How to improve California’s deadly record of outcomes for Black births

Wanted pregnancies are often a joyous occasion filled with baby clothes and parties. But for Black parents, pregnancy can also be filled with fear of wondering if they or their babies will become a statistic. 

Unfortunately in California, that fear becomes reality far too often.

Earlier this month, the California Department of Public Health released a report from its Pregnancy Mortality Surveillance System, and the findings are not good. From 2008-16, the pregnancy-related mortality ratio for Black people grew to 4-to-6 times greater than all other racial and ethnic groups, a number much worse than the state health department’s 2011 report, when the pregnancy-related mortality ratio for Black people in California was 3-to-4 times greater than other groups. What’s more, California’s outcomes for Black births are now worse than the national average, and higher than they were 30 years ago. 

The most recent national statistic provided in Maternal Mortality Rates in the United States, 2019, cites the birth-related mortality rate for Black people at 44 per 100,000. California’s health department 2011 report, The California Pregnancy-Associated Mortality Review, 2002-07, cited a birth-related death rate for Black people at 39.9 per 100,000, but the recent report put it at 56.2 per 100,000 between 2014-16.

California slid back on its own progress, and fell behind the rest of the country. In a state openly striving to make inroads in unhealthy and unnecessary outcomes like these, the news in this month’s health department report underscores the need to expand interventions beyond what California is currently doing.

Senate Bill 65, introduced by state Sen. Nancy Skinner, a Democrat from Oakland, made it through the Legislature and awaits the governor’s signature. If signed, SB 65 will implement additional components to the department’s existing efforts with proven interventions that are not yet part of state practice.

SB 65 codifies and strengthens the state’s health department’s  pregnancy-associated mortality review committee by requiring it to be more diverse, report more frequently, do voluntary interviews of affected family members and medical personnel, and make recommendations to reduce the disparities. 

It also frees pregnant CalWORKS recipients from burdensome paperwork requirements, creates a fund to grow and diversify the midwifery workforce, and establishes a workgroup to support doula access for people on Medi-Cal. Additionally, the bill requires collection and tracking of Lesbian, Bisexual, Trans, Intersex and Gender Non-Conforming birth-related mortality rates. 

Earlier this year, SB 65 also included pieces that were passed via the 2021-22 state budget over the summer: extending Medi-Cal for one year for all enrollees at the end of their pregnancy, establishing a Medi-Cal doula benefit, increasing the pregnancy supplement for CalWORKs enrollees for the first time since the 1980s, and including pregnant households as a priority population in county guaranteed income pilot programs. 

Taken as a whole, these elements are intended to reimagine maternal health by looking at all of the supports needed to close the racial and socioeconomic gaps in maternal health: access to health care during the postpartum period when maternal deaths often occur, access to doulas to help mothers be heard during labor and delivery, and answer questions before and after birth, and additional cash assistance to support pregnant households. 

The remaining pieces of SB 65 not included in the budget are important for resolving birth disparities by requiring more in-depth and frequent analysis of maternal death in California, aligning county efforts in reviewing infant deaths, and funding the training of midwives to address the scarcity of perinatal providers. 

Importantly, these efforts also build off of 2019’s SB 464, the California Dignity in Pregnancy and Childbirth Act, which requires perinatal providers to have implicit bias training. It takes all of these elements to get at the root of why we are failing Black people before, during and after childbirth.

The governor needs to sign SB 65 to round out a comprehensive package of interventions to put California on a better path toward desirable outcomes for all birthing people, and especially for Black people who continue to be neglected, disrespected and put in danger during pregnancy. 

We cannot rest with the current status quo, because as the California Department of Public Health’s research shows, the status quo is dangerous for Black pregnant people and their families.