Dozens of maternal health organizations and advocates have called on the California surgeon general to suspend plans aimed at reducing maternal deaths, saying the announced initiatives will not effectively address the crisis and “risk increasing existing inequalities.”
In a letter shared with The Times, representatives of organizations including the California Black Women’s Health Project, Black Women for Welfare and the California Nurse-Midwives Assn. faulted the plan for “placing disproportionate burdens on individuals” and failing to “clearly name and address racism as a root cause of maternal health disparities.”
The California Maternal Health Blueprint unveiled in September outlines strategies to try to reduce maternal deaths. Among them: Ask Californians of child-bearing age to fill out a new questionnaire to assess the risk of pregnancy complications, even before they get pregnant.
In a letter dated October 21 to the state surgeon general Dr. The advocacy group’s Diana Ramos said the maternal health blueprint acknowledges racial disparities in maternal mortality rates, but does not “underline the disparity in evidence that points to systemic racism as a driving factor.”
Asked for comment on the letter, the state surgeon general’s office released a statement saying it is “committed to working with partners across the state … people.”
Black women have suffered a maternal mortality rate more than three times that of white women in California, state data show. The Centers for Disease Control and Prevention has blamed many factors, including disparities in health care and underlying chronic conditions as well as structural racism and implicit bias.
Studies have shown disparities exist even for Black women who are prosperous, spurring maternal health researchers to increasingly focus on racial inequities in health, bias and discrimination experienced by patients, and the physical effects of the extreme stress of racism lasting over time.
In an interview in September, Ramos said that California focused primarily on “health care settings” in previous efforts to prevent maternal deaths, helping to achieve “the lowest maternal mortality rate in the country.”
As of now, California has a lower rate of deaths related to pregnancy, birth and its consequences than other parts of the US, although maternal deaths have increased in recent years amid the COVID-19 pandemic. The country has become a model for maternal mortality review systems.
“If we continue to do the same thing – just focus on the health team – we will get the same result,” Ramos said in September, explaining why the newly announced plan emphasizes patients knowing their level of risk. “That’s why we bring patients.”
The Maternal Health Blueprint sets a goal to have at least 50% of “individuals of reproductive age” across the country complete a questionnaire about the risk of pregnancy complications by December 2026.
In a letter opposing the plan, a coalition of groups said asking people to fill out the questionnaire “gives the impression of personal fault and/or individual behavior to blame, burdens users and undermines the system’s role in creating. this crisis.”
The group said there was no research to establish a “personalized risk assessment” as a way to improve outcomes for those giving birth. Nor does the blueprint clearly state the next steps or what will happen to the data, the letter said.
Dana Sherrod, founder and executive director of the California Coalition for Black Birth Justice, said that “by not addressing systemic racism, we’re blaming the patient again.” The only time the words “systemic racism” appear in the blueprint is a reference to the findings of another country’s report.
Sherrod said that even accounting for other factors, “Black women still have worse outcomes.” For example, one analysis of maternal mortality in California found that black mothers with the highest incomes had higher rates of pregnancy-related deaths than white mothers with the lowest incomes.
An earlier study found that black women did not have higher rates of preeclampsia, postpartum hemorrhage and other major complications than white women, but black women who developed these complications were two to three times more likely to die than white women. that situation.
Even though “they’re a healthy weight, they’re educated, they’re married — things that should be protective — even if they do all these things, we’re still seeing bad results,” Sherrod said.
The California plan also calls for medical facilities to use existing screening tools to gauge the risk level of pregnant patients. Ramos told The Times that the screening could help guide patients to childbirth, ensuring that those at higher risk go to the facilities best equipped to support them.
The coalition warned that doing so could “further marginalize high-risk populations and divert resources from struggling facilities while simultaneously overburdening higher-level facilities.” California already faces a “critical shortage in maternal care” as labor and delivery wards have closed, he said.
“It’s already very difficult for many people to navigate the health care system and know where to go to get the best care,” Sherrod said, “and this can be even more complicated.”
Coalition leaders sought a meeting with Ramos and First Lady Jennifer Siebel Newsom, the wife of Gov. Gavin Newsom, who joined Ramos in announcing the plan in September.
Ramos’ office said in a statement Monday that since the initiative was launched, “Dr. Diana Ramos has met with several partners in the maternal health space and will continue to meet with others, including members of the coalition, to find opportunities to work together.
