Speaker 1: (00:00)
Governor Gavin Newsome signed the mommy bus act into law to address racial disparities in maternal and infant health. This week, the new law will put resources behind growing and diversifying the midwifery workforce extend California's Medicaid coverage for doulas and extend Medi-Cal eligibility for mothers up to 12 months after giving birth the new law aims to reduce maternal and infant mortality rates, particularly among black women and babies who are much more likely to die due to structural racism that causes complications in pregnancy and birth. My Shariki could do mood director of maternal and infant health for March of dimes, greater Los Angeles worked on the new legislation and joins us now. Musher. Re-key welcome.
Speaker 2: (00:44)
Thank you so much for having me
Speaker 1: (00:46)
First. Let's talk about the problems this bill is trying to address overall. The us has the highest maternal mortality rate in the developed world, but for black women, giving birth is even more dangerous. What do statistics in California reveal?
Speaker 2: (01:01)
Sure. Well, we see in California, there was a recent report put out by the California department of public health that shows the pregnancy related mortality ratio for black women is four to six times higher than their counterparts. And so that ratio is actually increasing. So we're seeing the disparities gap widen. We used to in California, that black women have a preterm birth rate. That's about 43% higher than their counterparts. And we also see that in San Diego county. So in San Diego county, black women have a higher preterm birth rate. That's higher than the county average as well as higher than the state average. And we also see that with our native American moms as well, our native American indigenous moms also have preterm birth rates that are higher than their other counterparts. We also see that the infant mortality rate is higher for black women in California. Um, so for black women, what we see is that these disparities really exists regardless of income, socioeconomic status education. And so that whining really does look at structural racism, some of the structural barriers that black women encounter about other women.
Speaker 1: (02:14)
And let's dig into that more. I mean, what do we know about what's causing higher mortality rates for black pregnant women and black and native American infants?
Speaker 2: (02:22)
A couple of things that are happening. It is the, um, lack of reciprocate care. So not having a provider in your community that can take care of you. If you're having a heart condition, if you have a high risk pregnancy in California, there's about nine counties that don't have, um, an obstetric provider, we call them maternity deserts. So they don't have enough obstetric providers or enough, um, hospitals. And so really trying to travel the distance to get to appropriate care, to get to your hospital. And that's one thing that this bill will help do when we look at drawing and diversifying the midwifery workforce and having more midwives and areas where women can have access to more care. Um, so it's also to the experience that black women, um, encounter when they seek medical care. And so, you know, I know from my own experience, um, of being disrespected and not listened to when my baby was in the NICU, I know from my sister's experiences and we all have college degrees, San Diego state do Stanford, Berkeley, um, and we all have faced these challenges. And I hear from my friends who are at college educated, who aren't listened to, who are their pains dismissed when they know something is not right, they, um, aren't listened to in the healthcare space. So implicit bias, it really is impacting the care that folks receive and the care that is given.
Speaker 1: (03:58)
And my Shariki, I can relate to everything you just said. Cause I to share in that experience, um, you know, one way this bill would address those causes is by increasing access to doulas and midwives. What's the impact of having a doula or midwife?
Speaker 2: (04:14)
Sure. So there is research that shows that having a doula and midwife or midwife really reduces some of the adverse outcome. So Laura is a C-section rate increases rates of breastfeeding as well as patient satisfaction. And so all those things really point to lower healthcare costs, right? Um, better outcomes and better improve patient experience. And so having that support, having the support of a doula with you, not only during birth, but before to help with some of the prenatal education, you know, afterwards, um, and postpartum to be able to help with some of the maternal warning signs, um, to help me navigate not only the healthcare system, but some of the community resources that you need and move your free care also does the same thing. And so what we see is just that lack of connection. A lot of times between OB providers and the community and OB providers, not always knowing where to send their patients for, you know, help with food or housing or mental health resources and the community doulas and midwives really do have that impact and have those connections. I was on Medi-Cal when I was in graduate school and pregnant, I have midwifery care. Um, I use GSD and I had a doula and all about really did impact my care, increase my satisfaction and just feeling supported through the process
Speaker 1: (05:46)
Beyond increasing access to doulas and midwives. What else would the California mom bus act do?
Speaker 2: (05:52)
Yeah, so they'll do a few other things. It will improve data collection, our maternity mentality review committees, as well as our lead on infant mortality review committees as well. We know when there's better data collection about the causes of death. When they're preventable, we can make better decisions regarding programs, services, system changes not only in the hospital, but also in the community as well. So having better data collection well, um, improved outcomes will improve programs also too with a little do. Um, it all will develop a work group for the doula, a Medi-Cal benefit to make sure, um, to help with the state implementing the program. So making sure that everyone who wants to doula can get one, it'll also to reduce some of the cumbersome, um, barriers for CalWORKs, for women who are on pregnant. So women who are pregnant, who are on CalWORKs, there's an increase in the supplement that they'll get.
Speaker 2: (07:01)
And this is the first increase that's happened in almost 40 years and also re remove the, uh, welfare to work requirement for pregnant women who, who are have CalWORKs. So what that really does is it allows women to have more resources that allows them to now have these requirements. That'll really kind of sometimes a burdensome and get in a way, uh, just, um, um, seeking care. And also there's a pilot or a guaranteed basic income that prioritizes pregnant women. And so this is income. That's no strings attached, um, that will give families more resources. And so the research shows that there's a couple of different, um, programs that have this guaranteed basic income, one coming out of Stockton, um, that show that this extra money, no strings attached, reduces stress, improves mental health and also improves, um, people's economic opportunities, because then you are able to take time off work, to get childcare, to go to the job. That'll give you benefits, it'll give you full time employment. Um, so it was interesting that it came out that the extra income improves economic opportunities. It reduces stress, which we know increased stress, put some women I'm more at risk for preterm birth.
Speaker 1: (08:28)
Do you think, uh, overall that the mom, the bus act does as much to address structural racism and healthcare as it does to address income inequality?
Speaker 2: (08:40)
It does. I think what it will do is it'll improve access. And when we look at improved access to healthcare, quality of healthcare services and resources, we know that that'll reduce of, um, the registered disparities and the Apres outcome. So what impacts a woman's health and her birth outcomes is not just her access, you know, whether or not she shows about the doctor, right? It is. Does she live in a safe community? Does she have, um, access to transportation? Does she have access to healthy foods and opportunities to move her body? Is she going to a provider who can address all her issues? So when we talk about women having access to midwives, doulas, extra income with the CalWORKs supplement, extra income with the guaranteed basic income pilot, those will improve healthcare. Um, those will improve outcome. But what we know Jane is that this is just a stop, that there is more work that needs to be done. Wyatt asked me 65 does a mom and best as bill does is we imagine what pregnancy and birth can look like for our families. But we know that we also have to reimagine systems that are more responsive, that are more respectful, that really do seek to improve patient outcome safety and experience. So while this bill does a lot, we know that there is still more work to be done.
Speaker 1: (10:18)
I've been speaking with musher. Riki could do move director of maternal and infant health for March of dimes, greater Los Angeles. Musher. Ricky, thank you so much for joining us. Thank you.
