2020 Democratic Presidential Candidates Propose Policy for Maternal Care

By Makaila Jackson

Maternal health and mortality, which has been a prominent issue for minority communities for many years, has come to the forefront of the 2020 presidential race. The United States has the highest rate of maternal mortality in a developed county and had continued to increase since the 1990s. Looking at Detroit, data from the Michigan Department of Community Health shows that at least six Detroit mothers died yearly on average and from 2008-11 26 maternal deaths were reported. These results translate to the maternal rates of 58.7 per 100,000 babies, exceeding countries like Libya, Uruguay, and Vietnam.

A look into the pregnancy-related death rates in Southeastern Michigan showed that the City of Detroit had higher rates from 2008-13 (combined) than any other governmental unit reported for the region. Recent data on maternal mortality was not collected by the Michigan Department of Health and Human Services, but in early 2017, Public Act 479 of 2016 was signed into law making maternal death reporting mandatory. Prior to this law reporting was voluntary, leaving the issue not up for evaluation or be considered.

Among the presidential prospects, Senators Cory Booker (D-NJ), Kirsten Gilbert (D-NY), Kamala Harris (D-CA) and Elizabeth Warren (D-MA), have proposed developments on maternal health. Their efforts are commendable and address different aspects of maternal morbidity and mortality:

• Warren: “Pay well for what matters;” financially incentivizing hospitals to improve their care quality. Senator Warren has broadened her outlook on racial equity in the quality of care. This would be beneficial to Detroit mothers, considering most maternal complications and deaths in the Metropolitan Detroit area are African American and Hispanic women.
• Harris: “Maternal CARE Act;” promoting implicit bias training and innovation in prenatal care to improve birth equity. Senator Harris’s proposal focuses on prenatal care and the establishment of implicit bias training grants for professional schools that train maternity care clinicians. Sen. Harris also proposed pregnancy medical homes, centers that provide comprehensive perinatal care and participate in value-based payment models. However, a five- year trial recently showed that group prenatal care and midwifery care out-performed pregnancy medical homes in preventing adverse birth outcomes, maternal satisfaction, and costs. The pregnancy medical home model is one tool, not a comprehensive solution.
• Gillibrand: “MOMS Act;” improving maternity care quality and state infrastructure and using Medicaid policy to increase access, create new care models, The MOMS Act focuses on evidence-based care but lacks the focus on the underlying issue of equity and outcome. Implementing care bundles have been proved to reduced maternal morbidity and improved quality metrics in states like New York and California yet continues to show racial bias and would not cater to the suffering population in Detroit, but nonetheless could be beneficial.
• Booker: Enhance quality through Medicaid and exploration of telehealth. Sen. Booker’s “MOMMIES Act” focuses on telemedicine to give mothers more options to receive effective and adequate care. Early explorations of telemedicine in pregnancy have demonstrated the ease of access, high patient satisfaction, and reduced costs. This offers an option for low-income mothers in urban and rural areas with inadequate access to onsite consulting and communicating with their physicians.

Primary debates provide politicians a platform for articulating policies that may otherwise not be discussed. The proposals to improve maternal health are innovative and may mean a turn in the right direction for decreasing the amount of maternal and infant complications.

Makaila Jackson is a Health Science student at Spelman College who is serving as a health policy intern at Authority Health this summer.