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As we mark Mother’s Day, we at the Budget Center believe it is an important opportunity to recognize how California can improve the health and well-being of all mothers. Becoming a mother should be a joyous occasion, but too many women in the United States die due to pregnancy-related causes. In 2015, the United States had the highest maternal mortality rate of any developed country. While other countries have successfully taken steps to decrease maternal mortality, the rate of pregnancy-related deaths in the US has doubled in 20 years. This is despite the fact that women in the US pay top dollar for maternity care compared to women in other countries.

Over a decade ago, the California Department of Public Health (CDPH) noticed the alarming rise in pregnancy-related deaths, and state administrators took action in 2006 by launching an investigation of maternal deaths and by forming the California Maternal Quality Care Collaborative (CMQCC). The CMQCC has been credited in reducing the number of mothers dying in childbirth by using data and research to improve outcomes. It seems to be working. California’s maternal mortality rate peaked in 2006 and has since dropped by more than half. In 2013, the most current and accurate data available, the maternal mortality rate in California was 7.3 maternal deaths for every 100,000 live births — one-third the rate for the US, overall (22.0).

While this is certainly good news for mothers in California, this figure masks severe and persistent disparities experienced by black women. While pregnancy-related deaths have declined in California for women of all races and ethnicities, the black maternal mortality rate was still 3.8 times higher than the rate for white women in 2013. In fact, in California the rate of maternal mortality for black women has consistently been 3 to 4 times higher than the rate for white women over the past two decades.

It’s becoming increasingly clear that race can affect health and wellness over the lifespan, including outcomes in pregnancy and childbirth. For black women who live at the inhospitable intersection of racism and sexism, it can be deadly. A recent report from the Center for American Progress (CAP) recognizes these systemic problems, and outlines a range of policies to address the health inequities experienced by black women, some of which are active policy proposals this year in California. CAP recommendations include:

  • Improving the quality of care pregnant women receive. Senator Holly Mitchell’s Dignity in Pregnancy and Childbirth Act (SB 464) would require evidence-based implicit bias training for health care practitioners who provide care to mothers before, during, and after childbirth.
  • Addressing maternal mental health outcomes. In a blog post earlier this month, the Budget Center discussed strategies to improve maternal mental health, including expanded mental health care for new mothers enrolled in Medi-Cal (AB 577).
  • Enhancing supports for families. The Governor’s proposed budget for the next fiscal year invests more dollars in home visiting programs and in the Black Infant Health Program, both designed to improve outcomes for families.
  • Helping families meet their basic needs. The Governor and state legislators are backing a wide range of budget and policy proposals that would do just that, such as boosting CalWORKs cash assistance, increasing the size of the CalEITC, expanding access to subsidized child care, and extending the duration of paid family leave.

While California has done a commendable job in reducing the maternal mortality rate, the state can do more to address the severe disparities in the number of black women dying due to pregnancy-related causes. Budget and policy proposals outlined above provide a path forward, but there is significant work to be done to ensure all mothers have the opportunity to celebrate Mother’s Day.

— Kristin Schumacher

Aureo Mesquita provided research assistance on this blog post. Support for this piece was provided by First 5 California.

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