On Our Minds

Welcome to On Our Minds, the latest feature from the Farley Health Policy Center, where we will share commentary on policies affecting health, trends from findings in data and research, and the issues that matter most in our communities. We invite you to share your perspectives and input. Drawing on expertise from our evolving network, we’re eager to work with you, learn from you, build and share policy commentary that brings us together and continues to move us forward.

Maternal Health is a Policy and Research Priority

Liza M Creel, PhD, MPH and Conoshia Odum, BA

On November 13, 2023, President Biden issued a presidential memorandum outlining a new initiative on women’s health research. The administration’s goal in directing the new initiative is to identify recommendations for advancing women’s health and to encourage and support research to address health disparities and inequities. The initiative, led by Jill Biden, encompasses women’s health across the lifespan, including pregnancy, childbirth, and postpartum health. Maternal health is very important for families, communities, and policymakers, especially given the well-documented inequities in maternal morbidity and mortality.

Nationally, Black birthing people are three times more likely to die from pregnancy-related complications than those who are White. In Colorado, both the pregnancy-associated and pregnancy-related mortality ratios for Black birthing people are more than twice those of the overall population. The pregnancy-associated mortality ratio for Native American mothers in Colorado is three times that of the overall population. In addition, Black, Native American, Native Hawaiian, and Other Pacific Islander people with Colorado Medicaid coverage have lower rates of prenatal care and higher rates of preterm births compared to White birthing people. These disparities are present regardless of education and income, suggesting they are consequences of structural racism, gender oppression, and other social inequities that drive these disproportionately high rates of maternal mortality and morbidity.

Further exacerbating these disparities are economic, geographic, and health systems factors that impact access to needed care during pregnancy and the postpartum period. Many states, including Colorado, are expanding Medicaid eligibility to guarantee birthing people coverage for a full 12 months after delivery. This policy change seeks to minimize postpartum coverage disruptions, facilitate access to needed care during the postpartum period when most pregnancy-related deaths occur, and reduce financial barriers to needed postpartum care. This is an area of considerable research nationally.

Addressing these barriers for Medicaid beneficiaries is not the whole story. For example, in rural communities, being able to pay for care does little when there are no services to access. Rural communities across the United States have faced a crisis of hospital closures, including labor and delivery service line closures, that may impact both maternal and infant health. These closures are associated with some adverse outcomes, including higher rates of preterm births.

Often an individual’s needs extend beyond what many may think of as the usual medical care for pregnant and postpartum people. Substance use and behavioral health needs can be persistent during and after pregnancy. Overdose and suicide are a leading cause of maternal mortality in Colorado and nationally. Despite this, in 2020 fewer than half of birthing parents in Colorado received postpartum depression screening. Further, social services like transportation, financial assistance, and legal services, are critically important for supporting people with complex needs that span physical and behavioral health.

Black Maternal Health Week, an event first announced by President Biden in 2021 and founded and organized by the Black Mamas Matter Alliance (BMMA), is held annually in April to “build awareness, activism, and community-building​ to amplify ​the voices, perspectives and lived experiences of Black Mamas and birthing people.” Last April, former Farley Health Policy Center Coordinator Conoshia Odum attended the rally. Conoshia shared her experience during one of our team meetings and this On Our Minds piece was conceptualized.

In her words, “Being that I am well-informed of the current Black maternal health crisis here in the U.S., I logged into the BMMA virtual rally feeling helpless and angry. However, I left the rally feeling hopeful and proud. To see so many different organizations from across the country come together to do this incredible work-- advocating for the lives of Black mamas and birthing people-- gave me hope that they can have healthy pregnancies, deliver healthy babies, and live to tell the story.”

We applaud the national focus, prioritization, and investment in women’s health and the efforts underway in Colorado to support pregnant and parenting people and address disparities in their care and outcomes.

Colorado resources:

• Peer Support Specialists: A critical factor in integrating medical, behavioral, and substance use care for pregnant people
• Colorado Perinatal Care Quality Collaborative (CPCQC)
• Maternal Health Equity Report from the Department of Health Care Policy and Financing (HCPF)
• Maternal Mortality in Colorado Report