A ‘Very Serious Conversation': Pa. House Panel Hears Fixes On Maternal Mortality Crisis

By Cassie Miller, Pennsylvania Capital-Star

April 17, 2023

Pennsylvania faces a mortality crisis among women and birthing people of color, healthcare experts told a legislative panel on Thursday, as they offered ideas about how to fix it.

“Too many women and birthing people are subject to lack of protections or policies that are harmful and oppressive,” Jada Shirriel, chief executive officer of the Pittsburgh chapter of Healthy Start, Inc., a national network to improve access to maternal and child health care, told members of the House Democratic Policy Committee.

The hearing, led by state Rep. Gina Curry, D-Delaware, who serves as co-chair of the Pennsylvania Women’s Health Caucus, focused on addressing the maternal mortality crisis, which disproportionately affects women and birthing people of color.

“This is a very serious conversation,” Curry said. “We have a very serious crisis going on.”

A 2022 report from the Pennsylvania Maternal Mortality Review Committee, which reviews all maternal deaths in the commonwealth, found that Pennsylvania had an overall pregnancy-associated mortality ratio (PAMR) of 82 deaths per 100,000 live births. Non-Hispanic Blacks had the highest PAMR of 163 per 100,000 live births.

The somber, reflective tone of the hearing was in contrast with an exuberant press conference held hours before in the Capitol rotunda to recognize Black Maternal Health Week, which runs April 11-17. There, advocates joined lawmakers in a chant – “Black Mamas Matter.”

“We cannot ignore when policy is harmful and rooted in racism — and how this disenfranchises our collective ability to be human together,” Shirriel said.

Dr. Sharee Livingston, chair of obstetrics and gynecology at UPMC Lititz in Lancaster County, said the maternal mortality statistics discussed at the hearing are not usual “nor should we accept it.”

“It is critical that we prioritize safer care for birthing people and focus on solutions to the current maternal health crisis, with particular focus on Black maternal health,” Livingston said.

One of the ways Pennsylvania can improve maternal health care is by expanding access to Doula care through Medicaid coverage, Livingston said.

Doulas cannot provide medical care or deliver babies, but they can provide emotional, informational, and physical support before, during, and after pregnancy and childbirth, according to Livingston.

Studies have found that women who are supported by doulas throughout their pregnancy are less likely to require a cesarean birth or use pain medication, and have a shorter labor, according to the National Health Law Program.

State Rep. Morgan Cephas, D-Philadelphia, and Sen. Judy Schwank, D-Berks, have companion bills before their respective chambers that, if passed, would extend Medicaid coverage to doula services in Pennsylvania.

It also would establish a Doula Advisory Board to oversee “accreditation organizations for doulas, the competencies that should be required to ensure doulas are properly equipped to serve the mothers of Pennsylvania, and setting standards based on best practices for doula professionals,” according to a co-sponsorship memo.

“By expanding access to doulas, maternal health outcomes will be improved, and racial disparities reduced,” Livingston said.

Another consideration in the maternal health crisis is the current lack of representation and diversity in medicine.

Panelists said that by improving diversity and representation in the medical field, health disparities can be eliminated and cultural competency improved.

“We must increase the pipeline of minority students who are entering the field of medicine,” Livingston said. “We have to get the right people in the room.”

Data from the U.S. Census Bureau shows that the number of physicians and surgeons who identify as Black has remained stagnant at 5% over a 40-year period. Additionally, just 2% of female doctors are Black women.

When asked by lawmakers about what can be done to help improve diversity in the medical workforce, Livingston said the Legislature should do more to support community organizations supporting medical students of color.

“Support organizations that are already doing the work, that are already investing in young students,” Livingston said. “The reality is patients are waiting for black and brown students to become doctors, because these health outcomes can be fixed.”

“When the most vulnerable birthing people are centered, then all birthing people can enjoy the safety and beauty of childbirth,” Livingston said, pointing out to lawmakers that environmental, economic, and social factors all affect mothers and families.

Shirriel, echoing Livingston’s comments, told lawmakers that other economic factors, such as housing policies and access to mental health supports, are connected to maternal health outcomes.

Shirriel suggested that increasing Pennsylvania’s $7.25/hr minimum wage and passing the Family Care Act, would boost family wellness and maternal care across the commonwealth

Legislation has the potential to drive systemic change in Pennsylvania, Shirriel said, adding that the commonwealth is only as strong as those who are most in need.

“Our most vulnerable community members and families are counting on us,” Shirriel said.

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