Assessing New York State’s Progress on Maternal Mortality and Racial Disparities

Jamilia Sly, PhD, Assistant Professor, Population Health Science and Policy, and Oncological Sciences at the Icahn School of Medicine at Mount Sinai, discusses breast cancer disparities during a recent seminar at The Blavatnik Family Women’s Health Research Institute.

It’s been more than 18 months since the launch of the New York State Taskforce on Maternal Mortality and Disparate Racial Outcomes. It’s a good time to ask: so what has been done?

With the increased media coverage over the last few years of the disproportionate number of women dying or suffering from complications during childbirth, politicians have begun to see the importance of changes in government policy to combat rising maternal mortality rates. New York State is ranked 30th in maternal mortality rates, with higher rates among Black and Latina women.

New York State has taken a number of steps to help in preventing maternal death, especially for women of color. In April 2018, the state launched a Doula Pilot Program that would expand the state’s Medicaid program to cover the cost of doula services for those enrolled in Medicaid and Medicaid managed care. That same month, a taskforce of experts on maternal mortality and disparate outcomes convened, including Elizabeth Howell, MD, MPP, Blavatnik Family Women’s Health Research Institute Director.

Then, a year later, the taskforce released a series of detailed recommendations to lower the maternal mortality rate in New York and committed $8 million to implement them over the next two years. The task force has begun working with the Department of Health and the American College of Obstetricians and Gynecologists to implement these recommendations.

The recommendations included the following:

1. Establish a statewide Maternal Mortality Review Board (MMRB) in statute
2. Design and implement a comprehensive training and education program for hospitals on implicit bias
3. Establish a data warehouse on perinatal outcomes to improve quality
4. Provide equitable reimbursement for midwives
5. Expand and enhance community health worker services in New York State
6. Create a scholarship program at the State University of New York (SUNY) for midwives to address needed diversity
7. Create competency-based curricula for providers and medical and nursing schools
8. Establish an educational loan forgiveness program for providers who are underrepresented in medicine and who intend to practice in women’s health care services
9. Convene a statewide expert workgroup to optimize postpartum care in New York State
10. Promote universal birth preparedness and postpartum continuity of care

Progress has been made on a number of the recommendations:

• 3276 (Joyner)/ S.1819 (Rivera), a New York State bill which establishes state and New York City maternal mortality review boards and maternal mortality and morbidity advisory councils, was signed into law by Governor Andrew Cuomo on August 1, 2019. This bill passed the New York State Senate unanimously. The review boards and councils will review all maternal deaths and maternal morbidity in New York and disseminate findings, recommendations, and best practices to prevent deaths and reduce maternal morbidity.
• The FY 2020 New York State budget included $8 million over two years to support the taskforce’s recommendations, including the maternal mortality review boards and maternal mortality and morbidity advisory councils in New York City and New York State. The investment will also cover the creation of a comprehensive education program to reduce implicit bias in health care across the state and a data warehouse of information on maternal mortality and morbidity. The creation of these two programs has not yet been reported on.
• The FY 2020 budget also included more than $2 million for the Department of Health’s Maternal Infant Community Health Collaborative to increase access to community health workers in high-risk areas statewide for social support, advocacy, care coordination, and education. This addresses the taskforce’s recommendation to increase community health services in New York State.
• The Maternal Child Health Program based at the University of Albany School of Public Health was awarded $150,000 from the New York State legislature to fund research and education on maternal mortality across the state. Six graduate students from the program worked with the Department of Health to analyze maternal mortality data and establish best practices in the spring semester of 2019. The program plans to continue to collaborate with the Department of Health on addressing the need for more research and effective training.
• The New York State Perinatal Quality Collaborative expanded its focus to include leading causes of maternal morbidity and mortality, specifically, obstetric hemorrhage through the NYS Obstetric Hemorrhage Project. This project will work with hospitals in New York to put evidence-based guidelines into clinical practice to reduce and properly treat obstetric hemorrhage.
• The SUNY Office of Academic Health and Hospital Affairs created a Maternal Fetal Medicine workgroup of experts to create recommendations for education on maternal mortality and morbidity and racial disparities across varied levels of medical education, including undergraduate, graduate, and post-graduate. This addresses several of the taskforce’s recommendations to improve education on maternal care and racial disparities.

Although not part of the 10 recommendations by the taskforce, the New York State Doula Pilot Program announced in April 2018 went into effect in Erie County (Buffalo) on March 1, 2019. In Phase 1 of the pilot program, women enrolled in New York State Medicaid and living in Erie County are eligible to receive doula services. During this time, doulas in Kings County (Brooklyn) are being enrolled as Medicaid providers and once provider capacity is reached, the program will launch Phase 2, which covers women in Kings County.

These two counties were chosen to start this program as they have high maternal and infant mortality rates and a high number of Medicaid births. This program was launched to support women, especially minority women, during the childbirth process, including prenatal and postpartum care. Studies found that pregnant women matched with a doula had better birth outcomes, but availability and coverage of costs are two limiting factors in gaining access to doula care.

The program has been delayed because it has been having trouble recruiting doulas. This is potentially because of the state certification requirement to get Medicaid reimbursement, low reimbursement rates, or the billing process which could take up to six months for reimbursement. The certification requirement would increase regulation of doula services. The state is still actively recruiting doulas in Brooklyn to begin Phase 2.

Many aspects of the taskforce’s recommendations have begun to be addressed by workgroups, state laws, and inclusion in the FY 2020 state budget. There is still a long way to go, but progress in policy and programming is being made towards addressing maternal mortality, maternal morbidity, and racial disparities in New York. It is yet to be seen if these steps forward will impact health outcomes.

Anna Kheyfets is a Clinical Research Coordinator in the Department of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. Her work focuses on hospital quality and racism and discrimination in maternal and child health care.