In Detroit, for example, pregnant Black women are 4.5 times more likely to die compared to their white counterparts. “This is a staggering disparity,” Gov. Whitmer said last month.
Every year, more than 100,000 babies are born in Michigan. What should be a happy occasion for many families doesn’t always end up that way: Nearly 100 Michigan moms die during pregnancy, at delivery, or within a year of giving birth, and more than 700 of those babies don’t make it to their first birthday.
Determined to reduce those horrifying numbers, Gov. Gretchen Whitmer introduced a new plan last week to tackle the state’s maternal and infant mortality crises.
Whitmer’s Healthy Moms Healthy Babies plan, if approved by the legislature, would expand health coverage for low-income new mothers, expand access to evidence-based home visiting programs, and allow women to choose their own birth control. It would also create a partnership between providers and universities to address glaring racial disparities in the state’s maternal mortality rates.
The problem Whitmer is trying to tackle is one that affects women and families across the United States. Black women are in particular bear the brunt of this crisis: They are three times more likely to die from a pregnant-related complication than non-Hispanic white women.
“This is a staggering disparity,” Whitmer said in January during her State of the State speech.
In Michigan, the disparities are even greater. Detroit’s maternal death rate is three times the national average, and pregnant Black women are 4.5 times more likely to die compared to their white counterparts. The state also has the 13th highest infant mortality rate in the nation, with 6.8 infant deaths per every 1,000 live births, above the national rate of 5.8.
In 2018, this translated to 723 Michigan infants who died before they turned one. The state’s infant mortality crisis also disproportionately affects Michiganders of color: Babies born to Black, non-Hispanic women in 2018 were more than three times as likely to die as babies born to white, non-Hispanic women. American Indian infants were about twice as likely to die as white infants.
The state has made some progress in the past decade, reducing both the maternal and infant mortality rates, but a recent analysis by the Michigan Maternal Mortality Surveillance Committee found that 44 percent of Michigan’s maternal deaths from 2011 to 2015 were preventable.
Whitmer’s plan aims to achieve those sorts of reductions.
Her proposal would spend $37.5 million to expand Medicaid family planning benefits to women making up to 200 percent of the federal poverty level (up to $43,440 for a family of three, for example) and extend postpartum coverage from 60 days to a full year after birth. The plan—as recommended by the American College of Obstetricians and Gynecologists—would also move a woman’s first postpartum visit to within three weeks of birth and provide for a comprehensive visit within 12 weeks.
“This will help new moms work through postpartum depression and anxiety, substance use disorder treatment, challenges with breastfeeding, and other healthcare needs,” the proposal reads.
Her proposal would spend $37.5 million to expand Medicaid family planning benefits to women making up to 200 percent of the federal poverty level and extend postpartum coverage from 60 days to a full year after birth.
In order to address the glaring racial disparities, Whitmer’s plan will also create a partnership between practitioners and students to require future doctors and nurses to be trained in implicit bias.
Research has shown that providers who hold unconscious racial biases dominate conversations with African-American patients during routine visits and pay less attention to their patients’ social and emotional needs. Another study of white medical students and residents found that half of them believed inaccurate differences about Black and white patients, including the falsehood that Black people have less sensitive nerve endings. Many of those future healthcare providers who held false beliefs were also found to rate Black patients’ pain lower than that of white patients and made “less accurate treatment recommendations.”
Furthermore, a 2017 investigative report from NPR and ProPublica found that unconscious biases were “embedded in the medical system,” and that African-American mothers constantly felt “devalued and disrespected” by medical providers.
Whitmer’s proposal also aims to expand the state’s home visiting program, which connects expectant mothers with visiting nurses who can provide support and direct high-risk and vulnerable mothers to community resources and services. The governor also wants to give women more autonomy over their own family planning by allowing them to choose their own birth control.
“We’re going to ask a woman what she wants, ensure she can get it in one visit, and provide coverage for it,” Whitmer said during her State of the State speech. The crowd erupted in applause.
The governor’s proposal has received praise from several different stakeholders.
“Improving access to health care is a huge step,” said Bret Jackson, president of the Economic Alliance for Michigan, a coalition of business and labor groups focused on healthcare access and costs.
“Making sure that expectant mothers and postpartum mothers have coverage so they can access the health services they need and not only get the care, but the education on how to take care of themselves and how to take care of a newborn, I think is really critical to reducing the maternal and infant deaths that are happening in Michigan,” Jackson told COURIER.
The Michigan Council for Maternal and Child Health (MCMCH), an advocacy organization, also expressed support for the Healthy Moms proposal. “We applaud Governor Whitmer’s announcements today,” MCMCH executive director Amy Zaagman said in a statement. “We thank her for putting the human future of our state on the same platform with our infrastructure and workforce challenges.”
Whitmer’s larger budget proposal also includes other measures aimed at helping mothers, such as $27 million in federal funding to expand access to child care for low-income families. Under the expansion, families earning up to 150 percent of the poverty level, or $31,995 for a family of three, would be able to access childcare services starting Jan. 1, 2021. The expansion is expected to help 5,900 Michigan children.
Whitmer also wants to spend $10 million to expand 12 weeks of paid parental leave to 48,000 state employees. Workers can currently take 12 weeks of leave, but it is unpaid.
It’s unclear whether the Republican-led legislature will sign onto Whitmer’s budget proposal as is or seek to negotiate, but Senate Majority Leader Mike Shirkey (R-Clarklake) indicated he was receptive to the issue.
“I’m very anxious to roll my sleeves up and get into that solution,” Shirkey told Bridge Magazine last week, before noting that “the devil is in the details.”
Zaagman also indicated an eagerness to hammer out a solution. “We look forward to working with the administration and the legislature on these common-sense ways to improve outcomes for moms and babies,” she said.