Increased reimbursement for maternal health providers, community-based services, and disaggregated data were key themes among Virginia maternal health advocates at the Joint Commission on Health Care meeting last week. Policy makers heard testimonies from three agencies to better inform their priorities for the upcoming 2022 legislative session.
Carol Sakala, PhD, director for maternal health at the National Partnership for Women and Families, said Virginia is mostly on par with national indicators for maternal health, such as maternal and infant mortality, preterm births, and cesarean births. However, she said there are still gaps in access to maternal care in the Commonwealth.
“Several dozen Virginia counties have been designated as maternity care deserts due to the lack of essential services.”
Sakala highlighted a few recommendations for the Commission, which include restructuring payment models for maternal care and increasing funding for midwifery programs across the state. She also encouraged the Commission to adopt flagship legislation from California called the Dignity in Pregnancy and Childbirth Act. This program, passed in 2019, ensures that perinatal providers complete implicit bias training to serve patients more equitably.
Stephanie Spencer, executive director for Richmond and Hampton Roads-based organization Urban Baby Beginnings (UBB), highlighted the need for more community-based maternal health services to ensure equitable access to care. UBB has served over 2,000 families since 2015, according to Spencer, 99% consisting of birthing people of color (“Birthing people” is a gender-neutral term which has been used in the Biden Administration’s discussion on Black maternal mortality). These families are also usually uninsured or underinsured and live at or below 200% of the federal poverty level.
According to Spencer, the top complaint she hears from the communities UBB serves is the lack of coordinated care and trained professionals across the state.
UBB’s solution to this issue is the creation of sustainable, community-based maternal health hubs. UBB currently has four operating hubs in the Commonwealth that provide information, supplies such as diapers, and other services to pregnant and postpartum people.
“It’s important that [legislators] realize how hubs can really support community, and how they really bring people in. And they can exist in different ways — they don’t have to be the same everywhere. But, they are collaborating in these systems with hospitals, with providers, [and] with community to have safe outcomes.”
Still, a lack of funding has kept UBB from expanding to other parts of the state, which results in having to turn away hundreds of families each year, according to Spencer.
Dr. Christian Chisholm, professor of obstetrics and gynecology at the University of Virginia and past chair of the American College of Obstetrics and Gynecology – Virginia, rounded out the discussion with data on maternal mortality and disparities, particularly among causes of death. According to Dr. Chisolm, Black birthing people account for up to 75% of deaths from cardiovascular diseases, despite accounting for 19.2% of the state population.
Members of the Commission applauded the speakers’ work and began discussions of potential actions to achieve maternal health equity in the next session.
Delegate Emily Brewer (R – Smithfield) called for more specific, disaggregated data that would analyze the impacts of social determinants of health on maternal mortality rates.
“We’re not looking at the age groups of women where we are seeing these issues. We are not seeing where they live, if it’s a travel or access issue. We’re not seeing what health concerns lead to [mortality] based off of their age … I’m not seeing enough here to help me make an informed decision if it ever came to us, to be able to understand it more clearly.”
Virginia Secretary of Health and Human Resources, Dr. Daniel Carey, reminded Commission members to focus on value-based solutions that improve access to care, rather than solely on improving “high-tech” medical procedures. These value-based solutions, Dr. Carey said, will then translate to better health outcomes.
“It’s the community-based services, it’s that trusting health care system, that is the entry point to [those] high-tech services … yes, cardiologists could always get better, but the treatment is not that complicated. It’s more [about] access to care. It’s transportation, it’s social determinants — all of those community-based wraparound services.”