Combating stubbornly high Black maternal mortality with ‘Justice and Joy’ in Pa. • Pennsylvania Capital-Star

In a country with one of the highest maternal mortality rates among wealthy nations, Black women are two-to-three times more likely to die in childbirth than their peers. 

Years of repeated attention have barely moved the needle, but dozens of state Capitol advocates this week were clear-eyed about how they’d change those numbers.

“This is about justice, but justice is not enough to sustain us alone. We also need joy,” said Rep. La’Tasha Mayes (D-Allegheny) on Tuesday. “Because ‘justice’ is the fight and ‘joy’ is the inspiration. Joy is what keeps us going when we’re overwhelmed by the numbers. 

“Joy is what reminds us to keep fighting for healthy families, thriving communities and lives that are not cut short,” she added. “Every single week, we find the joy and the justice.” 

Justice and joy are themes for Black Maternal Health Week events across the country, where an estimated four in five pregnancy-related deaths are preventable. In Pennsylvania, 129 women died in 2021 — the most recent year available — 98% of which were preventable, according to the state’s maternal mortality review committee. 

Black mothers shared their stories before crowds and with each other, detailing the close calls and doctor indifference that brought them into the advocacy space. Keynote speaker Mercedes Sheri Wells made national news after an Indiana hospital discharged her ten minutes before she gave birth on the side of the road in November. 

“What should have been a safe hospital birth became a frightening and dangerous situation,” Wells said before a policy committee on hospital accountability. “Our daughter survived that night, but many mothers and babies across our country do not.” 

Wells and her husband Leon, who delivered their child in his truck, are the inspiration behind legislation sponsored by Mayes and another before Congress to reform how hospitals discharge pregnant patients. 

Members of the Black Maternal Health Caucus — co-chaired by Mayes, Rep. Gina Curry (D-Delaware) and Rep. Morgan Cephas (D-Philadelphia) — have a package of bills, dubbed MOMNIBUS 2.0, seeking to reduce disparities and improve maternal well-being. 

The number of deaths has been relatively flat since the caucus launched in late 2023, but Black women are still twice as likely to die despite being a smaller portion of the population. 

“I feel like this particular caucus has brought light and attention in such a way that people can’t deny,” Curry told the Capital-Star. “We want people to know that until this statistic gets better, we’re here for the fight.” 

Spotlight on hospitals

The vast majority of Pennsylvania births take place in a hospital and most babies are delivered non-vaginally, making the health providers a key intervention point for reducing deaths. 

“Access to and improved maternal health is no longer just a goal or something that we’re all conversating about. It is a top strategic priority for HAP,” said Arielle Chortanoff, the vice president of state advocacy for the Hospital and Healthsystem Association of Pennsylvania. “Hospitals are taking steps and they’re not waiting for the crisis to solve itself.”

Chortanoff said hospitals were expanding remote blood pressure monitoring, initiating free home health visits and hiring staff to identify non-clinical barriers to care. 

But public reporting purposefully anonymizes deaths to protect the deceased, offering little information about geographical area or hospital specifics. Members of the Pennsylvania Maternal Mortality Review Committee sign non-disclosure agreements, a point of frustration for some.

Cephas pushed to increase transparency for each facility, floating the possibility of hospitals sharing their birthing history with patients. 

“How are we holding them accountable to ensure that their numbers absolutely do change?” Cephas asked. “If you don’t understand the devil in the details, if you don’t understand the bad actors in the hospital structure, we cannot hold you accountable.  

“I understand it’s not solely the hospital system that’s causing challenges, but you all represent about 30% of deaths. So if we can fully address what you all have concerns with or how they contribute to this crisis, it will inevitably bring our numbers down.” 

Chortanoff noted several challenges for hospitals, including low Medicaid reimbursement, expensive liability policies, staffing shortages and financial pressure amid ongoing federal cuts. 

“I want to be clear that hospitals are not avoiding responsibility. We take full responsibility,” said Chortanoff. “Nobody wants this outcome for their patients … but there are all sorts of variables that are difficult to identify and control as part of the patient experience.”  

Identifying solutions

Last month, the Shapiro administration released its five-year Maternal Health Strategic Action Plan, informed in part by a statewide survey and 16 roundtable discussions. The budget proposal approved by the state House earlier this week included an additional $7.5 million on top of the Department of Health’s $12.3 million dedicated to maternal and child health programs. 

Prior to the plan’s publication, so much of the discussion around maternal health felt like “just talking about the problem,” said Sara Goulet, who co-led the report with the state Department of Human Services. “It got to the point where we all knew the problem, but we have to do something about it.”

Goulet said part of the work was collaborating with community-based organizations already pushing for change, two of which recently received grants. But the state is also hoping to become a go-to site for trusted information, and is currently developing an app for new moms across the commonwealth.

“Think about when you leave the hospital and they’re handing you papers and, ‘Here you go, here’s the baby.’ And you don’t even know what you’re doing,” said Goulet about the app. “To have something that you feel comfortable to look at in the middle of the night when you’re not quite sure what’s going on?”

“That’s the kind of stuff that we really feel is going to make a big difference for people getting credible information,” she continued.

Goulet noted that women — and specifically Black women — have age-old reasons to distrust the medical system. The field of gynecology was founded by someone who experimented on enslaved Black women and drug trials didn’t include women until recently, often with deadly results.

“If you think about it, women (were used to) not really being listened to for their health care needs,” said Goulet. “These things are exacerbated for Black women, and so women will not seek care — whether it’s because they don’t trust the health system or the access to care isn’t there.”

Just 72% of mothers in the Commonwealth get “early and adequate” prenatal care. Goulet said Medicaid, which covers one-third of births, might not even realize an enrollee is pregnant until after the birth because she didn’t get any care.

“Get to care as early as you can in your pregnancy and post-pregnancy,” advised Goulet.

Finding hope and joy

Capitol attendees pointed specifically to support from midwives or doulas, two different professions that can coach women through the pregnancy and birthing process. 

Sharee Livingston, a licensed OB-GYN, noted that poor birthing outcomes don’t just impact Black mothers during another event this week, adding that “white women in America are four times more likely to die than their global counterparts.” 

“We are the wealthiest nation with access to the best health care,” said Livingston. “Let’s ask ourselves what our other country counterparts are doing.” 

In Chile, for example, there are 80 midwives and medically trained doulas for every 1,000 births, compared to eight in the United States. But adding those practitioners won’t be enough, she continued. 

“I think we have to be careful not to put too much on doulas. It’s not up to doulas to solve this Black maternal health crisis,” added Livingston. “It’s system-level change.” 

Despite the “mind-boggling numbers” Livingston emphasized that “Black people birth beautifully,” encouraging optimism.

“I want everyone to leave this room today with hope and strategy. Because hope should lead to strategy,” said Livingston. 

Diversifying providers, a long-term goal of the state plan, could also help, said Livingston, sharing that just 10% of OB-GYN providers identify as Black. 

Curry pushed for all of her legislative colleagues to take action on her caucus’ proposals, saying that systems were failing Black women. 

“We are here today because we believe in something greater. We believe in justice, where every woman is heard, protected and receives the care and services that she deserves. We believe in joy, not just survival, but the ability for mother to live whole, healthy and abundant lives after birth,” said Curry. 

“Joy should not be a privilege. It should not be optional.”