Chelsi West Ohueri, PhD, is a sociocultural anthropologist at the University of Texas at Austin. Her research is closely related to the work at The Blavatnik Family Women’s Health Research Institute, and her personal story underscores the importance of bringing evidence-based research to the public. We are privileged to honor her powerful perspective as a guest contributor. – Teresa Janevic, PhD, Member of the Institute, Assistant Professor of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Sciences at the Icahn School of Medicine at Mount Sinai

 It was Christmas Eve. I was in the hospital emergency room, just four days after what had been a normal delivery of my second child. As I lay on the bed moving in and out of the CT scanner, I tried to remain still and slow the panic in my mind. My left breast was full of breast milk that had just come in. The pain in my head was wrenching. I worried whether I would ever hold my newborn daughter and her sister again.

I had good reason to be concerned.

I am a cultural anthropologist and I research race, belonging, and inequality. One of my research areas includes health disparities, specifically the social and root causes of racial and ethnic inequities. As a social force, racism dehumanizes and assigns value, and as a result, there are varying health impacts. My research and scholarship examine how structural and systemic racism in particular impacts Black people and people of color.

It was during this period in 2018 that numerous news outlets – ProPublica, NPR, USA Today – were discussing the increasing maternal mortality rate in the United States. And Black women were dying at even higher rates.

Also, I had had complications during my first delivery three years earlier.

My first pregnancy included quite a bit of nausea and vomiting, but aside from this, it was pretty typical. My child however, was not quite ready to make her appearance until almost 42 weeks. The labor was slow and onerous, lasting 33 hours. After an additional three hours of pushing, my baby was yet to be born.

At some point I began to shiver, my palms were sweaty, and my heart rate was more rapid. I was extremely fatigued from the labor but in that moment, I felt very different. The nurse, however, delayed contacting the doctor. She kept insisting that I was experiencing side effects from the anesthesia. Then the nurse became unresponsive, maintaining that there was no need to contact the physician. When I asked if she could take my vitals she did, and got a high temperature read but then kept wondering if something was wrong with her thermometer. She kept reiterating that everything was fine and that she just needed to check her equipment. I asked again if she could contact the physician and my husband did as well.

Finally, at the urging of my mother, who is a physician, the nurse eventually went to get my doctor, who, upon seeing me and my temperature reading, said we needed to act quickly because I had more than likely developed an infection. A second doctor came into the room and said they had to quickly get me to the OR for an emergency C-section. My temperature was 103.9. The diagnosis was chorioamnioitis, an infection of the placenta and the amniotic fluid. My baby was delivered and had to spend a week in the Newborn Intensive Care Unit. We were both treated with antibiotics. Though we were both able to be healthily discharged after a week, the feelings of not being listened to, of being dismissed and devalued, remained with me.

As a result, my first doctor’s visit during my second pregnancy in 2018 began with the retelling of the first delivery story. I had a new doctor, a Black woman, mostly because we had moved to a new part of the city. After my previous experience, it was important for me to build a trusting relationship with my medical care team.

Throughout my second pregnancy I worked on multiple research projects about race and health disparities. Between my own pregnancy and my work, it was difficult to escape the issue of maternal mortality. People would often tell me not to worry about “those bad things” while I was pregnant, but as a Black woman in the United States and as a researcher, I was unsure how someone could not worry about potential problems, especially in a moment of such urgency. Compared to white women, Black women in the United States are 243 percent more likely to die from pregnancy or childbirth-related causes.      

I often thought about Shalon Irving, a Black woman with a PhD who worked for the Centers for Disease Control. Like me, she was a health disparities researcher. Only weeks after giving birth to her first child, she died from complications of high blood pressure, even though she was seen by multiple medical professionals during the early postpartum period. I also thought about Kira Johnson, a second-time mother who died just ten hours after giving birth because of excessive bleeding. Her husband told stories about delayed attention from health care providers, even though his wife complained of severe pain as her catheter filled with blood. 

My second C-section was scheduled at 39 weeks, and the procedure went smoothly and according to plan. At discharge my baby and I were both healthy, and my doctor noted that recovery from a second C-section is often easier than the first. We were discharged on December 20 and made our way home to adjust to our new life as a family of four.

On Christmas Eve night I was sitting on the couch and watching television with my mother. I began having abdominal pain on my right side. The pain was sharp, but I assumed it was gas, a common symptom after delivery. I mentioned the pain to my mother who suggested that I look for some gas medication in the bathroom. At that point my head began to hurt as well. But I suffer from migraines and was exhausted from the initial days of sleeplessness with a toddler and newborn. When I stood to go look for medicine, however, it felt as if my skull was being seared, and the pain rushed down the back of my neck. Then my vision went blurry and I could not see. I stumbled back to the couch. My mother jumped up, grabbed my robe, put some socks on my feet, and walked me to the car. She put the baby in the car seat just as my husband and daughter were returning home from a Christmas Eve service. We all immediately drove to the hospital.

When I arrived at the ER, I was quickly wheeled to triage, and the nurse took my blood pressure. It was 198/95. It would actually increase to over 200/100 before the medicine fully kicked in. The staff at the hospital acted quickly, sending me for a CT scan to check for brain bleeds, giving medication for the pain, drawing blood, and beginning a magnesium sulfate bag, all standard care for what I learned was postpartum preeclampsia, a complication of pregnancy that results in high blood pressure. I had never had any symptoms of preeclampsia, never had even a slightly elevated blood pressure reading during pregnancy, or in my life for that matter. Prior to this, I did not even know that preeclampsia could occur after delivery. Yet there I was, Christmas Eve night, in a hospital bed, unable to move, full of worry.

Fortunately, my health care providers acted swiftly. I was admitted immediately and received excellent care. But this is not the case for many other Black women.

Since 1996, researchers have known that the top reasons for maternal mortality among Black women are hemorrhage, pregnancy-induced hypertension, and embolism. Oftentimes, the conversation about these areas quickly turns to patients’ lifestyles and behavior, but this conversation needs to be refocused. First, there needs to be an examination of what happens when patients present with symptoms during and after birth, and the ways that Black women of many backgrounds, are often dismissed and not believed, as was shown in the case of the Serena Williams story. Second, there is a need for more research about the impact of racism on the physical body throughout the life course. Third, it is time for the health care field to reckon with systemic racial inequities. The current system is failing Black mothers. 

 As a research fellow at a medical school I had the opportunity to talk with many health care providers, and have even facilitated discussions around race and equity. I would regularly hear from people who felt that they respected all patients, but our current state of racial health disparities is not simply about a matter of respect. A health care provider may believe that they are offering the same level of care for all patients but still carry out practices that are shaped by deeply imbedded forms of racism. Health care is considered a helping profession, but if that help is not equitable and is steeped in unexamined racism, then it can harm more than it helps. 

Chelsi West Ohueri, PhD, is a sociocultural anthropologist with research interests in race, structural inequality, marginalization, and health disparities in Eastern Europe and the United States. She is an assistant professor in the Department of Slavic and Eurasian Studies at the University of Texas at Austin. She is currently working on a book project that examines racialization and belonging in Albania and Southeastern Europe.

Shuto Orizari, a municipality in Skopje, Macedonia, with a majority Roma population

I first became aware of the deplorable health disadvantage of Roma, the largest minority group in Europe, in 2006. At the time, I was an epidemiology doctoral student at Columbia University working on a study that demonstrated the harmful effects of lead exposure during pregnancy from a smelter in Kosovo, Yugoslavia. I learned from an article in The New York Times that Romani children in United Nations refugee camps were suffering from severe lead poisoning due to living in U.N. refugee camps placed by the same lead smelter. I was outraged and quickly penned a Letter to the Editor. My eyes were opened to how structural racism can affect health in diverse social and historical contexts, and I decided to use my knowledge and training to call attention to the impact of racism on the health disadvantage of Romani women.

The first step was to build relationships in the field with Romani NGOs in Serbia and Macedonia. As I spoke with local gynecologists and Romani women, I was struck again by the similarities between what I knew about racism and maternal health in the United States and what I was seeing and hearing in the Balkans. I heard a Romani woman describe how she lay bleeding after childbirth and felt ignored by staff. I heard a gynecologist attribute poor birth outcomes of Romani women to genetics. I saw neighborhoods that were predominantly Romani with no access to a gynecologist.

These experiences made me think of the powerful work of Camara Jones, MD, PhD, MPH, Senior Fellow at the Satcher Health Leadership Institute and Cardiovascular Research Institute at the Morehouse School of Medicine, on how race is a sociologic construct, and how racism operates at various levels—institutional, interpersonal, and internalized—to create and perpetuate health inequalities.

International discourse on how to dismantle the impact of racism on maternal health may help us learn together how to achieve health equity within and across borders, writes Teresa Janevic, PhD, MPH, a perinatal epidemiologist and Assistant Professor in the Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai.

Although race wasn’t a concept frequently applied in the Balkan context, I used Dr. Jones’ framework in my research to show how racism influences access to maternal health care and delivering a low birth weight infant among Romani women. Back in the United States, in an ongoing research project on racial-ethnic discrimination during obstetric care, I can hear echoes of the voices of Romani women in the black and Latina women’s stories describing feelings of being ignored and given low priority.

Recently, I was invited by the International Journal of Public Health to contribute an editorial on the progress to the goal of improving the health of Roma, in which I noted positive steps but an overall lack of evidence on improved health equity. Since that 2006 article in The New York Times article, news headlines now often feature “Roma” instead of the pejorative term “Gypsy”, a marker of some progress in international awareness of Roma identity and human rights. However, where have we come in advancing Romani maternal and child health, and what is next? In my editorial, I outline several paths forward for research. Again, despite the distinct historical and political contexts, there are commonalities with the struggle for maternal health equity in the United States:

1. Building equity-sensitive surveillance systems: Vital statistics systems lack detailed information on ethnic background in the Balkans for maternal and child health surveillance, and data on disparities in health care quality is sorely lacking. In the United States, we have somewhat more advanced systems for surveillance. But, as Elizabeth Howell, MD, MPP, Director of the Blavatnik Family Women’s Health Research Institute, recently pointed out in testimony before the House Committee on Energy and Commerce, we lack quality metrics to sufficiently monitor disparities in quality of obstetric care, and we must support infrastructure to improve data collection and measurement.
2. Rigorously evaluating health interventions and policy: The impact of policies across sectors on maternal health equity is not sufficiently evaluated. Research on the social determinants of maternal morbidity and mortality in the United States has been limited in scope and lacks a focus on macro-level determinants. Likewise, in the Balkans, policies implemented across sectors for Roma inclusion have not been sufficiently evaluated in regard to their impact on maternal and child health. Tools provided by implementation science may assist in identifying why interventions and policies do or don’t work to improve equity. To cite an example from the Balkans, health mediators are one of the most widely implemented health interventions targeting Romani women, yet an implementation science study brought to focus factors weakening their impact, such as insufficient numbers and lack of systematization. Implementation science can play in a role in the United States by testing if quality improvement efforts are equitably implemented.
3. Disrupting structural racism through workforce development and civil society building: Programs to strengthen and increase the diversity of the public health workforce, particularly in non-European Union countries with large populations of Roma, are essential to shift the structures of power and privilege in health systems. A successful program in Serbia showcases the potential of this approach. It is also essential to include Romani women in policy discussions across sectors. In the United States, workforce development to increase the diversity of the maternal and child health workforce is crucial. Both at home and abroad, training in implicit bias and health care discrimination of health care professionals is needed, not only in trainees, but also in the field.

The late Esma Redzepova, queen of Romani music and an activist who fought for the rights of Romani women, defined racism as “the poisonous shafts of contempt and intolerance.” International discourse on how to dismantle the impact of racism on maternal health may help us learn together how to achieve health equity within and across borders.

Teresa Janevic, PhD, MPH, is a perinatal epidemiologist and Assistant Professor in the Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai. Dr. Janevic’s research focuses on how social determinants such as neighborhoods, racism, migration, and policy influence maternal and child health.

Whitney Lieb, MD, MPH, dispensing medication in a clinic in Jamaica.

With a background in public health and a desire to create sustainable global health projects, I was excited about the opportunity to join the Blavatnik Family Women’s Health Research Institute and develop the research skills needed to enhance women’s health services around the world.  And as I complete my first year in the Women’s Health Scholars Program, I can now reflect on what I have learned.

Before joining the Institute, I completed a fellowship in Global Women’s Health at the Icahn School of Medicine at Mount Sinai.  I focused my fellowship on international residency training, health workforce capacity, and HPV screening and treatment, among other critical global health issues affecting women.

As part of my global health work I traveled to Nepal, Uganda, Jamaica, and Liberia, however, some of my global health work is also done in the United States. Specifically, I work with Physicians for Human Rights as a volunteer faculty member in the Mount Sinai Human Rights Program aiding victims of female genital mutilation, domestic violence, and sex trafficking in their applications for asylum in the United States.

At the Institute, I have strengthened my skills in biostatistics, epidemiology, research design, data analysis, informatics, bioethics, and grant writing.  I have learned how to create and analyze biostatistical models and successfully collaborated on research projects while developing advanced analytical strategies that I can apply to my research questions.

One of my ongoing research projects is defining the prevalence of hepatitis B, hepatitis C, and HIV among health care workers at the largest tertiary hospital in Liberia. I conducted this study as a Global Women’s Health Fellow under the guidance of Ann Marie Beddoe, MD, MPH, a gynecologic oncologist and an Institute faculty member, in collaboration with on the ground partners in Liberia. Armed with these new analytical skills, I am excited to explore the data in hopes of furthering vaccination efforts among health care workers in Liberia.

The Women’s Health Scholars Program, with the Master of Science in Clinical Research, has thus far provided me with rigorous training in patient and population-based research, and prepared me for life-long learning in scientific discovery, clinical innovation, science education, and health policy.  I feel honored to be a part of the Institute—under the guidance of Elizabeth Howell, MD, MPP, Director of the Blavatnik Family Women’s Health Research Institute and a Professor in the Departments of Obstetrics and Gynecology and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai—and to have the opportunity to prepare for an academic career in women’s health research.

I look forward to the year ahead.

Whitney Lieb, MD, MPH, is the current Women’s Health Scholar with the Blavatnik Family Women’s Health Research Institute.  She is also an Assistant Professor in the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

As an expert in psychiatric disorders during pregnancy and the postpartum period, Veerle Bergink, MD, PhD, understands the importance of mental health, specifically during these periods in a woman’s life.

“The mental health of the mother has a major impact on her baby,” said Dr. Bergink, a Professor in the Departments of Psychiatry, and Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai. Dr. Bergink, a faculty member at the Blavatnik Family Women’s Health Research Institute, noted how physical changes during pregnancy are intrinsically tied to the mom’s environment, her mental health, and the baby’s development.

In a video Q&A, Dr. Bergink discussed maternal mental health in observance of Maternal Mental Health Awareness Month in May 2019. Her research focuses on psychiatric disorders during pregnancy and the postpartum period, and she is currently developing a women’s mental health research program at Mount Sinai.

There is a difference between “Baby Blues” and postpartum depression, she says. “It is normal for women having a child to feel low now and then,” Dr. Bergink said about the prevalence of feelings of anxiety, insecurity, and sadness. But the symptoms of postpartum depression are more serious and can last longer. Dr. Bergink went on to discuss how anxiety and depression affect women during this period of high expectations, both from herself and the world around her and how loved ones can help the mom experiencing these symptoms get through them.

Dr. Bergink’s work also includes the association of primary education and maternal mental disorders, the mother’s use of lithium as treatment for mental disorders during breastfeeding, parental psychopathology as a risk factor for bipolar disorder and the importance of emergency care in preventing infanticide and suicide in the postpartum period.

We look forward to more cutting-edge women’s mental health research from Dr. Bergink!

My mother took this picture, and these are her cooking tools. The charcoal is located on both sides—it is easier in case any additional meal needs to be cooked.

Many people in Haiti depend on organic substances such as manure, wood, and food waste for fuel. These materials are burned indoors, often in rudimentary stoves, and the resulting smoke causes immense indoor air pollution. This smoke often contains carcinogens, particulate matter emissions, agricultural residues, and other harmful chemicals.

According to studies from the World Health Organization (WHO), three billion people cook with open fires and, as a result, indoor smoke from solid fuels causes an estimated 4.3 million premature deaths annually.

I can recall the times where my grandmother and mother would cook using charcoal, and I know my grandmother still does. On average, both would spend about five hours each day cooking. This type of prolonged exposure is detrimental to their health. There were times when my young cousins were visiting, and we would be in such close proximity to the kitchen that we could smell the charcoal constantly burning.

I also know there are some solutions to this problem.

These deaths are due to large particulate matter from carbon dioxide released from rudimentary cooking stoves. It is estimated that 34 percent die due to stroke, 26 percent to ischemic heart disease, 22 percent to chronic obstructive pulmonary disease, 12 percent to childhood pneumonia, and 6 percent to lung cancer, according to the WHO.  Cooking indoors can also contribute to cardiovascular disease, tuberculosis, cataract issues, and adverse pregnancy outcomes such as low birth weight, acute lower respiratory infection, and stillbirth, according to a study in the International Journal of Tuberculosis and Lung Disease.

Haiti suffers from high levels of poverty and limited economic growth; the 2010 earthquake and Hurricane Matthew in 2016 have not helped its development. Because of these crippling disasters, firewood and wood charcoal have been adopted as the primary fuel used for cooking in the country due to their reliability and accessibility for most of the population.

Naissa Piverger, MPH, is a Clinical Research Coordinator in the Department of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai

Women and children, whose days often center on gathering fuel and cooking, are disproportionately exposed to pollutants. This comes from the traditional framework that Haitians follow of women cooking and taking care of the children.  They are also more vulnerable to the effects of household air pollution because of their time spent indoors, according to a study in Global Public Health.

In a recent study, researchers worked with a group of home cooks in Nepal and used art as a means for discussing the ways in which household air pollution from cooking affects their health.  The women interviewed identified a myriad of health effects that were associated with the eye and respiratory system.

There are possible solutions that can assist in reducing household air pollution effects while improving the health of women in the community. For instance, investing in ethanol based fuel or using electric stoves can reduce exposure from cooking with open fires. Solid fuel use has important environmental and human health consequences and there is much work to be done to prevent these illnesses in both moms and babies.

Elizabeth Howell, MD, MPP, Director of the Blavatnik Family Women’s Health Research Institute, testifies before a House subcommittee

“The United States is the most dangerous place to deliver a baby in the developed world,” stated Congresswoman Anna Eshoo from California in her opening remarks at the House Committee on Energy and Commerce hearing in Washington on improving maternal health, quoting an investigation by USA Today from 2018.

Approximately 700 women die from a pregnancy-related cause each year. The United States maternal mortality rate is higher than other high-income countries, and the numbers are far worse for women of color. In addition, for every death, more than 100 women experience a severe complication related to pregnancy and childbirth, resulting in thousands of women every year experiencing one of these events according to the Centers for Disease Control and Prevention.

For these reasons, on Tuesday, September 10, Elizabeth Howell, MD, MPP, Director of the Blavatnik Family Women’s Health Research Institute and a Professor in the Departments of Obstetrics and Gynecology and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, testified before the Subcommittee on Health of the Committee on Energy and Commerce.

Click here to watch Dr. Howell’s testimony before the House subcommittee

Dr. Howell emphasized six important action items to improve maternal health, which included elements of four proposed bills that were discussed in the hearing:

1. Develop quality of care metrics for maternal health that are patient-centered and address disparities
2. Authorize the Alliance for Innovation on Maternal Health (AIM) program
3. Extend Medicaid to cover up to one year postpartum
4. Develop and expand perinatal care quality collaboratives
5. Provide support for training in implicit and explicit bias to all health care providers
6. Support infrastructure to improve data collection and measurement

We do not know yet whether these bills or parts of these bills will be passed and signed into federal law. But there are things that the government and the health care system can do and should implement in order to address the problem of maternal death in this country. Dr. Howell ended her testimony as follows: “We have to value pregnant women from every community. We can and must do better.”

In addition to Dr. Howell, Patrice Harris, MD, MA, President of the Board of Trustees of the American Medical Association; David Nelson, MD, Chief of Obstetrics at Parkland Health and Hospital System in Texas; Usha Ranji, Associate Director of Women’s Health Policy at the Kaiser Family Foundation; and Wanda Irving, mother of Shalon Irving, PhD, provided testimony on the four maternal health bills that the House of Representatives is considering. The proposed bills aim to improve access to care for pregnant and postpartum women and to reduce severe maternal morbidity and mortality. All five of these experts instructed Congress that there are concrete steps Congress can take to improve maternal care before, during, and after delivery.

Wanda Irving is the mother of Dr. Irving who died after childbirth despite multiple visits to health care providers in the three weeks postpartum before her death. In her testimony, Ms. Irving declared, “What infuriates me is that Shalon’s death was a preventable tragedy. She was a 36-year-old woman of color who went to her health care workers again and again in distress–and she was not properly treated.” Later in her testimony she added, “It should not have happened.” We must do better. We can do better.

The following four bills address varied aspects of health inequity and current shortfalls in our health care system that impact maternal health.

The Quality Care for Moms and Babies Act (H.R. 1551)

H.R.1551 proposes to identify and publish a recommended set of core maternal and infant health quality measures. The legislation calls for a list of recommended measures including standardized processes, experience requirements, and outcomes of maternity care (including postpartum care) across a variety of healthcare settings and health plans by January 1, 2021. Additionally, this list of recommendations must also address disparities in maternal care, care coordination, and the importance of shared decision making between the patient and provider. By January 1, 2022, these measures are to be published, disseminated, and applicable to all Medicaid and Children’s Health Insurance Program (CHIP) eligible patients. By January 1, 2023 the government will standardize reporting information based on the initial measures, and this reporting will occur by January 1, 2024 and every three years thereafter. H.R. 1551 also includes the following:

• Establish a Maternal and Infant Quality Program that publishes maternal and infant health quality measures that will inform future recommendations and research studies that develop and test evidence-based measures
• Establish the Maternal Consumer Assessment of Health Care Providers and Systems Survey to measure health care experiences.
• Annual State Reports of specific maternal and infant quality of care measures for those under Medicaid or CHIP
• Expand quality collaboratives that facilitate performance data collection and feedback reports to physicians on performance and achieving benchmarks, create protocols and checklists to foster safe evidence-based practice, translate evidence-based science into clinical care, and to evaluate quality improvement (QI) programs and projects.

The Mothers and Offspring Mortality and Morbidity Awareness (“MOMMA’s”) Act (H.R. 1897)

H.R. 1897 proposes mandating the submission of the United States Maternal Mortality Rate to the international data repositories, as the U.S. has not since 2007. Due to a lack of standardization across state maternal mortality review committees as well as the lack of 100 percent state reporting, data has not been sufficiently reported to the CDC for them to do a proper analysis. The bill discusses the danger of underreporting maternal mortality and morbidity and the racial disparities in maternal death in the United States. This legislation discusses maternal death in the postpartum period. According to the CDC report of maternal deaths from 2011-2015, 21 percent of maternal deaths occurs 7-42 days postpartum and nearly 12 percent of deaths occurred between 43 and 365 days postpartum. Additionally, this bill focuses on oral health—some evidence that suggests women with periodontal disease during pregnancy could be at greater risk for poor birth outcomes, including preeclampsia. H.R. 1897 also includes the following:

• Establish state-based perinatal collaboratives to work with hospital-based, outpatient, and clinical teams, experts, and stakeholders to spread best practices and optimize resources.
• Provide CDC support to states to report severe maternal morbidity, oral health, maternal health, and breastfeeding data back in a standardized manner.
• Extend Medicaid and CHIP to 1 year postpartum and expand to include oral health.
• Make resources for pregnant and postpartum women publicly available on the Department of Health and Human Services website.
• Establish an accreditation of Regional Centers of Excellence Addressing Implicit Bias and Cultural Competency for hospitals, health systems, medical schools, and other health services education institutions.
• Establish a special supplemental nutrition program for women, infants, and children up to 2 years postpartum via SNAP.
• Tax the tobacco industry to pay for the measures in this bill.

The Healthy MOMMIES Act (H.R. 2602)

H.R. 2602 proposes to improve maternal and child health outcomes, health equity, and communication by providers and integrate support services in maternal and infant care. A unique aspect of this bill is that it has a focus on primary care and doula care for Medicaid beneficiaries. H.R. 2602 includes the following:

• Extend Medicaid and CHIP up to 1 year postpartum, requiring oral health services for pregnant and postpartum women.
• Establish the Maternal Care Home Demonstration Project, a five-year project to reduce severe maternal morbidity and to reduce avoidable mother and infant rehospitalizations.
• Require the Comptroller General to submit report to congress on gaps in Medicaid in CHIP no later than one year after the passage of this act to create recommendations on how to improve gaps, especially for low income, women of color in health care shortage areas.
• Use telemedicine to increase access to maternity care and increasing access to doula care to Medicaid beneficiaries.

The Maternal Care Access and Reducing Emergencies (Maternal CARE) Act (H.R. 2902)

H.R. 2902 proposes to reduce severe maternal morbidity in the United States through better quality health care. However, the scope of this act would only include 10 states. Several measures that would be enacted by the passage of this act are:

• Provide Implicit Bias Training for Health Care providers. This would be done by federal grants to health professional schools, prioritizing disparities in OB/GYN care.
• Establish the Pregnancy Medical Home Demonstration Project to deliver integrated health care services to pregnant women and new mothers. A care manager would be assigned to each patient and each patient will have a standardized medical, OB exam, and psychosocial risk assessment at their first prenatal visit.
• Collaboration with the National Academy of Medicine to study and make recommendations for incorporating bias recognition in clinical skills testing for accredited allopathic and osteopathic medical schools.

Amy Balbierz, MPH, is a program manager in the Department of Population Health Science and Policy and for the Blavatnik Family Women’s Health Research Institute.