Dozens of maternal health organizations and advocates are urging California's surgeon general to halt the rollout of a plan aimed at reducing maternal deaths, saying the newly announced plan will not address the problem and “risks exacerbating existing inequities.”
In a letter shared with The Times, representatives of organizations including the California Black Women's Health Project, Black Women for Wellness and the California Nurse-Midwives Assn. she accused the program of “placing an unnecessary burden on individuals” and failing to “clearly name and address racism as a primary cause of maternal health disparities.”
The California Maternal Health Blueprint unveiled in September lays out strategies to try to reduce maternal deaths. Among them: Getting Californians of reproductive age to fill out a new questionnaire to assess their risk of pregnancy complications, even before they get pregnant.
In their letter dated 21 October to the provincial surgeon Dr. Diana Ramos, the advocacy group, said the maternal health plan acknowledged racial disparities in maternal mortality rates, but “did not attribute these disparities to evidence that shows systemic discrimination as a primary cause.” .”
Asked for comment on the letter, the surgeon general's office released a statement saying it is “committed to working with partners across the state … to improve maternal health outcomes, reduce maternal mortality, and save the lives of California mothers and pregnant women.” people.”
Black women face a maternal mortality rate more than three times that of white women in California, state data show. The Centers for Disease Control and Prevention is wrong about many things, including disparities in health care and chronic conditions as well as structural discrimination and implicit bias.
Research has shown that disparities exist even among affluent Black women, prompting maternal health researchers to focus more on racial disparities in health care, bias and discrimination experienced by patients, and the physical effects of chronic stress from enduring racism over time.
In an interview in September, Ramos said California had focused on the “health care landscape” in its previous efforts to prevent maternal deaths, helping it achieve the “lowest maternal mortality rate in the country.”
As it stands, California has had a much lower rate of deaths related to pregnancy, childbirth and its outcomes than other parts of the US, although maternal deaths have increased in recent years during the COVID-19 pandemic. The state has been held up as an example of its own maternal mortality review system.
“If we continue to do the same thing – just focus on the health care team – we will get the same results,” Ramos said in September, explaining why the recently announced program emphasized patients knowing their level of risk. “That's why we bring the patient in.”
The Maternal Health Program sets a goal of having at least 50% of “people of reproductive age” nationwide complete a questionnaire on their risk of pregnancy complications by December 2026.
In a letter opposing the program, a coalition of groups said that asking people to fill out such questionnaires “gives the impression of personal fault and/or that human behavior is culpable, burdens the user and diminishes the role of the system in creation.” this is a critical situation.”
The groups say they know of no research to support “personalized risk assessment” as a way to improve reproductive outcomes. And the plan doesn't clearly state next steps or what will happen to the data, their letter argued.
Dana Sherrod, founder and executive director of the California Coalition for Black Birth Justice, said that “by leaving the talk of systemic racism, it puts the blame back on the patients.” The only time the term “systemic discrimination” appears in the plan is in reference to the findings of another federal report.
Sherrod said that even when other factors are taken into account, “Black women still have the worst outcomes.” For example, one analysis of maternal mortality in California found that high-income black mothers had worse rates of pregnancy-related deaths than low-income white mothers.
A previous study found that black women did not have significantly higher rates of preeclampsia, postpartum hemorrhage and other serious complications than white women, yet black women with such complications were two to three times more likely to die from them than white women with such complications. such situations.
Even if they're “a healthy weight, educated, married—things that should be protective—or doing all these things, we're still seeing negative results,” Sherrod said.
California's plan also requires medical facilities to use an existing screening tool to measure the risk levels of pregnant patients. Ramos told The Times that such tests could help guide where patients are born, and ensure that people at high risk go to facilities better equipped to support them.
The coalition warned, however, that doing so “could turn back the most vulnerable people and divert resources from struggling institutions while at the same time burdening high-quality institutions.” California already faces “significant shortages in prenatal care” as maternity wards have closed, they said.
“It's been very difficult for many people to navigate the health care system and understand where to go to get the best care,” Sherrod said, “and this could make that difficult.”
Coalition leaders want a meeting with Ramos and First Lady Jennifer Siebel Newsom, wife of Gov. Gavin Newsom, who joined Ramos in announcing the program in September.
Ramos' office said in its statement on Monday that since they started their program, “Dr. Diana Ramos has met with several partners in the area of maternal health and will continue to meet with others, including coalition members, to find opportunities to work together.”
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