In ‘Essence’ op-ed, Elizabeth Warren addresses black women maternal mortality

U.S. Sen. Elizabeth Warren says racism is to blame for why black women are more likely to die in childbirth, but she has also offered a possible solution.In an op-ed for Essence, a magazine geared toward black women, the 2020 presidential candidate noted that work is already being done to increase survival rates, but that she also wants to “hold health systems accountable for protecting black moms.”Roughly 700 women die during pregnancy or from complications of giving birth each year, Warren wrote. Deaths of pregnant women or women giving birth have increased over the last 25 years.“And for Black moms, particularly those living in rural areas, it’s an epidemic,” she said, noting that mortality is three to four times higher for black women over white women. “In a detailed report, ProPublica found that the vast majority of maternal deaths are preventable, but decades of racism and discrimination mean that, too often, doctors and nurses don’t hear Black women’s health issues the same way they hear them from other women.”Some groups, like Black Mamas Matter Alliance, MomsRising, and the March of Dimes, have been working for change, Warren said. She noted that U.S. Sen. Kamala Harris, a fellow 2020 candidate, has a “smart proposal to address the structural racism that puts Black women and their babies at risk and improve care coordination.”Warren said her own proposal would build on the successes in health care reform made elsewhere.“Rather than paying separately for each visit or each procedure, these new models set one price for an entire ‘episode’ of care – and then hold health systems accountable for the outcome,” she wrote. “The data show that these so-called ‘bundled payments’ give health systems both greater incentives and greater control to improve results.”Outcomes would be monitored, according to Warren, and types of care would be covered based on if they work, “not on their reimbursement rate.”“If health systems are able to coordinate their care and improve overall outcomes – like raising survival rates, reducing complications, and narrowing the mortality and morbidity gap between white women and women of color – they can earn a bonus,” she wrote. “If care doesn’t improve, they’ll be on the hook. But they won’t be abandoned. Paying for better care means both rewarding excellent health systems and identifying, investing in, and demanding more from struggling ones.”Warren noted that the proposed changes “have limits,” and that “rigorously” testing them is key.“Health systems will need the resources to implement evidence-based best practices,” she said. “Determining what outcomes should be measured and how exactly an ‘episode’ of childbirth should be defined will require extensive input. Reforms must, for example, account for the profile and volume of a hospital’s patient population, recognize that different hospitals are set up to provide different levels of maternity care, reward providers that take care of the most challenging patients, and make room for non-hospital settings where many mothers receive their care.”Accountability could save lives, according to Warren. She said women of color shouldn’t have to “develop elaborate birth plans or personally shell out thousands of dollars for extra eyes and ears at the hospital to ensure they survive the experience of childbirth.”“We’ve done enough observing and debating the effects of bias and racism in our health care system,” she said. “It’s time to demand better outcomes.”Read Warren’s full op-ed at Essence

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