Black maternal health is at the core of the ACLU of Kentucky’s mission. All the ACLU of Kentucky's work is through a racial justice lens. How can we have racial justice without addressing the deep disparities in maternal and infant health outcomes between Black Kentuckians and their white counterparts?
I am a Black woman from eastern Kentucky. My mother was one of seven, her mother one of 11. I am a mother of four and a grandmother of three, so I have some lived experience being a parent. I advocate and lobby for better policies for reproductive health, and especially Black Maternal Health, among many other issues in the Kentucky General Assembly.
From both my lived experience and my work as a policy strategist, it’s clear to me that Black parents today face enormous challenges. The maternal mortality crisis in the United States and Kentucky continues to skyrocket, and the disparities between Black and white maternal and infant health only continue to grow.
Maternal & Infant Mortality in Kentucky
The United States has the highest maternal mortality rates among wealthy nations, and Kentucky has some of the worst birth outcomes in the US, putting Kentucky at the forefront of the global maternal health crisis.
Maternal mortality rates in the US increased by 14% between 2019 and 2020 and increased by 26% among Black birthing people during that same period. In general, Black birthing people are three times as likely to die during or after childbirth compared to white birthing people. Some conditions—like postpartum cardiomyopathy—are said to be 5-6 times higher for Black birthing people. The high rates of mortality extend to Black infants as well. Currently, Black infants are more than twice as likely to die than white infants.
Even more shocking and heartbreaking than these deaths are that they do not have to happen. A recent Kentucky public health report found 78% of maternal mortality cases were considered preventable.
Maternal and infant mortality is a human rights concern, and that’s why we have made Black maternal health a platform issue for the ACLU-KY's Reproductive Freedom Project. We have worked with several legislators, especially former Representative Attica Scott, to create legislation to decrease these destructive realities for Black families. We fought to pass bills like Dignity Bills I and II to protect the rights of pregnant people who are incarcerated, and House Bill 212, a 2021 measure requiring the maternal and infant mortality review board to track race.
While other maternal and infant mortality measures have not yet passed, I’m proud that the conversation around Black maternal health is happening among state legislators.
We cannot talk about Black maternal and infant mortality without addressing the root causes, and we’re committed to advocating for policies created by Black birthing people and birth workers, like the Breaking Barriers Council, that empower Black birthing people and their families.
When talking about issues that are harmful to Black birthing people and their families, we must mention postpartum depression (PPD). The postpartum period is critically important but often overlooked in maternal health care. Up to 45 percent of maternal deaths happen in the weeks after delivery, a time when people are generally more removed from medical care and their regular support systems. Studies suggest that PPD is twice as likely to occur in Black birthing people, and people of color are less likely to report PPD.
Postpartum is a vulnerable time for new parents and their babies, and this is especially true for birthing people on Medicaid, many of whom were at risk of losing their health insurance coverage just 60 days after the end of pregnancy. Despite the increased risk of postpartum death and illness, up to half of people do not receive routine care after birth.
That’s why we advocate for better postpartum education in the commonwealth. We’ll continue to push bills like House Bill 174, sponsored by Rep. Mackenzie Cantrell, which expanded Medicaid coverage to 12 months postpartum and passed the Kentucky General Assembly in 2022.
Doulas & Medicaid Reimbursement
A doula is a non-clinic professional who provides physical, emotional, and informational support to pregnant people before, during, and after childbirth. Many studies have shown that increased access to doula care, especially in under-resourced communities, can improve a range of health outcomes for parents and their babies, like decreasing the chances of complication involving themselves or their baby during birth, and increasing the rates of breast/chest feeding.
Experts from the March of Dimes, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and others all agree that doula care improves outcomes for parents and infants. However, doula care comes with a cost, and often the people who would benefit the most from doula care have the least access to it financially. Expanding access to doula care also benefits medical practitioners, hospitals, and the greater community in reducing the financial and personal costs of adverse birth outcomes.
That’s why a key piece of our Black maternal health is advocating for Medicaid reimbursement for qualified doula services. Rep. Beverly Chester Burton has picked up the torch started by Rep Attica Scott, and we are hoping to see movement in 2024.
Another issue directly at the heart of Black Maternal Health in Kentucky is the availability of birthing centers. Many people have had traumatic experiences with our healthcare system, or don’t want to be forced into a situation they don’t agree to. Often, in a hospital, there is pressure to give birth in a timeframe that works best for the institution, and not necessarily right for the birthing person.
Birthing centers deliver babies under the care of a midwife in a home-like setting that utilizes a shared decision-making model between the midwife and the birthing person, giving clients the opportunity to make birthing decisions on their own. This shared decision-making model decreases the rate of C-sections and infant and maternal mortality and while promoting the bodily autonomy that birthing individuals want and deserve.
At the heart of the birthing center debate in Kentucky is a legal document called a Certificate of Need, a document that is required for healthcare providers to open a new facility and acquire major medical equipment, among other things.
Certificate of needs laws were designed for good reason but have quickly devolved to become a barrier to care. Today in Kentucky, a certificate of need means the birthing center has to essentially ask hospital systems if they can exist. Hospitals often push back, saying birthing centers are unnecessary because they have a labor and delivery unit. We support the many advocates working in the legislature to change Certificate of Need regulations for birthing centers.
From the disparity between Black and white birthing outcomes, to the role of a doula, to how freestanding birthing centers decrease rates of C-sections, I hope you learn something this Black Maternal Health Week. We encourage you to support your local Black birth workers, and we will be highlighting some of the best in the commonwealth. Black maternal health is an issue we ALL should be monitoring, both during Black Maternal Health Week and beyond. This fight requires all of us.
Jackie McGranahan, Senior Policy Strategist