Is California failing women on maternal care?

Expectant mothers in California have been struggling for years to get the healthcare they need, and a new report from the state auditor underscores just how difficult it is for the state to keep tabs on vulnerable mothers-to-be.

Recent stats are grim. In 2020, the state reported its highest maternal mortality rate in a decade. And from 2012 to 2019, at least 19 California hospitals stopped offering labor and delivery services — creating “maternity care deserts.” 

Maternity care is particularly bad for Black women, who are at least three times more likely to die of pregnancy-related complications than others. They also report poor experiences with medical professionals, including difficulty convincing doctors that they are in pain.

And things don’t appear to be getting better. Last year, at least 11 more hospitals announced maternity ward closures. California midwives who could help mitigate the care gap for the state’s poorest can barely keep their businesses afloat. And the state Department of Justice unveiled in October that many California hospitals were largely ignoring a 2019 law that requires them to train perinatal care providers on unconscious bias and racial disparities.

Now the latest rub comes from the state auditor, explains CalMatters health reporter Kristen Hwang. Earlier this month, it released a report that found that two state departments — Health Care Services and Public Health — fail to adequately track the state’s 40-year-old Comprehensive Perinatal Care Program, which aims to help moms enrolled in Medi-Cal and their babies.

Medi-Cal, the state’s health benefits program for low-income Californians, pays for about 40% of all births in California. But women on Medi-Cal are at least three times more likely to die from pregnancy complications than those with private insurance. To assist them, the perinatal program helps provide nutrition counseling, psychosocial services, prenatal vitamins, referrals to other social services and more.

Among the report’s key findings:

• So little data was available that the auditor’s office could not determine how many eligible patients are getting the help, or if the program is improving the health of new mothers and their babies.
• While figures were available for 14% of the roughly 14 million Medi-Cal enrollees, only about half received the special benefits during pregnancy.
• The two departments have conducted very little oversight of the doctors, health departments and insurers that administer benefits, and have not made any major improvements to the program since its establishment.

In a joint statement to CalMatters, the directors of the two departments said they would work together to address the audit’s findings.

• Michelle Baass of health care services and Tomás Aragón of public health: “It is our collective responsibility to hold each other accountable while raising the standard higher to ensure that pregnant individuals in the Medi-Cal program have timely access to quality, equitable maternal health care services.”

For more on the auditor’s report, read Kristen’s story. Kristen is also moderating a CalMatters panel on the impact of maternity ward closures and state efforts to protect access. Register here to attend in person or online, March 27 in Sacramento.

Soon after a welcome center for migrants shut down in San Diego, U.S. Border Patrol agents have been dropping off migrants at a local transit station — often with scant resources or directions to guide them to their final destination.

These “street releases,” as Wendy Fry of CalMatters’ California Divide team reports, come as an unprecedented number of people arrive at the southern border. Federal, state and local officials disagree on how to help the migrants and who should pay for it.

Since opening in October, the San Diego Migrant Welcome Center provided services to more than 81,000 migrants, said its CEO. In addition to transporting people from a federal detention center, the center also provided food, toiletries and connected people with loved ones. The center received about $6 million from the county, which came from leftover federal pandemic aid.

But with the money dried up, the migrant center closed its doors last week. Border Patrol officials said overcrowded facilities left them no choice but to release the migrants on the streets, as well as transit stops such as the Iris Avenue Transit Center in San Diego. 

Speaking to some migrants released over the weekend at the transit station, Wendy reported that some were disoriented and unclear about where they were. Many received notices to appear in immigration courts in other cities, some tried to catch the next trolley to the airport and others were unsure how to reconnect with family members whom they were separated from during the detention process. 

Said one 19-year-old from Ecuador: “I’m just very worried about my family.”

For more on the migrants arriving in San Diego, read Wendy’s story.

Assemblymember Chris Ward boasts a distinction: The San Diego Democrat is the first legislator guaranteed another term at the Capitol. No challengers filed to run against him, and no one qualified as a write-in candidate last week. 

Ward was first elected in 2020 and for this session, Assembly Speaker Robert Rivas tapped him as chairperson of the Housing Committee, pleasing YIMBY activists. I sat down with him to discuss homelessness, renters’ rights and more. The interview has been shortened for clarity and length.

Why is housing a priority for you?

To be able to support cities in their responsible community development has evolved now. Things have gotten to be more difficult with housing pricing and the ability for a middle-income family to make it here, or for kids to graduate and see themselves as Californians with professional opportunities. It’s very demanding of us to prioritize. 

What do you think of the bill to exempt San Francisco from certain CEQA regulations?

While I’ll reserve judgment for (Sen. Scott Wiener‘s) bill as it comes before my committee, I would say that I don’t necessarily like a specific carve-out for a specific area. There are characteristics of downtown San Francisco that might deserve review of whether or not CEQA should be exempted, and I think those characteristics are what we should be focusing on from a statewide policy perspective.

Any concerns about the governor’s January budget proposal?

The absolute evisceration of housing programs that are producing housing and are trying to sustain some level of affordability for the people who are benefiting. I’m mindful that the budget situation and the revenue situation is different, but it seems that housing proportionally is taking a greater hit compared to recent investments in other funding areas. 

What’s your take on the fund to clear homeless encampments?

I was not impressed with the data that was presented so far. I’ll reserve full judgment for a report coming out from HCD that is due in April. But for what we know so far, the success of the number of individuals properly getting into housing solutions is low.

How do you feel about measures for renters, such as the one to limit corporations from buying and renting out homes?

Very strong. Half of Californians are renters and they feel like there is an imbalance of power when it comes to their ability to be here and to not get gouged.

How do you balance the interests of small-business landlords?

I get it. There’s a fairness that I’m mindful of, especially for mom-and-pop landlords that have put a lot of investment and are counting on that cash flow to pay the bills on the very unit that’s in question. 

There is a balance there — trying to make sure that if somebody is subject to an eviction that we are all doing our part to figure out what their next steps are so they don’t end up adding to our totality of homelessness that are on our streets.

Last year was a big year for pro-production housing bills. Do you see the same big push this year or is it time to step back?

No, you have to do more. I think that we have been punching a little bit higher and that’s great. We have to build on that, while at the same time evaluating what’s effective or not from past legislation. 

How do you hope to steer the committee?

I think it builds on the work that Assemblymember (Buffy) Wicks did and I’m so grateful that she’s our Appropriations chair. That means we’re going to have somebody who is symbiotic with our goals. My hope is…we’re not tripping over each other, trying to work on a particular policy idea. But two, we’re covering the gamut of what needs to be covered in housing policy. 

Meet more lawmakers: Read my interview with another committee chairperson, Assemblymember Alex Lee, a Milpitas Democrat.

In recent months, there has been headline after headline about layoffs at tech companies. But is Silicon Valley really shrinking? Read this story from CalMatters economy reporter Levi Sumagaysay for the answer.