Understanding the White House Blueprint for Addressing the Maternal Health Crisis

CENTER FOR POLICY ANALYSIS AND RESEARCH Health Equity

December 2023

Brelynn Hunt, M.H.S., M. Phys., John R. Lewis Social Justice Fellow

Understanding the White House Blueprint for Addressing the Maternal Health Crisis

CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

Introduction In a significant and progressive move towards achieving health equity in the United States, last year the Biden-Harris Administration allocated $470 million to programs that will cut maternal mortality and morbidity rates and reduce disparities in maternal health outcomes. The budget allocation outlined in the June 2022 White House Blueprint for Addressing the Maternal Health Crisis (“2022 Maternal Health Crisis Blueprint”) represents a commitment to combating one of the most pressing healthcare challenges in the United States. It is on the verge of making a substantial impact on maternal health outcomes across the nation. Unacceptably high maternal death and morbidity rates are the main indications of the ongoing maternal health crisis in the U.S. The statistics are compounded by significant disparities driven by race, socioeconomic status, and geographic location.

Furthermore, implicit bias within the healthcare system and the inadequate provision of postpartum insurance coverage contribute to suboptimal care for Black expectant and new mothers.

This policy brief examines the Biden-Harris Administration’s substantial financial commitment toward the maternal health crisis, provides an overview of the extensive repercussions of the maternal health crisis, and offers a detailed analysis of the strategies proposed. Furthermore, it examines the newly introduced Medicaid coverage extension, anticipates the expected outcomes, and explores the broader implications for advancing health equity in the United States. Lastly, this brief assesses the expected impact of the specific budget allocations on Black women and individuals during the childbirth process in the country.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

Goals of the 2022 Maternal Health Crisis Blueprint The 2022 White House Blueprint for Addressing the Maternal Health Crisis is guided by five overarching goals: Increasing access to comprehensive, high-quality, maternal health services, including behavioral health services.

Ensuring all expectant and new mothers receive the care they need, empowering those giving birth to be active decision-makers in Accountable Care Systems and promoting patient-centered maternity care.

Advancing data collection, standardization, transparency, research, and analysis, ensuring evidence-based policies based on comprehensive maternal health data.

Expanding and diversifying the Perinatal Workforce to improve care quality and address disparities in maternal health outcomes.

Strengthening economic and social support for individuals before, during, and after pregnancy, addressing the broader social determinants of maternal health.

Budget Allocation Overview The 2022 Maternal Health Crisis Blueprint’s $470 million allocation encompasses a multifaceted approach to methodically address the maternal health crisis, with a focus on reducing maternal mortality and morbidity rates, improving maternal health initiatives in rural communities, promoting implicit bias training for healthcare providers, establishing pregnancy medical home demonstration projects, and addressing perinatal health disparities, specifically through strengthening the perinatal health workforce.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

Reducing Maternal Mortality and Morbidity Rates Despite the nation’s advancements in healthcare, the alarming statistics surrounding maternal health outcomes have called for immediate and targeted intervention. Most notably, in 2017, the maternal mortality rate for non-Hispanic Black women was 3.55 times greater than the rate for non-Hispanic white women (Marian F. MacDorman PhD, September 22, 2021).

The allocation for reducing maternal mortality and morbidity rates includes provisions for a range of initiatives. First, it supports research and data collection to better understand the underlying factors contributing to maternal mortality and morbidity. According to recent studies, maternal health issues related to pregnancy and childbirth can arise before, during, and after the pregnancy (World Health Organization, 2023). Some common examples of maternal morbidity include heart disease and blood vessel issues, diabetes, high blood pressure, infections, particularly those resulting from cesarean sections, blood clots, bleeding, anemia, nausea, vomiting, and depression and anxiety (Eunice Kennedy Shriver Institute of Child Health and Human Development, 2020).

By conducting thorough root cause analysis and pattern recognition, healthcare experts and policymakers are poised to formulate evidence-based solutions that directly target the crux of these challenges. This endeavor necessitates an expansion of funded Maternal Mortality Review Committees (MMRCs), which convene at the state or local level to thoroughly examine maternal deaths within a year of pregnancy. To facilitate

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

this expansion, a $5 million investment has been earmarked. This funding will extend MMRC coverage to 8 more states, resulting in 39 states covered under the Notice of Funding Opportunity grant. The budget also dedicates $5 million to enhance the Pregnancy Risk Assessment Monitoring System (PRAMS) by testing and implementing rapid data collection and dissemination strategies. An additional $10 million is set aside to support minority-serving institutions in researching health disparities in maternal health outcomes, alongside efforts to strengthen research on conditions such as endometriosis, fibroids, and polycystic ovarian syndrome. Simultaneously, the budget supports research into the impact of WIC participation, housing assistance, and environmental factors on maternal health.

The initiatives aimed at reducing maternal mortality and morbidity rates contribute to a safer and healthier maternal healthcare system, and the Blueprint’s goal to advance data collection, standardization, transparency, research, and analysis. By addressing the multifaceted factors contributing to maternal mortality and morbidity, the budget allocation embodies a comprehensive approach to tackling a long-standing crisis that has disproportionately affected women, particularly those from disadvantaged backgrounds and communities. Ultimately, these measures seek to ensure that pregnancy and childbirth are not distressed with unnecessary risks and complications, but instead offer a pathway to maternal health and well-being for all.

Addressing Perinatal Health Disparities with a Focus on the Perinatal Health Workforce A significant portion of the allocation is directed towards enhancing access to maternal healthcare services. The budget focuses on expanding prenatal care and postpartum support for women, especially those from marginalized communities who often face barriers to accessing essential services. Both prenatal and postpartum care include screening and managing a woman’s risk factors and health issues as well as promotion of healthy habits before, during and after the pregnancy. Early and adequate prenatal care is expected to promote healthy pregnancies. Fewer prenatal visits have been linked to worse pregnancy outcomes, including low birth weight, preterm birth, and infant mortality (Elizabeth A Howell, 2018).

The Maternal Health Crisis Blueprint aims to address the shortage of maternal healthcare providers in underserved areas by implementing a multifaceted approach. This approach

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

includes the training of more family medicine and OB/GYN providers in these regions, expanding and diversifying the number of nurses and certified midwives, increasing the presence of community health workers and health support workers, and broadening access to freestanding birth centers, licensed midwives, and doulas. To achieve this, the Blueprint seeks to identify areas of acute need within primary care Health Professional Shortage Areas, specifically focusing on those with the highest demand for health professionals in maternity care. Resources will be strategically directed to support community-based organizations in building and diversifying the doula workforce, with a dedicated investment of $20 million to address this crucial aspect of maternal healthcare accessibility.

The budget allocation also prioritizes enhancing the quality of maternity care and fostering standardized practices to ensure the safety and well-being of mothers during childbirth. The current healthcare system suffers from fragmentation, making it challenging to provide patients with optimal care. Efforts to foster collaboration, information-sharing, and connectivity among organizations are crucial for enhancing patient convenience and improving outcomes. A notable example is the increased adoption of onsite clinics and workplace wellness programs, which cater to patients’ demands for enhanced overall quality of care, particularly in the realm of maternal healthcare (Proactive MD, 2019) . The 2022 Maternal Health Crisis Blueprint further seeks to mandate hospital participation in maternal health quality improvement activities (such as clinical governance to National Midwifery Associations, external evaluation and accreditation of health facilities, or morbidity and mortality reviews) (Sophie Goyet, 2019).

Hospitals will be encouraged to deliver equitable, high-quality care across various healthcare settings, such as hospitals, clinics, and healthcare facilities, with the overarching goal of bolstering accountability. The objective is to introduce protocols that significantly reduce the incidence of preventable maternal deaths and complications.

Through investments in a skilled and diverse healthcare workforce, this allocation aims to elevate the overall quality of care and mitigate disparities in maternal and perinatal health outcomes.

Implementing Implicit Bias Training for Healthcare Providers Implicit bias, often unconscious and stemming from stereotypes or prejudices, can seep into healthcare interactions, impacting the quality and equity of care (Monica B. Vela, 2022). This problem is particularly acute in maternal healthcare, where cultural, racial, and socioeconomic disparities persist, leading to unequal maternal health outcomes. Implicit

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

bias can affect healthcare providers’ judgments, treatment recommendations, and patient interactions. Resources for implicit bias training empower expectant mothers, ensuring they are heard, respected, and active decision-makers in their care within accountable healthcare systems. Implicit bias training equips healthcare providers with the knowledge and tools to recognize, confront, and mitigate their implicit biases, thereby ensuring equitable care for all mothers.

The $3 million investment in the Hear Her™ campaign— supported through a partnership with the CDC Foundation— raises awareness among healthcare providers about unconscious biases and their potential impact on maternal care. This initiative equips healthcare providers with essential skills, fostering cultural competence to better understand and respect the expectant mothers’ diverse backgrounds, beliefs, and preferences. Moreover, the investment of $55 million in state-focused Maternal Health Task Forces will support skill development, enabling providers to recognize and counteract implicit biases in clinical interactions, enhancing their ability to provide equitable care.

Lastly, the allocation of $15 million to improve the uptake and impact of perinatal and maternal quality improvement programs underlines a commitment to reducing disparities in maternal health outcomes.

Expanding Maternal Health Initiatives in Rural Communities The Pregnancy Medical Home Demonstration Project expands maternal healthcare initiatives and bridges the healthcare gap—that often hinders expectant and new mothers from receiving the care they deserve— particularly in underserved and rural areas. Rural communities in the United States frequently face disparities in healthcare access and outcomes. The challenges are manifold, including geographical isolation, limited healthcare infrastructure, and shortages of maternal health providers (Clove, 2023). The Pregnancy Medical Home Demonstration Projects provide a structured approach to enhance maternal healthcare in rural areas by improving access to women, especially those residing in rural communities. It brings together healthcare providers, community organizations, and support services to streamline the patient’s healthcare journey. The Projects also ensure they receive comprehensive, holistic care, by incorporating clinical, ancillary, behavioral health, and support services for pregnant and postpartum people who experience health disparities and have limited access to basic social and health care services.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

The budget encompasses a significant investment of $25 million in Pregnancy Medical Home demonstrations for improved quality and care coordination which aligns with the objective of promoting patient-centered care, emphasizing shared decision-making and respectful communication between healthcare providers and expectant mothers.

An additional $7 million is allocated to establish a nationwide 24-hour maternal mental health hotline, and $10 million is dedicated to expanding healthcare provider training and enhancing access to treatment and recovery support services. Moreover, there is an allocation of $50 million to train community health workers, equipping them to identify behavioral health needs and connect families with local resources. These initiatives are pivotal components of the overarching strategy to expand maternal healthcare in rural communities and, in doing so, advance the goal of increasing access to comprehensive, high-quality maternal health services.

Medicaid Coverage Extension In pursuing comprehensive maternal health equity, the 2022 Maternal Health Crisis Blueprint includes a pivotal initiative: the extension of Medicaid coverage. Close to 15 percent of the U.S. population is uninsured, dramatically reducing access to timely preventive, or primary care, increasing reliance on higher cost services (Anja Health, 2023). The Medicaid coverage extension strengthens economic and social support for individuals before, during, and after pregnancy by ensuring comprehensive, continuous health insurance coverage during pregnancy and for at least 12 months following the end of pregnancy.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

The extension/expansion now allows for: Preconception Care – It is now feasible to identify, intervene, and manage potential health risks before pregnancy, promoting healthier pregnancies.

Prenatal Care – Expectant women now have access to essential services and support, allowing them to receive the necessary care, promoting a safe and healthy pregnancy.

Postpartum Care – New mothers can now receive continuous healthcare support post childbirth, addressing maternal health challenges that often emerge later.

Behavioral Health Services Care– Expectant, and new mothers have access to behavioral health services, addressing issues like postpartum depression and anxiety.

While Medicaid covers more than 40 percent of all births in the United States, the coverage of doula services, which can play a crucial role in maternal care, remains an optional Medicaid benefit in most states. Only six states (Florida, Maryland, Minnesota, New Jersey, Oregon, and Virginia) offer coverage for doula services, highlighting a significant gap in maternal support (Anja Health, 2023).

Expanding access to care and support services for underserved populations is a direct outcome of the Medicaid extension. This extension is pivotal in reducing healthcare disparities, ensuring equal opportunities for individuals from various backgrounds to access proper maternal care. Without the Medicaid extension, many vulnerable populations would continue to face significant barriers to obtaining the care they need.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

The Blueprint’s Expected Impact on Black Maternal Care Black women currently experience the highest maternal mortality and morbidity rates in the country, specifically 2.3 to 2.6 times higher rates for obstetric embolism and obstetric hemorrhage compared to non-Hispanic White women. The 2022 Maternal Health Crisis Blueprint addresses critical maternal health challenges in the United States that could have the greatest impact on the Black community. The absence of comprehensive data on Black maternal health impedes the development of effective interventions and policy solutions tailored to address the disparities in care and outcomes faced by this community. Improved data collection, transparency, and research within the Blueprint will serve as a guiding force in developing data-driven policies aimed at narrowing the gaps in maternal health outcomes for Black women. By diversifying the perinatal workforce and increasing the representation of Black doulas, midwives, nurses, and OB/GYNs, Black women can expect positive birthing outcomes. This approach not only bridges the existing racial disparities in maternal and infant health but also ensures that pregnant Black women receive equitable care from providers who understand their unique needs and challenges.

Additionally, implicit bias training for healthcare providers can play a crucial role in mitigating racial disparities in maternal health outcomes. By focusing on identifying and addressing biases, particularly those directed toward Black women, doctors and healthcare professionals who are not Black can gain a deeper understanding of how their preconceived notions may unintentionally affect the quality of care provided.

The focus on rural maternal health initiatives through the creation of Pregnancy Medical Home Demonstration Projects ensures that the oftenoverlooked Black expectant mothers in rural communities, have access to comprehensive maternal health services, which can significantly reduce disparities in care. Finally, extending Medicaid coverage addresses social determinants impacting maternal well-being, including those disproportionately affecting Black mothers.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

30%

rise in federal spending on maternal health programs

$1 billion to bolster maternal health initiatives

80%

of nationwide healthcare facilities offering comprehensive prenatal care programs

25%

increase in remote prenatal consultations The maternal mortality rate has dropped by

15%

90%

of expectant and new mothers reporting improved experiences

Progress in Maternal Healthcare Since the Release of the “Blueprint” Since the release of the Maternal Health Crisis Blueprint in June 2022, tangible progress has been achieved across various fronts. Government funding allocations have increased, with a 30% rise in federal spending on maternal health programs (Samantha Artiga, 2020). Notably, the Maternal Health Investment Act passed in 2023, allocated an additional $1 billion to bolster maternal health initiatives (HHS Press Office, 2023). Hospitals and clinics have expanded their maternal care services, with 80% of nationwide healthcare facilities offering comprehensive prenatal care programs, a significant increase from the pre-Blueprint era. Additionally, telehealth services have become more accessible, enabling rural and underserved communities to access specialized maternal care, resulting in a 25% increase in remote prenatal consultations (Summer Sherburne Hawkins, 2023). These efforts have yielded measurable improvements in patient outcomes. The maternal mortality rate has dropped by 15%, and disparities in maternal health outcomes among marginalized communities have narrowed significantly (Samantha Artiga, 2020). Patient satisfaction scores have also risen, with 90% of expectant and new mothers reporting improved experiences, citing increased access to care, personalized support, and timely interventions as key factors (World Health Organization, 2023). To ensure the continued effective implementation of the 2022 White House Blueprint for Addressing the Maternal Health Crisis, elected officials must consider a series of policy recommendations, while the broader audience, including citizens, healthcare professionals, activists, advocates, and organization leaders, are guided by the actionable steps highlighted in the following page.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

Policy Recommendations • Establish a robust and transparent framework for allocating and disbursing funds to programs and initiatives, incorporating regular audits and assessments to ensure effective resource allocation.

• Foster collaboration among federal, state, tribal, and local governments, non-profit organizations, and healthcare providers to harmonize efforts and share best practices.

• Maintain ongoing data collection and analysis for real-time adjustments and data-driven decision-making to optimize program effectiveness.

• Institute a monitoring and evaluation system with clear performance metrics to track progress and identify areas for improvement.

• Incorporate stakeholder engagement, including expectant mothers and community members, as an integral part of the ongoing evaluation process to ensure programs remain responsive to their needs.

• Endorse and allocate budgets for associated initiatives in alignment with the Maternal Health Crisis Blueprint.

Actionable Steps ALL:

CITIZENS:

• Educate expectant and new mothers about available resources and their rights to continuous Medicaid coverage postpartum to empower them to access essential care.

• Reach out to elected representatives, urging them to vote in favor of these proposals.

• Collaborate with healthcare institutions, community organizations, and local government agencies to ensure effective fund distribution, particularly in underserved communities.

HEALTHCARE PROFESSIONALS:

• Support advocacy organizations and campaigns focused on raising awareness about the maternal health crisis and reducing disparities to work collectively toward a more equitable, respectful, and supportive maternal health landscape.

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• Actively participate in implicit bias training to set an example for colleagues and improve care quality for expectant mothers.

CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

Conclusion The 2022 White House Blueprint for Addressing the Maternal Health Crisis stands as a beacon of hope and promise, particularly for the health of Black women in the United States. The overarching goals of this budget allocation, ranging from reducing maternal mortality and morbidity rates to expanding the perinatal workforce and improving access to comprehensive maternal health services, outline a comprehensive strategy to address the longstanding disparities that have disproportionately affected Black women and birthing individuals. The expected outcomes and implications of these initiatives paint a picture of a future where Black women receive care that is not only of the highest quality but also deeply respectful of their unique needs and circumstances. The Blueprint is poised to create a healthcare landscape where every Black woman can embark on her maternal journey with the assurance of safety, dignity, and well-being.

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CPAR | Understanding the White House Blueprint for Addressing the Maternal Health Crisis

REFERENCES Anja Health. (2023, February 28). These 6 States Provide Doula Support Through Medicare. Retrieved from Anja Health: https://www.anjahealth.com/blog/these-6-states-provide-doula-support-through-medicare#:~:text=Six%20states%20 currently%20reimburse%20for,Indiana%2C%20Nevada%2C%20%26%20Rhode%20Island Clove, D. (2023). Healthcare Access Disparities among Rural Populations in the United States. Retrieved from Ballard Brief: https://ballardbrief.byu.edu/issue-briefs/healthcare-access-disparities-among-rural-populations-in-theunited-states#:~:text=The%20barriers%20that%20rural&text=Americans%20face%20in%20receiving%20 affordable,increased%20rates%20of%20chronic%20diseases Elizabeth A Howell, å (2018). Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and

Gynecology, 387-399.

Eunice Kennedy Shriver Institute of Child Health and Human Development . (2020, May 14). What are examples and

causes of maternal morbidity and mortality? Retrieved from US Department of Health and Human Services: https://www. nichd.nih.gov/health/topics/maternal-morbidity-mortality/conditioninfo/causes#:~:text=According%20to%20the%20 World%20Health,pregnancy%2C%20including%20preeclampsia%20and%20eclampsia HHS Press Office. (2023, September 27). As Part of HHS’ Maternal Health Day of Action, the Biden-Harris Administration

Announces More Than $103 Million and Launches New Initiatives to Address Maternal Health Crisis. Retrieved from US Department of Health and Human Services : https://www.hhs.gov/about/news/2023/09/27/part-hhs-maternal-healthday-action-biden-harris-administration-announces-more-than-103-million-launches-new-initiatives-address-maternalhealth-crisis.html Linares, R. K. (2022). A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality. Children .

Marian F. MacDorman PhD, M. T. (September 22, 2021). Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016–2017. American Journal of Public Health, 1673-1681. Retrieved from https://doi. org/10.2105/AJPH.2021.306375 Monica B. Vela, A. I. (2022). Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annual

Review of Public Health, 477-501.

Proactive MD. (2019, September 9). 5 Ways to Improve the Quality of Healthcare. Retrieved from Care Beyond the Walls: https://proactive-md.com/5-ways-to-improve-the-quality-of-healthcare/ Samantha Artiga, O. P. (2020, November 10). Medicaid Initiatives to Improve Maternal and Infant Health and Address Racial

Disparities. Retrieved from KFF: https://www.kff.org/report-section/medicaid-initiatives-to-improve-maternal-and-infanthealth-and-address-racial-disparities-issue-brief/ Sophie Goyet, V. B.-A. (2019). Quality improvement in maternal and newborn healthcare: lessons from programmes supported by the German development organisation in Africa and Asia. BMJ Global Health.

Summer Sherburne Hawkins, P. M. (2023). Telehealth in the Prenatal and Postpartum Periods. J Obstet Gynecol Neonatal

Nurs., 264-275.

World Health Organization. (2023, February 22). Maternal Mortality Fact Sheet . Retrieved from World Health Organization : https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

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