same
community
would
mean
and
talk
together
in
one
visit.
A
practitioner
would
talk
with
them
answer
their
questions,
educate
them.
K
A
second
practitioner
would
see
them
individually
check
their
vital
signs.
Do
the
exam
the
finance
people
in
the
back
room?
They
could
bill
for
ten
patients
in
an
hour
and
a
half
that's
when
they
can
ever
go
at
a
15-minute
slot.
Oh
and
there's
childcare
provided
the
children
that
come
with
the
mothers.
There
are
other
children,
they
have
a
safe
space
to
be
so.
The
mother
can
really
pay
attention
to
her
appointment.
The
entire
staff
in
the
clinic
is
aware
of
bias.
K
Racism
and
the
historical
basis
of
oppression,
and
they
understand
the
physiologic
effect
of
drama
and
then
there's
outreach
members,
community
members
doulas
that
are
hired
from
the
community
as
temple
as
academic
medical
center
employees.
Moving
that
forward
so
I
know
it
sounds
expensive,
but
I
I'm,
confident
that
if
we
create
this
environment
it
will
save
so
much
more
money
than
it
will
cost.
In
my
testimony
you
will
see
there's
billions
of
dollars
spent
on
the
complication
of
pregnancy,
both
for
the
mother
and
the
child.
K
K
So
we
believe
that
academic
health
centers
need
to
come
together
and
put
together
the
plan
of
how
we
could
fund
trauma-informed
spaces
to
be
able
to
do
that.
We're
running
a
pilot
right
now
out
of
temple,
we're
also
partnering
with
the
School
of
Public
Health,
where
we
do
have
doulas
that
are
going
to
be
trauma-informed
doulas
that
are
working
with
christy
Santora
who's
in
our
public
health
department
who's.
Here,
who
is
working
to
do
just
that?
So
we
truly
believe
that
we
have
to
make
big
change
here.
K
A
Right
I
want
to
thank
you
for
your
testimony.
I'd
really
hate
to
cut
you
off,
because
your
testimony
is
just
really
comprehensive
and
I
can
assure
you
that
I'm
going
to
really
take
the
time
to
sit
down
and
digest
everything
because
there's
a
whole
lot
of
information
here
today.
It's
all
really
good
and
powerful
information
that
we
can
use
to
address
this
issue,
and
so
I
am
going
to
take
the
time
and
make
sure
that
I
read
all
the
testimony.
A
That's
here
today,
I'm
likely
going
to
have
to
leave
this
hearing
in
a
few
minutes,
but
I
want
to
stay
in
here
as
much
of
it
as
possible.
So
again,
I.
Thank
you
for
your
for
your
testimony.
If
we
could
have
you,
sir
state
your
name
for
the
record
and
begin
or
asking
really,
if
focus
could
limit
their
testimony
to
about
two
minutes,
if
that's
okay
for.
N
The
record
I
am
Edward,
Gilmore
and
I.
Don't
have
a
lot
of
papers
in
front
of
me
to
flip
okay.
What
I'm
going
to
say
is
gonna
come
from
my
heart,
alright
I'm,
basically
here
of
testifying,
because
I
recently
lost
my
daughter
ten
weeks
ago,
so
I'm
still
in
grieving
of
childbirth.
Okay
matter
of
fact,
I
don't
live
in
this
state
anymore.
I
drove
up
from
North
Carolina
nine-hour
drive
last
night
to
be
here
to
represent.
You
know
my
daughter,
her
friend,
that's
sitting
back
there.
N
My
background
is
I'm
69
years
old,
quite
naturally
I'm
an
afro-american
male
had
three
daughters
raised.
Three
daughters
by
the
same
woman
was
married:
42
years,
okay,
I'm
a
Vietnam
veteran
I
work
for
the
US
Postal
Service,
37
years
retired
as
a
high
level
of
manager.
So
when
it
comes
to
health
care,
my
kids
got
the
best
health
care.
Yet
still
my
daughter
died
at
childbirth.
N
July
26
I
saw
my
doing
the
day
before
she
was
in
perfect
health
and
I
heard
a
lot
of
testimony
from
everybody
about
not
having
enough
time
you
gotta
take
care
of
the
kids.
My
daughter
was
not
affected
by
that
she
came
from
a
loving
family,
all
her
life.
She
was
a
fitness
expert.
She
ate
the
proper
foods
she
had
no
symptoms
during
pregnancy
matter.
N
Of
fact,
I
saw
her
today
before
July
25th
I
hugged
up,
lashena
I'll
see
you
next
week,
many
wife's
gonna
drive
up
to
see
you
delivered
and
she
was
very
excited
about
it.
So,
like
I
say
once
again,
I
don't
have
any
notes,
I'm
here
representing
my
daughter
and
what
I'm
hearing
from
everybody
else
in
this
room.
Hopefully
what
happened
to
my
daughter
won't
happen
to
anybody
else.
N
I
can't
bring
her
back,
I've
accepted
that
it's
hard,
but
I've
accepted
it
and,
like
I,
say
once
again,
you
know
I'm
here
representing
her
and
I'm,
her
father,
still
her
father
and
and
at
this
present
time
I
think
that's
about
all
I
have
to
say
because,
like
I
said,
it's
for
his
prenatal
machello
was
special
great.
Ladies
and
gentleman
she
was
special.
She
was
on
top
of
everything
and
she
got
along
very
well
with
people.
So,
for
so,
for
this
happened
is
a
total
shock.
Okay,
total
shock.
N
You
know
she
had
no
problem
leading
up
to
this
event,
none
whatsoever
she
had
a
child
before
leshawna
leshawna,
he's
ten
years
old,
no
problem
with
that
pregnancy
matter
of
fact,
when
you
leave
outside
of
these
walls,
if
you
ask
anybody
on
the
outside,
they
think
this
is
unheard
of
now.
Okay
and
I
get
along
with
everybody,
not
prejudiced.
I
got
white
friends,
black
friends
and
everybody
I've
talked
to
about
what
happened,
my
daughter.
N
They
cannot
believe
it
and
if
they
an
age,
they
can't
believe
me
so
I'm
sitting
here,
testifying
on
behalf
of
my
daughter,
hopefully
that
we
can
save
other
lives.
They
don't
happen
again
again
because
I
hear
all
the
statistics
and
that's
it's
going
over
my
head
right
now
because,
like
I
said
it
didn't
matter
because
my
daughter
far
the
rules
and
regulations.
You
know
you
know
she
was
a
health
expert,
Zumba
instructor,
you
name
it.
She
ate
the
proper
foods,
you
name
it,
but
yet
you
still
had
end
up
bearing
her.
That's
my
testimony.
A
I
I,
thank
you
for
your
testimony
and
your
words
are
powerful
and
it
goes
back
to
a
statement
one
of
my
colleagues
Councilwoman
Sanchez
made
earlier,
which
was
that
as
we
have
all
of
these
you
know
conversations
and
groups
and
medical
teams
and
experts
and
research.
We
really
need
to
make
sure
that
there
is
a
voice
for
those
who
have
gone
through
and
for
the
families
of
those
who
have
gone
through
a
loss
such
as
this
because,
it's
you
know,
I
agree
with
you,
which
it
shouldn't
be
happening.
A
People
think
it
doesn't
happen
and
until
I
have
my
experience,
I
didn't
believe
it
could
happen,
but
we
need
to
spread
the
word.
We
need
to
make
sure
that
our
young
women
who
have
X
access
to
excellent
health
care
that
they
are
heard
that
their
concerns
are
validated.
You
know
one
of
the
things
that
was
mentioned
earlier
is
the
doctor
who
mentioned
when
folks
come
in.
Well,
you
don't
feel
a
certain
kind
of
way.
Do
you
or
you
don't?
A
N
N
N
N
A
O
It
Nina
Emmett
and
I'm
here
from
representing
National
Organization
for
Women
I,
just
want
to
extend
my
deepest
condolences
to
you.
Thank
you.
We
must
do
better
good
afternoon.
I
would
like
to
thank
honourable
Cindy
bass
and
honourable
members
of
the
committee
on
Health
and
Human
Services,
for
convening
this
public
hearing
on
the
critical
topic
of
maternal
mortality.
O
I'm
grateful
for
this
opportunity
to
justify
maternal
mortality
is
a
death
of
a
woman
during
pregnancy
or
up
to
one
year
following
the
end
of
pregnancy,
regardless
of
the
outcome
of
the
pregnancy,
the
nation
and
Pennsylvania
has
seen
an
alarming
rate
of
maternal
deaths.
What
is
more
alarming
is
that
the
net
that
nationally
African
American
women
are
3.5
times
more
likely
than
white
women
to
die
from
pregnancy
related
conditions.
Until
recently,
the
racial
disparity
in
maternal
mortality
has
largely
been
ignored.
O
The
Philadelphia
Health
Department
report
titled
maternal
mortality,
which
was
published
in
2015,
acknowledged
the
problem,
but
not
once
was
the
fundamental
cause
of
the
disparity
in
the
data
regarding
african-american
woman
discussed
in
the
recommendations.
A
recent
feature,
long
news,
New
York
Times
article
identified
racism
as
the
fundamental
cause
of
what
is
clearly
a
public
health
crisis.
The
higher
maternal
death
rates
of
African
American
women
has
been
recently
in
the
news
since
tennis,
star
Serena
Williams
shared
her
near-death
experience
after
giving
birth
to
her
first
child.
O
Her
story
underscores
the
fact
that
the
disproportionate
number
of
black
mothers
dying
within
a
year
of
giving
birth
is
not
solely
tied
to
socio-economic
factors,
as
Stephanie
total,
a
key
who
leads
the
maternity
care
portfolio
at
the
California
Health
Care
stated.
The
problem
is
not
that
pregnant
women
are
undereducated
or
uninformed.
The
problem
is
that
those
in
charge
are
not
listening
to
them.
What
can
be
done
to
start?
We
have
to
listen
to
the
women
affected
and
bring
critical
information
straight
to
the
community.
O
At
the
same
time,
we
have
to
integrate
multifaceted,
anti-racist
measures
in
every
strata
of
our
medical
institutions,
while
our
entire
society
struggles
to
dismantle
racist
and
gender-based
barriers,
we
need
to
put
the
spotlight
on
our
medical
institutions,
because
these
barriers
are
literally
a
matter
of
life
and
death
for
african-american
women.
We
need
immediate
measures
such
as
ongoing
implicit
bias,
training
and
strong
consequences
when
such
bias
is
detected.
O
Data
showed
that,
with
this
continuous
support
system,
doulas
positively
impact,
both
mothers
and
babies
and
help
families
achieve
a
healthy
and
positive
birthing
experience
from
a
dollars
and
cents
perspective.
Continuous
care
from
doulas
can
improve
birth,
birth
outcomes
for
both
mothers
and
infants,
resulting
in
fewer
preterm
and
low
birth
infants
and
reductions
in
cesarean
sections,
all
of
which
contain
cost.
The
association
of
state
and
territorial
health
officials
has
published
a
state
policy
approach
to
incorporating
doula
services
into
maternal
care.
It
models,
savings
average
in
$986
or
Medicaid
if
covered
if
it
covered
doula
services.
O
I
am
encouraged
by
the
recent
interest
of
Pennsylvania
legislators,
including
our
own
state,
Rep
Morgan
Cephas,
who
has
been
spearheading
this
as
well
as
governor
wolf.
Regarding
this
maternal
mortality
crisis,
there
have
been
recent
resources
from
CDC
and
mark
awarded
for
this
crisis.
I'm
hopeful
that
governor
Wolf's
recently
created
maternal
mortality,
review
committee
tasked
to
collect
information
and
to
investigate
and
disseminate
findings
related
to
maternal
deaths,
we'll
use
racial
equity
lens
in
analyzing.
O
This
data,
as
recommended
by
aster,
including
doulas
as
members
of
the
key
Advisory
Committee,
is
critical
to
meaningful
reform
and
I
hope
that
some
of
our
journal
notable
doulas
were
here
today
are
at
that
table.
I
did
not
see
their
names
on
on
that
committee
as
of
yet
but
most
importantly,
we
have
already
have
solid
data
that
doulas
are
an
important
resource
in
fighting
maternal
mortality
in
Oregon
in
2012
and
Minnesota
2013.
O
They
instituted
what
Pennsylvania
should
institute
equitable,
equitable
and
I.
Underline
that
Medicaid
reimbursement
of
doulas.
Not
only
will
it
help
mitigate
the
tragic
problem
of
maternal
mortality,
it
will
be
a
job
creator
for
our
communities
as
well.
It
will
be
critical
to
ensure
that
african-american
doulas
are
front
and
center
in
addressing
the
needs
and
advocating
for
african-american
mothers
who
are
dying
due
to
racism
embedded
in
our
health
care
institutions.
I,
thank
you.
A
Thank
you
for
your
testimony
and
I
do
apologize
as
I
said,
I
do
have
to
leave
for
another
appointment,
but
again,
I
want
to
thank
everyone
for
being
here.
I
really
appreciate
your
testimonies,
written
and
unwritten,
sir
and
I
will
certainly
review
all
of
the
testimony
that
I
have
and
work
with
my
colleagues
to
find
some
sort
of
solutions
that
we
can
do
there
are
things
I
believe
that
we
can
do
here
in
the
city
of
Philadelphia.
We
can
do
better.
We
can
all
do
better.
A
D
Good
afternoon,
please
whoever
like
to
start
think
mister
I,
think
you
were
called
first,
if
you'd
like
to,
if
you
have
written
testimony
that
won't
all
be
made
part
of
the
record
again
we're
running
behind
schedule
here.
So
if
you
could
summarize
any
statement,
we'd
appreciate
and
your
written
testimony,
you've
made
part
of
the
record.
Thank
you.
You're.
L
Welcome
so
good
afternoon,
and
thank
you
to
the
Public
Health
and
Human
Services
Committee
Councilwoman,
fast
and
representative
Cephas,
for
inviting
me
Maryanne
Frey,
a
CEO
for
maternity
care
coalition
to
testify
on
the
maternal
mortality
epidemic
I'm,
going
to
skip
much
of
this
and
just
go
to
some
salient
points
that
I
think
highlight.
What's
really
important,
MCC
has
found
that,
among
our
clients,
largely
low-income
and
women
of
color,
the
leading
factors
contributing
to
poor
health
outcomes
are
and
have
been
spoken
about
in
a
lot
earlier.
L
Institutional
racism,
chronic
illnesses
effectively
navigating
the
healthcare
system
and
lack
of
sufficient
paid
leave
I'd
like
to
focus
my
remaining
comments
on
solutions.
So
last
year
or
earlier,
dr.
Gioia
career
of
peri,
a
founder
of
the
national
birth
equity
collaborative
provided
some
testimony
to
the
US
House
of
Representatives
Subcommittee
on
health
in
support
of
HR
1318,
and
that
was
preventing
maternal
mortality.
Act
of
2017
and
she
said
quote.
The
legacy
of
hierarchy
of
human
value
based
on
the
color
of
our
skin,
continues
to
cause
differences
in
health
outcomes,
including
maternal
mortality.
L
Racism
is
the
factor
not
black
skin.
So
what
can
we
do
about?
It
there
have
a
previous
testimony
has
been
focused
on
some
work.
That's
been
done
at
the
city
and
state
level.
Maternity.
Excuse
me,
the
maternal
mortality
review
committee
and
asked
to
spoke
about
there
earlier
and
there's
some
findings
that
have
helped
in
form
a
design
that
MCC
has
in
a
program
in
a
fit.
That's
called
safe
start
and
that's
what
I'd
like
to
talk
about.
L
L
P
I'm
takiyah
Gainey
good
afternoon,
and
thank
you
to
the
Public
Health
and
Human
Services
Committee,
Councilwoman
bass
and
representative
Cephas
for
having
me
to
share
information
about
the
role
of
doulas
in
addressing
Philadelphia's
maternal
health
crisis.
I
am
the
program
associate
for
the
breastfeeding
community
doula
program
at
maternity
care
coalition
and
I'm,
also
one
of
their
community
doulas
in
communities
of
color,
where
discrimination
in
the
health
care
system
is
prevalent
and
people
often
feel
disempowered.
Doula
care
can
make
a
big
impact.
P
There
are
so
many
things
designed
to
take
our
power
away
in
these
situations,
including
the
unknowns
we
have
around
our
bodies
and
in
birth
in
particular,
and
then
you
have
the
vulnerability
of
labor
and
birth,
but
doula
care
can
help
shift
the
power
during
that
moment
and
provide
mothers
with
information
tools
and
confidence
to
speak
up
and
advocate
for
the
care
time
or
attention
that
they
need.
Doulas
are
not
superheroes.
I
hear
a
lot
of
the
conversation
today.
Deferring
to
well
get
a
doula
have
doulas
fun
doulas.
P
We
are
not
the
the
solve
all
problem
solve
all
solution
to
this
problem,
but
doulas
are
trained
birth
companions
that
provide
informational,
emotional
and
non-medical
support
to
women
before,
during
and
after
childbirth,
the
care
is
individualized
and
extensive.
Research
has
correlated
doula
care
with
higher
breastfeeding
initiation
rates,
fewer
cesarean
sections,
fewer
low,
/,
3
birth
weight,
babies,
lower
risk
for
postpartum
depression
and
improved
satisfaction
with
the
overall
childbirth
experience.
P
Disappointingly,
however,
it
is
mostly
people
who
can
afford
to
hire
a
doula
who
benefit
from
having
this
care.
Community-Based
doula
programs
have
emerged
around
the
country
in
recent
years
to
help
fill
that
gap
to
address
the
needs
of
communities
of
color
and
other
communities
and
the
margins
who
experience
poor
health
outcomes.
The
community-based
doula
program
at
maternity
care
coalition
is
one
of
these
innovative
models.
It
has
been
a
catalyst
for
ongoing
shift
in
the
birth
worker
community
and
for
birthing
families
and
Philadelphia.
P
Currently,
in
partnership
with
Temple
University,
we
are
now
gearing
up
to
expand
our
community-based
doula
program
for
a
new
perinatal
community
health
worker
training,
which
will
prepare
women
and
the
North
Philadelphia
community
to
serve
pregnant
people
as
both
birth
and
postpartum
doulas,
as
well
as
breastfeeding
counselors.
So
this
new
perinatal
health
worker
model
aligns
with
Pennsylvania's
proposed
standards
for
community
health
worker
certification.
P
Our
program
to
date
has
trained
more
than
170
community
doulas
and
breastfeeding
counselors,
predominantly
people
of
color
and
have
matched
them
with
over
1,500
pregnant
people
who
request
our
services
or
were
referred
for
doula
breastfeeding
support
by
their
insurance
provider,
care
coordinators
or
self
select
n
community-based.
Do
let's
help
women
find
their
voice
their
voice
in
their
confidence
and
walk
with
them
with
respect
community
based
doula
programs
also
promote
economic
and
professional
growth
and
sufficiency.
Many
of
the
people
who've
had
the
support
of
one
of
our
doula
networks.
Later
became
trained,
doulas
themselves.
P
Many
of
our
trained
birth
workers
have
formed
their
own
groups
and
projects
and
have
gone
on
to
nursing
or
midwifery
school,
or
have
found
jobs
and
maternal
and
infant
health
arena
now.
I
just
want
to
speak
to
some
of
the
key
points
to
note
and
some
things
that
the
city
of
Philadelphia
and
Pennsylvania
can
implement.
One
of
those
being
reimbursement
must
allow
for
increased
accessibility
of
doulas.
P
Currently
doula
care
is
an
out-of-pocket
expense
for
most
families
and
unless
they
connect
with
a
doula
program
through
an
organization
such
as
maternity
care
coalition,
reimbursement
rates
must
allow
for
duelists
to
earn
a
living
wage
and
I
repeat
that
reimbursement
rates
must
allow
for
duelists
who
earn
a
living
wage.
This
is
heart,
work,
its
invested
work
and
a
lot
of
duelists
who
are
employed
as
community
doulas
experience
burnout
very
early
while
doing
this
work.
P
Another
suggestion
suggestion
is
to
invest
and
community
based
models
to
ensure
that
doulas
are
enrolled
in
Medicaid
reimbursement
programs,
are
trained
and
supported
to
serve
communities
of
color
and
provide
funding
to
train
a
diverse
community
of
doulas
and
breastfeeding
counselors
from
communities
of
color,
immigrant
communities
and
others
facing
poor
access
to
care.
Thank
you
thank.
Q
Afternoon,
my
name
is
Leticia
garland
I
am
representing
Family
Practice
and
counseling
network
I
am
the
center
director
for
the
impending
family,
health
and
birth
center
project,
I'm
standing
gratitude
to
Councilwoman
Cindy
bass
and
the
Public
Health
and
Human
Services
Committee
for
allowing
us
to
be
here
today
to
give
testimony
when
you
think
of
countless
women,
chillon
Irving,
Cara,
Johnson,
Erica,
garner
Krystle,
Galloway,
LaShonda
hazard,
tamesha,
Dickie
Yolanda
mentioned
lashonna
Gilmore
my
condolences
family
name
moment.
These
are
just
a
few
of
the
names
of
women.
Q
Black
women
who
have
died
prematurely
from
pregnancy
or
birth,
related
causes
in
this
country
and
I
too
understand
this
all
so
well,
when
I
was
presented
with
the
opportunity
to
be
a
part
of
the
family,
health
and
Birth
Center
project
I
bring
my
own
lived
experience
while
pregnant
with
my
son.
My
birth
plan
was
very
simple:
I
was
going
to
have
a
natural
birth
and
I
was
going
to
breastfeed,
I
had
a
happy
healthy
pregnancy,
I
prepared
and
I
was
looking
forward
to
motherhood.
Q
Going
to
weeks
past
my
due
date,
I
needed
to
be
induced,
and
despite
my
preparation
and
positive
attitude,
things
did
not
go
my
way.
I
nearly
died,
countless
hours
of
painful
induced
labor
stress
when
my
doctor
shift
ended
and
my
care
was
transferred
to
strangers
and
what
I
felt
was
the
violation
at
hands
of
what
seemed
to
be.
The
entire
hospital
staff
led
to
my
dysfunctional
labor
I
was
told
that
they
would
need
to
go
and
grab
my
son
via
c-section,
my
blood
pressure
spiked.
Q
What
was
supposed
to
be
the
happiest
moment
of
my
life
was
clouded
by
sadness
in
short,
violation,
trauma
and
failure.
These
are
words
that
define
my
birth
story
and,
unfortunately,
the
birth
stories
of
all
too
many
black
women
here
in
the
city
in
this
country,
and
here
I
thought
I
was
the
exception.
Statistics
proved
that
black
women
are
twice
as
likely
to
suffer
from
severe
complications
during
pregnancy
and
childbirth,
and
we
are
having
more
and
more
these
instances
through
personal
stories.
Black
women
need
to
be
validated.
Q
Knowing
this
I'm
convicted
and
I'm
inspired
to
help
make
a
difference.
Women
need
to
be
respected
and
engaged
in
their
own
experiences
of
pregnancy
and
in
childbirth,
and
this
is
an
issue
that
is
affecting
our
city.
Our
communities
and
our
families,
as
we
are
all
aware
of
Philadelphia,
has
some
of
the
worst
maternal
and
infant
mortality
rates
in
major
among
major
US
cities.
Here
in
Philadelphia,
black
women
account
for
45%
of
annual
birthing
population,
but
account
for
75%
of
pregnancy,
related
maternal
deaths,
black
women
facing
discrimination,
internalized
stress,
leading
to
poor
health
outcomes
over
time.
Q
A
birth
center
is
a
home-like
setting
where
midwives
provide
care
to
women
with
low-risk
pregnancies.
A
recent
study
done
by
CMS
the
strong
start
study
within
Medicaid
populations
concluded
that
birth
centers
have
healthier
outcomes
at
a
lower
cost
when
compared
to
births
in
a
hospital
setting
improving
patient
experience.
This
model
will
help
save
lives,
reduce
health
care
costs
tremendously
and
improved
community
health
and
well-being,
so
family
practice
and
counseling
is
a
network
of
community
centers
across
Philadelphia.
We
are
a
program
of
resources
for
human
development.
Q
We
have
a
strong
track
record
of
providing
integrated
healthcare
services
in
vulnerable
communities.
We
have
five
health
centers
over
the
27-year
over
the
past
27
years,
we've
grown
from
one
to
five
and
we
know
how
to
establish
new
initiatives
and
to
grow
new
ideas.
We
reach
about
25,000
patients,
annually,
inclusive
of
prenatal
care
services,
the
birth
center
plans
to
include
and
provide
integrated,
behavioral
health
care
for
all
patients,
health,
education
and
home
visitation
by
dually,
trained
community
doulas,
culturally
proficient
care
all
health.
Q
Centers
staff
receives
ongoing
racial
biases
training,
rich
data
tracking
systems
to
monitor
outcomes
over
time,
primary
care
and
dental
care
services
for
the
entire
family.
We
have
strong
alignment
with
organizations
like
New
Voices
for
reproductive
health.
Black
Mama's
matter
maternity
care
coalition
and
others,
we
have
a
partnership
with
hospitals
for
high-risk
deliveries
and
we're
committed
to
this
mission,
and
we
look
forward
to
joining
and
the
much-needed
collective
work
to
make
an
impact
here.
We
believe
that
maternal
mortality
is
not
just
her
issue,
but
it
is
our
issue.
Thank
you.
Thank.
B
Councilwoman,
yes,
I
just
wanted
to
add
my
voice
to
thank
you
very
much
for
all
the
work
that
you've
been
doing
and
especially
appreciate
all
your
testimony,
because
I
thought
it
was
very
direct
and
clear,
but
I
was
curious
about
who
you
think
ought
to
be
coordinating.
Some
of
the
recommendations
that
she
made
particularly
I
mean
there
are
recommendations
that
you
made
that
have
to
do
with
reimbursements.
B
That
sounds
like
it
might
be
more
at
the
state
level
than
it
could
be
at
the
local
level,
but
in
terms
of
some
of
the
other
recommendations
that
you
may
have
in
terms
of
investing
in
community
based
models
provide
funding
for
training
of
doulas
and
other
areas.
Do
you
see
that
as
being
a
locally
driven
initiative
that
could
happen
at
the
municipal
level
or
is
that
something
that
you
would
feel
you'd
want
to
see
led
by
the
city?
L
Probably
is
gonna
be
at
the
state
level,
because
I
really
think
that
there
has
to
be
this.
It's
a
combination
of
like
legislation,
as
well
as
the
MCO
SR,
really
with
the
pressure
from
the
states
on
the
NCOs
to
make
sure
that
they
are
gonna
meet
their
heat
as
measures.
That's
what's,
gonna
probably
help
because
the
MCO
s
have
the
money
mm-hmm.
R
L
B
L
It's
continuing
to
do
the
work
that
you
do
now
putting
pressure
on
every
single
one
of
asking
the
questions
of
the
departments
that
you
did
earlier.
I
think
that's!
That's
a
big
start,
because
there
is
influence
that
the
council
have
that
we
in
community
organizations
don't
have.
We
rely
on
these
bodies
to
keep
us
all
accountable,
so
I
think
it
is
making
sure
you
ask
those
tough
questions
and
expect
us
to
be
accountable
to
answer
them
to
not
only
answer
them
but
to
actually
be
doing
something.
Yeah.
P
G
C
G
D
D
S
My
name
is
Lily
McNeil.
Thank
you
for
having
me
today.
I
am
a
reproductive
psychotherapist
serving
Philadelphia
in
the
surrounding
counties.
I
come
with
you
experience
with
experience
on
multiple
levels:
I
used
to
be
a
doula
I
am
the
founder
and
CEO
of
ocean
Family,
Center
and
curator
of
the
maternal
wellness
village.
In
addition,
a
survivor
of
birth
trauma
I
delivered
my
son
in
2006
in
the
title
of
mother
made
me
a
statistic.
S
My
pregnancy
went
well
until
I
went
to
deliver
and
my
blood
pressure
was
200
to
over
153
I
was
instructing
and
I
did
not
understand
what
was
happening
to
my
body
at
the
point.
I
spent
nine
days
in
the
hospital
and
weeks
later,
my
postpartum
mood
fluctuations
started
to
begin
and
I
did
not
feel
I
can
tell
anyone.
I
didn't
tell
anybody,
because
I
did
not
trust
that
the
providers
who
were
caring
for
me,
what
understand
that
I
was
emotionally
depleted
and
not
anything
less
than
a
mother.
S
In
my
work,
I
come
across
mothers
that
are
looking
for
information
about
the
adjustments
occurring
throughout
their
bodies
and
support
and
recovering
after
giving
birth.
Parents
are
struggling
due
to
the
risk
factors
associated
with
one
of
the
most
joyous
times
in
their
life
childbirth.
Well,
my
husband
and
I
decided
to
expand
our
family.
I
have
discussed
the
risk
factors
and
blatantly
stated.
Please
don't
let
me
die
those
chilling.
Words
are
terrifying
and
it's
all
order
to
fill,
but
it
is
our
reality.
S
Black
families
are
deciding
to
have
children
despite
the
risk
factors,
and
it
is
undoubtedly
a
time
for
systemic
change.
California
is
making
strides
and
shifting
the
narrative
and
holding
providers
responsible
for
the
care
of
gestational
parents
by
addressing
their
biases.
We
have
to
ask
ourselves:
am
I
worth
saving
it's
Pennsylvanian
progressive
enough
to
change
the
narrative
for
black
and
brown
people
as
a
pleasent
bias
and
racism
is
killing
our
bodies
after
working
in
Riverside,
Correctional
Facility
for
a
few
years
with
the
pregnant
appearance
and
population
I
thought
that
I
would
never
hear
story.
S
They
made
me
cry
because
of
the
level
of
abuse,
neglect,
trauma
and
trauma.
Some
of
the
participants
discussed,
but
things
have
changed.
I
have
received
an
influx
of
clients
dealing
with
suicidal
ideations
attempts
on
their
life
and
self
harming
actions
these
women
are
pregnant,
may
have
newborn
babies
and
are
in
crisis.
I
will
tell
you
about
Rhonda.
She
is
an
educated
woman
of
color
working
in
one
of
the
top
companies
in
the
city.
She
is
currently
on
maternity
leave
and
dreads
the
moment
she
has
to
return
to
work
during
an
intake
appointment.
S
She
was
asked
about
suicide.
He
ate
suicide
ideations
and
denies
such
actions
and
thoughts.
Three
sessions
later
she
disclosed
I
tried
to
take
my
life
during
my
pregnancy.
She
proceeded
to
discuss
the
details
which
I
was
spare
you
of
hearing
today,
her
effect
was
fled,
her
words
were
cold
and
she
appeared
dissociated
from
the
story
in
which
is
how
she
survived.
S
Telling
me
I
thought
an
overwhelming
sense
of
sadness
for
her
I
had
a
knot
in
my
chest
and
tears
that
I
had
to
hold
back
at
the
conclusion
of
our
session
I
immediately
said
and
process.
What
I
had
heard
I
took
a
moment
to
release
all
that.
I
was
feeling
for
this
woman
and
every
gestational
parent
that
has
experienced
such
hopelessness
as
a
clinician
I
felt
defeated
as
our
work
continues
together.
Rhonda
is
better
now,
but
it's
still
diligently
working
to
live
every
day.
S
It
is
my
life's
mission
to
collaboratively
work
together
to
change
this
narrative.
I
do
not
want
another
parent
to
go
months
without
care
because
of
the
fear,
shame
and
guilt
associated
with
a
broken
system.
A
system
not
constructed
for
us
to
thrive
for
this
I
have
found
an
ocean
Family
Center
and
launched
a
citywide
initiative
to
assist
in
reducing
black
maternal
mortality
with
the
maternal
wellness
village.
This
village
is
comprised
of
birth
workers
of
color
that
include
therapists,
doulas,
lactation,
consultants,
holistic,
healers
and
fertility
warriors
and
nurses
combined.
S
We
have
levels
of
education,
35
years
of
parenting,
25
years
of
labor
support
and
a
host
of
other
things.
We
are
a
grassroots
and
working
without
funding
to
meet
the
needs
of
our
community.
We
do
it
from
a
place
of
survival
and
sheer
passion.
We
have
trained
professionals
doing
screenings
in
an
internal
referral
system.
This
creates
a
continuum
of
care
and
provides
a
better
glimpse
into
the
gestational
parents
world
and
factors
they
that
may
impact
the
outcome
of
their
delivery.
S
The
Oh
point
the
opioid
epidemic,
has
greatly
impacted
families,
just
as
the
correct
epidemic
did
when
it
hit
can
be
the
black
communities
and
the
eighties,
and
we
are
still
recovering.
Studies
have
shown
that
there
is
a
physiological
response
to
trauma
and
addiction
is
one
of
them.
We
need
the
support
of
our
city
officials,
hospitals,
insurance
companies
and
community
members
to
collectively
combat
this
issue.
We
need
you.
Thank
you.
Thank.
R
Next
good
afternoon,
my
name
is
Murray.
Gunman,
farmer
and
I
am
a
certified
nurse.
Midwife
I've
lived
in
West
Philly
for
25
years
have
been
a
doula,
childbirth,
educator
and
Midwife
for
the
last
18
years,
I'm.
Also
the
current
president
of
the
Philadelphia
chapter
of
the
Pennsylvania
affiliate
of
the
American
College
of
nurse-midwives,
the
Philly
Metro
midwives.
Thank
you
for
having
me
today.
R
Who
already
were
at
the
margins
of
society,
and
although
our
practice
has
recently
found
a
new
home
and
the
opportunity
to
establish
an
inaugural
midwifery
practice
at
Thomas,
Jefferson
University
Hospital?
It
will
take
quite
a
while
to
rebuild
the
highly
collaborative
team-based
practice
that
existed
at
hanaman.
R
I'm
honored
to
be
here
today
to
amplify
the
voices
of
the
people
being
most
affected
by
this
closure
and
to
advocate
for
equity
and
policy
and
practice
so
I'm
going
to
focus
specifically
on
the
midwifery
model
of
Karen
and
how
that
can
perhaps
change
the
situation
that
we're
in
nationally
80%
of
maternal
deaths
are
happening
outside
of
hospitals
and
60%
occur
more
than
a
week
after
birth.
Several
people
have
mentioned
this
already.
R
Research
also
shows
that
80%
of
the
factors
that
create
health
happen
outside
of
providers,
offices
and
hospitals,
while
we
can
still
improve
care
in
our
hospitals.
Deaths
due
to
acute
pregnancy
conditions
have
been
declining
all
deaths
due
to
chronic
conditions,
especially
mental
health
and
substance
use
disorder,
has
been
rising.
Much
of
the
attention
paid
to
the
maternal
mortality
crisis
has
focused
on
Sentinel
events,
but
the
increase
in
maternal
deaths
gives
the
impression
that
birth
is
inherently
more
risky
than
it
used
to
be.
This
is
simply
not
the
case.
R
The
increase
is
taking
place
because
we
aren't
supporting
childbearing
families
in
critical
ways
that
place
them
at
risk
for
poor
outcomes.
Mothers
are
dying
because
our
social
safety
net
isn't
strong
enough
because
of
the
insidious
history
and
current
manifestations
of
racism
and
white
supremacy
in
health
care,
and
because
of
our
failure
to
directly
address
social
and
structural
determinants
of
health
in
childhood
and
beyond.
In
order
to
be
truly
effective,
proposed
solutions
must
be
responsive
to
the
full
context
of
the
lives
of
childbearing
people.
R
So
what
does
community
based
investment
look
like,
and
these
are
some
solutions,
some
of
them,
which
have
already
been
proposed.
Expansion
of
home,
visiting
programs
like
nurse
Family,
Partnership
and
Visiting
Nurse
Association,
Medicaid
coverage
for
doula
care
and
support
for
community-based
training
for
doulas
and
perinatal
community
health
workers.
R
Postnatal
care
as
a
continuum
focused
on
diet
care,
with
multiple
points
of
contact
with
hel
care
and
social
service
systems,
which
also
includes
screening
for
postnatal
complications,
breastfeeding
support
mental
health
assessment
and
treatment
and
integration
with
primary
and
pediatric
providers,
support
for
seamless
transitions
between
our
Philadelphia
health,
centers
hospitals
and
provider
offices.
This
is
a
huge
problem
for
our
midwifery
practice
faces
on
a
regular
basis.
R
How
can
we
best
integrate
our
patients
who
get
care
in
the
city's
many
health
centers
when
they
need
specialty
care
and
provider
offices
or
impatient
care
of
one
of
our
city's
large
tertiary
care
hospitals?
We
need
more
investment
in
public
health
infrastructure,
ongoing,
well,
integrated
implicit
bias,
training
for
healthcare,
administrators,
medical
and
midwifery
students,
providers
and
staff.
This
is
work.
I
am
particularly
punish'd,
passionate
about
and
one
that
can
be
addressed
decisively
and
quickly.
R
As
was
recently
implemented
in
California,
and
finally,
investment
in
community-based
midwifery
led
birth
centers,
like
the
one
that
was
just
mentioned
by
Miss
Garland
they're,
well
integrated
in
our
city's
health
ecosystem.
These
types
of
birth
centers
offer
a
model
of
care
that
have
demonstrated
promising
results
and
she
already
referenced
a
strong
start
initiative,
which
was
what
I
was
going
to
do
now,
more
specifically
about
midwifery
midwifery
integration
and
expansion
of
the
perinatal
workforce,
particularly
providing
funding
to
make
midwifery
education
accessible
to
individuals
of
color
who
come
from
impacted
communities.
R
There
is
good
evidence
to
suggest
that
race,
concordant
care,
improves
care
outcomes,
and
we
know
that
drawing
from
these
communities
will
help
raise
health
care
leaders
that
understand
both
the
most
urgent
needs
and
the
most
viable
solutions.
Dr.
Jasmine
already
mentioned
that
for
medical
students,
medical
schools
and
I
would
echo
the
same
for
midwifery
education.
R
Here's
an
example
of
how
our
current
regulations
prevent
me
as
a
midwife
from
providing
optimal
life-saving
care
and
pregnancy.
As
we
all
know,
the
country
and
the
state
are
in
the
midst
of
an
epidemic
of
opioid
addiction
addiction,
which
has
a
significant
impact
on
childbearing
families
as
a
midwife
at
Jefferson
I
work
with
providers
on
the
frontline
of
caring
for
this
population
and
can
attest
to
the
dire
nature
of
this
crisis.
R
The
PA
perinatal
quality
quality
collaborative
reports
that
opioid
use
rate
per
1,000
maternal
hospital
stays
has
increased
from
3
per
1,000,
maternal
stays
in
2000
and
2001
to
a
rate
of
nineteen
point.
Six
per
hospital
stays
in
2016
and
17
pregnancy.
Associated
deaths
related
to
substance
use
disorder
have
has
risen
accordingly.
R
Although
federal
law
allows
certified
nurse-midwives
to
prescribe
medication,
assisted
therapy
after
completing
24,
additional
hours
of
training,
state
law
in
Pennsylvania
prevents
CNMs
from
appropriately
prescribing
this
therapy,
meaning
I
cannot
provide
the
optimal
evidence-based
care
to
childbearing
people
with
opioid
use
disorder
midwives,
our
safety
net
providers
in
many
counties
in
this
state
and
limiting
our
ability
to
practice
to
the
full
extent
of
our
education
and
training
is
causing
harm
to
childbearing
families.
I
think
dr.
meta
mentioned
that
our
takes
care
of
five
of
the
health
centers
in
the
city.
R
R
Our
current
reimbursement
system
reflects
the
value
society
places
on
the
lives
of
mothers
and
babies.
Maternity
care
is
a
low
margin,
specialty
considered
a
loss
leader
and
something
that
health
systems
offer
as
a
service
to
the
community
or
as
part
of
a
strategy
to
build
consumer
loyalty
for
more
lucrative
medical
services.
This
does
not
have
to
be
the
case.
R
Let's
imagine
a
bundled
payment
that
include
includes
comprehensive
mental
health
services,
access
to
providers
of
choice,
a
doula
for
every
childbearing
person,
community-based
postpartum,
home
visiting
nutrition,
lactation,
childbirth
and
parenting
classes
and
a
blended
case
rate
for
cesareans,
embed,
cesarean
and
vaginal
births.
Let's
imagine
multidisciplinary
prenatal
care
teams
so
that
families
receive
the
level
of
care
needed
by
the
provider
trained
to
provide
quality
care
at
the
best
value
and,
let's
imagine
a
system
that
is
designed
to
not
just
provide
safe
care
and
better
outcomes,
but
also
optimal,
empowering
and
life-affirming
care.
R
The
Philadelphia
of
midwifery
community
is
ready
to
partner
with
all
of
you
to
help
create
the
reforms
we
know
we
will
make
a
difference
for
childbearing
families
and
we
offer
our
hope
and
trust
in
all
of
you,
as
our
elected
officials,
to
lead
the
way
into
a
better
future
for
maternal
child
health
and
Philly.
Thank
you.
Thank.
D
T
Morning,
my
name
is
Teresa
Pettaway
found
the
ins
active
director
of
pet
away
pursuit
foundation,
and
this
is
my
story.
First,
thank
you
for
having
growing
up
my
family
moved
around
a
lot
from
one
place
to
another
into
another,
but
finally,
at
the
age
of
14,
we
bought
a
house
and
in
an
area
called
at
the
bottom
of
West.
Philadelphia
I
grew
up
as
a
tomboy
and
was
always
around
around
a
lot
of
boys.
T
With
this,
my
mother
thought
that
it
would
be
benefit
me
to
be
medically
examined
by
a
gynecologist
and
possibly
get
introduced
to
some
some
form
of
birth
control.
So
we
decided
to
bring
me
to
the
first
female
exam
at
the
age
of
15.
Dorn
ISM
is
during
this
examination.
The
doctors
discovered
that
not
only
was
I
26
weeks
pregnant,
but
I
was
also
in
labor
and
four
centimeters
dilated,
probably
from
playing
football
with
the
boys.
The
night
before
I
was
shocked
by
the
news.
My
mind
was
racing.
My
heart
was
beating
so
fast.
T
The
doctors
and
my
mother
decided.
The
best
course
of
action
was
to
give
me
some
medicine
to
stop
the
layer
labor.
They
admitted
me
to
the
hospital
to
be
monitored
closely
overnight,
my
mother
left
for
the
evening
and
promised
that
she
would
return
first
thing
in
the
morning.
I
was
alone,
I
was
scared
and
I
was
very
confused
very
confused
because
not
only
did
I
not
know
that
I
was
pregnant.
T
I
also
did
not
feel
the
pain
that
most
described
as
contractions
and
I
was
now
being
left
in
a
strange
place
overnight
without
my
mother
at
5:30
in
the
morning
and
before
my
mother
could
even
return.
Her
nurse
came
in
the
room
and
looked
at
my
mother
at
my
monitors
and
stated
that
the
contractions
are
increasing
instead
of
stopping
she
called
the
doctor,
so
that
I
could
be
examined
again.
During
this
check.
The
doctor
said
we
are
going
to
have
to
deliver
this
baby
now.
T
I
did
not
feel
any
pain,
but
I
was
still
so
frightened.
I
did
not
know
what
to
do.
In
my
mind,
I
cried
for
my
mother.
I
would
also
I
was
told
to
push
so
I
did,
but
when
nothing
happened,
the
nurses
begin
to
stimulate
my
breasts.
Everything
was
so
unclear
to
me.
I
asked
myself:
why
is
all
this
happening
to
me?
Finally,
at
8:30
a.m.
I
delivered
a
one
pound
nine
ounce
baby
girl.
She
was
whisked
away
in
an
incubator
due
to
severe
prematurity
and
to
the
NICU.
T
My
baby
girl
named
wave
on
a
miracle
remain
in
the
hospital
for
four
months:
hooked
up
to
heart,
monitors,
feeding,
tubes
and
various
medical
devices.
I
was
15
years
old,
as
a
team
I
had
to
learn
how
to
care
for
my
time,
tiny
baby,
what
each
piece
of
equipment
attached
to
her
was
used
for
it
and
to
it
attend
high
school,
maintain
grades
all
while
visiting
my
fragile
baby
and
the
NICU
daily.
The
hospital
helped
me,
but
they
were
not
focused
on
having
me
learn
all
the
medical.
T
T
I
was
high
risk
due
to
my
prior
pregnancy,
I
had
to
wear
my
belt,
monitor
twice
daily
for
15
to
20
minutes,
so
they
can
transmit
information
to
the
doctors
to
make
sure
that
the
baby
was
okay.
Having
to
do
that
did
not
reassure
me
and
it
caused
me
even
more
stressed.
One
morning
I
felt
my
baby
kick
my
sac
and
had
a
slow
leak
of
fluid
I,
feared
I
was
going
into
labor
and
that
morning,
ever
I
had
reservations
about
going
to
work.
T
But
the
doctor
reassured
me
that
everything
was
okay
and,
as
I
was
commuting
to
work,
I
felt
a
slowly.
My
legs,
I
was
thinking.
I
will
check
it
when
I
get
to
work.
I
worked
at
an
architect,
an
engineering
firm,
and
it
was
a
ten
floor
building,
while
riding
up
the
elevator,
my
water
broke
and
gushed
down
my
legs,
I
was
in
distress.
The
lady
that
was
with
me
tried
to
help
me.
However,
she
did
not
know
that
I
was
pregnant,
since
I
barely
had
a
stomach.
I
was
only
28
weeks
pregnant.
T
At
the
time
when
we
reached
to
the
reception
area,
the
receptionist,
who
happened
to
be
my
mother-in-law,
rushed
and
helped
me
and
said
your
water
broke,
so
she
hurt
her.
We
got
her
car
and
we
drove
to
the
hospital
I
was
admitted
placed
on
off
the
observation
once
again,
as
we
were
waiting
for
the
doctors,
the
nurses
are
me
by
telling
me
my
baby's
heart
rate
began
to
drop
that
made
me
so
worried.
They
started
preparing
me
for
emergency
c-section.
Everyone
rushed
out
of
the
room.
T
T
It
was
only
my
husband
who
was
visiting
her,
who
bonded
with
her.
Despite
those
circumstances,
I
was
eager
to
breastfeed.
The
hospital
staff
gave
me
a
hospital
great
pump
to
help
pump.
My
breast
milk
I
was
putting
I
was
pumping
multiple
times
a
day
to
ensure
my
newborn
was
well
fed,
with
no
assistance
or
prior
knowledge
of
breastfeeding
I
accumulated
whatever
milk
I
had
into
her
gallon
container,
of
which
my
husband
would
take
to
the
hospital.
T
However,
when
my
heart,
when
my
husband
gave
the
gallon
of
milk
to
the
nurses,
the
nurses
stated
that
the
milk
was
contaminated
due
to
improper
storage.
They
said
that
they
were.
There
was
no
way
that
I
could
accumulate
it.
Well
much
would
that
milk
with
one
possession
they
poured
my
hard
work
down
the
drain.
They
threw
away
my
liquid
gold
at
that
moment.
I
felt
that
society
had
felt
me
once
again,
and
that
was
not
the
last
time
in
1999.
In
my
early
30s
I
got
pregnant
with
my
third
child.
T
I
was
at
risk
due
to
my
pregnancy
history.
Due
to
my
age
at
20
weeks,
I
had
a
procedure
done
to
my
service
called
a
cerclage.
It
was
a
procedure
to
stitch
up
a
woman's
cervix
and
effort
to
maintain
a
full-term
pregnancy.
After
that,
I
was
placed
on
bed
rest
for
the
remainder
of
my
pregnancy.
My
husband
was
working.
My
kids
were
at
school,
so
most
of
the
day,
I
felt
so
lonely
I
had
no
activity
or
work
to
do.
T
I
became
depressed
one
night
during
my
32nd
week,
I
was
awakened
by
feeling
something
wet
on
the
bed.
My
water
had
broken,
so
my
husband
immediately
went
with
me
to
the
hospital
where
we,
where
I
was
quickly
provided
with
medicine,
to
slow
down
my
labor
and
place
on
monitors
by
observation
again,
my
doctors
immediately
called.
However,
my
doctor
was
immediately
called.
However,
he
was
on
vacation,
so
I
was
provided
with
a
doctor
on
call
that
doctor
knew
nothing
about
my
case
or
history.
T
After
several
hours
of
monitoring,
the
baby's
heart
rate
began
to
drop,
so
the
decision
was
made
to
do.
Emergency
c-section
I
was
devastated
at
6:27,
a
four
pound
two
ounce
baby
Ward
was
delivered
and
rushed
should
a
NICU.
My
baby
boy
was
fine
despite
early
arrival.
These
experiences
showed
me
that
there's
a
clear
lack
of
support
for
women,
especially
women,
of
color,
during
their
pregnancy
and
throughout
their
maternal
health
experience.
T
The
lack
of
service
I
received
in
the
overhaul
understanding
of
what
I
needed
to
care
for
myself
and
these
tiny
children
wasn't
communicated
or
understood.
There
was
times
where
I
couldn't
even
verbalize
exactly
what
I
needed,
because
I
was
unclear
myself.
It
was
my
faith
in
God
in
that,
so
the
strength
that
he
gave
me
during
these
traumatic
circumstances
surrounding
my
child,
burr
and
beyond
that
I
was
allowed
to
be
where
I
am
today.
T
Having
dealt
with
these
life-altering
bursts
and
both
my
team
and
adult
years
led
me
to
believe
that
there
are
some
instances
where
maternal
mortality
can
be
prevented
in
mothers
in
the
and,
if
the
proper,
if
mothers
were
properly
careful
during
their
process.
For
this
reason,
I
found
that
the
Pettaway
pursuit
foundation
was
promotes
awareness
and
education
to
inform
affected
families
about
high-risk
pregnancies
and
how
to
care
for
premature
infants.
We
were
not
rear
echelons
on
issue
and
hazard
and
we
have
rewritten
it
rewritten.
T
This
narrative
becoming
the
first
organization
to
collaborate
with
insurance
companies
to
offer
doula
support
throughout
the
entire
prenatal
experience
up
to
two
months,
two
months
postpartum.
So
we've
been
doing
the
work
since
2006
today,
we
have
helped
say,
help
serve
2026
mothers
in
Pennsylvania,
276
mothers
in
Massachusetts,
and
we
are
also
serving
Rhode
Island
as
well.
We
were
continued
as
a
journey
wherever
this
pursuit
will
lead
us
and
we
are
happy
to
help
in
any
way.
We
can
thank.
D
I
Kay
fields,
president
of
the
National
Coalition
of
100,
black
women,
Incorporated
Pennsylvania,
Chapter
I.
Thank
you
today,
Councilman
Greenlee,
as
well
as
councilman
green
for
the
opportunity
to
testify
before
you
as
we
come
off
the
heels
of
our
national
19th
biennial
conference
held
October
9th
through
the
13th
in
Atlanta
Georgia,
where
over
650
african-american
women
representing
63
chapters,
convened
for
leadership,
development,
advocacy,
training,
organizational
awards,
leadership,
elections
and,
ultimately
adopting
over
14
resolutions,
one
of
which
is
today's
topic.
I
And
whereas
recent
statistics
indicate
an
overwhelmingly
disparity
and
incidences
of
maternal
mortality
among
african-american
women
in
the
United
States
as
compared
to
other
developed
countries,
and
whereas
black,
expectant
and
new
mothers
in
the
u.s.
die
at
about
the
same
rate
as
women
in
countries
such
as
Mexico
and
Uzbekistan,
according
to
the
World
Health
Organization
estimates,
and
whereas
the
2019
National
Public
Radio
series,
one
lost
mother's,
maternal
mortality
and
the
u.s.
includes
information
that
there
is
racial
disparity
across
income
in
recent
years
as
high
rates
of
maternal
mortality
and
the
US
have
alarmed
researchers.
I
Once
the
statistic
has
been
assessed.
Specially
concerting,
concerning,
according
to
the
CDC
black
mothers
in
the
u.s.,
die
at
three
to
four
times
the
rate
of
white
mothers,
243
percent,
more
likely
to
die
from
pregnancy
or
childbirth,
related
causes
and
a
national
study
of
five
medical
complications.
There
are
common
causes
of
maternal
death
and
injury.
Black
women
were
two
to
three
times
more
likely
to
die
than
white
women
who
had
the
same
condition
and,
furthermore,
what's
even
more
relatively
well-off
black
women
died
and
nearly
died
at
higher
rates
than
whites.
I
Therefore,
be
it
resolved
that
the
National
Coalition
of
100
black
women
Incorporated,
is
charging
our
united
states
legislative
body
to
prioritize
research
and
preventative
methodology
to
correct
and
eradicate
the
reprehensible
practices
and
attitudes
in
our
health
care
system
that
allows
these
disparities
that
result
in
the
death
of
African
American
women.
Access
without
equality
is
an
equality
and
equity
in
health
care
is
not
acceptable
at
any
level.
I
I
wrap
up
by
asking
that
the
National
Coalition
of
100
black
women
incorporated
Pennsylvania
chapter
the
premier,
health,
education,
economic,
empowerment
and
public
policy
advocate
for
black
women
and
girls
here
in
Pennsylvania,
be
invited
to
the
table
for
all
legislation
going
forward
as
nationally
mandated
I.
Thank
you
for
the
opportunity
to
testify
today
and
look
forward
to
partnering
together
to
support
resolution,
one
nine
zero,
zero
four
zero.
Thank
you
thank.
D
You
very
much
and
I
think
I
can
speak
for
the
whole
committee,
certainly
chairwoman
bass
and
the
whole
committee
that
there
was
some
very
good
testimony
here
today.
This
won't
be
the
end.
I
know
that
the
committee
is
gonna
address
this
issue,
but
again
we
thank
everybody
for
taking
the
time
and
it
was
a
long
day
taking
the
time
of
hanging
in
there
and
giving
us
your
your
viewpoints.
So
again.
Thank
you
all
very
much
and
with
that
the
hearing
on
resolution
number
one
nine
zero,
zero
four
zero.