Striving for Maternal Health Equity: The Biden-Harris Blueprint
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Author(s)
McClain Sampson
Fellow in Maternal and Reproductive HealthPriscilla P. Kennedy
Postdoctoral Fellow, Graduate College of Social Work, University of HoustonShare this Publication
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McClain Sampson and Priscilla P. Kennedy, “Striving for Maternal Health Equity: The Biden-Harris Blueprint” (Houston: Rice University’s Baker Institute for Public Policy, June 3, 2024), https://doi.org/10.25613/KQ8C-RW69.
Overview
In January 2022, the White House released the Biden-Harris Blueprint for Addressing the Maternal Health Crisis (Blueprint). The Blueprint presents five priorities to be achieved through a comprehensive, “whole-of-government” strategy.[1]
The priorities as expressed in the Blueprint aim to accomplish the following:
- Goal 1: Increase Access to and Coverage of Comprehensive High-Quality Maternal Health Services, Including Behavioral Health Services
- Goal 2: Ensure Those Giving Birth are Heard and are Decisionmakers in Accountable Systems of Care
- Goal 3: Advance Data Collection, Standardization, Harmonization, Transparency, and Research
- Goal 4: Expand and Diversify the Perinatal Workforce
- Goal 5: Strengthen Economic and Social Supports for People Before, During, and After Pregnancy.[2]
Primary goals of the Blueprint include lowering the rates of maternal mortality and morbidity in the U.S., reducing racial disparities in maternal health outcomes, and improving the overall perinatal experience for individuals everywhere.[3] The timing for the rollout of this framework for change is ongoing because its approval requires buy-in from Congress and 12 federal agencies.
US Maternal Health Crisis: Unmet Needs and Systemic Barriers
Actions described in the Blueprint are underpinned by a focus on addressing non-medical drivers of health to enhance equity. These drivers include dismantling systemic barriers to maternal health and confronting the failure of medical professionals to “recognize, respect and listen to patients of color.”[4] Centering equity in the Blueprint is based on recent statistics documenting that the number of deaths in the U.S. from pregnancy-related causes has more than doubled during the past 20 years — with the most significant increases in the maternal mortality rate (MMR), meaning deaths per 100,000, among Black, American Indian, and Alaska Native individuals.[5] Maternal mortality remains significantly higher among in the U.S. compared with similar high-income countries, such as the Netherlands, Austria, and Japan, which spend far less per person on health care.[6] According to Dr. Elizabeth Cherot, chief medical and health officer at the March of Dimes, wealthy countries have lower maternal morbidity rates than the U.S. because they approach perinatal health differently: “They wrap services around new mothers. They give them [support for] everything from mental health, cardiovascular, diabetic, pelvic health. These things are just considered standard.”[7] For individuals who are pregnant or postpartum in the U.S., wraparound services are not considered standard practice. In fact, the U.S. stands alone among wealthy countries for not providing free or low-cost preventive care, comprehensive reproductive care, or coverage of midwifery and doulas as part of maternal health care benefits.[8]
A 2023 study found disparities in maternal mortality persisted in many U.S. states despite their ongoing prevention efforts.[9] Specifically, the study determined the risk of maternal mortality for Black mothers has steadily increased during the past 20 years to become two-to-four times higher than the risk for white mothers.[10] Although abundant research demonstrates an increasing trend of racial disparities, efforts to solve the crisis seem to lack focus on fixing the root causes of the problem.
According to 2017–19 data from Maternal Mortality Review Committees (MMRCs) included in a 2022 report from the Centers for Disease Control and Prevention (CDC), about 80% of maternal deaths are preventable.[11] This alarming statistic underscores the need for gaining a better understanding of the underlying factors, such as non-medical drivers of health including structural racism, that contribute to persistent and widening racial and ethnic disparities in maternal mortality and morbidity.[12] Actions proposed in the Blueprint are designed to identify and remove inequities by restructuring the processes and systems individuals access during pregnancy that currently contribute to preventable maternal deaths.
Proposed Actions for Addressing the Maternal Health Crisis
The Blueprint lays out specific actions that the federal government will take to reform maternal health, including:
- Improving access to postpartum coverage through Medicaid and Children’s Health Insurance Program (CHIP) to ensure coverage before, during, and 12 months after a pregnancy ends.
- Expanding data collection to better understand non-medical drivers of health, identify disparities in care and outcomes, and highlight best practices.
- Engaging individuals with lived experience to help states develop policies that improve the quality of care provided by Medicaid and CHIP during the perinatal period.
- Working with state agencies to improve access to diverse community-based perinatal care providers, such as midwives, doulas, and community health workers.
- Building connections between the Centers for Medicare and Medicaid Services (CMS) programs and community-based systems to provide whole-person care during the perinatal period through housing vouchers, nutrition services, and other assistance.[13]
Medicaid and the Blueprint: Implementing the Transforming Maternal Health (TMaH) Model
In alignment with the Blueprint, CMS announced its Maternity Care Action Plan in July 2023. As part of this plan, the CMS Innovation Center presented a new model in December 2023 titled the Transforming Maternal Health (TMaH) model, which is designed to help state Medicaid agencies develop novel approaches to maternal care. The primary goals of the TMaH model are to reduce disparities in accessing care and improve the quality of maternal care.[14] Specifically, the model supports state Medicaid agencies in implementing holistic approaches to perinatal care by addressing disparities in access and quality of perinatal care in three key areas as stated:
- Access to care, infrastructure, and workforce capacity.
- Quality improvement and safety.
- Whole-person care delivery.[15]
The TMaH model has a 10-year implementation plan set to begin in January 2025. This implementation plan includes three years of technical assistance during the pre-implementation period, which is designed to prepare participants for the seven-year implementation.[16]
Conclusion
The Biden-Harris Blueprint for Addressing the Maternal Health Crisis proposes several promising solutions for reducing maternal mortality and morbidity rates in the U.S. Concurrently, the execution of other structural and process-oriented changes in perinatal health systems can improve the perinatal health care services experience for individuals who have historically been denied high-quality care before, during, and after pregnancy.[17] By implementing the Blueprint and other policies that address structural barriers to care, we can reverse the upward trend in maternal morbidity, alleviate the negative consequences of disparities in perinatal care, and give all individuals the resources they need for a healthy pregnancy and postpartum.
Notes
[1] The White House, “White House Blueprint for Addressing the Maternal Health Crisis,” June 2022, 3, https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf. For a summary fact sheet of the Blueprint’s goals, see The White House, “FACT SHEET: President Biden’s and Vice President Harris’s Maternal Health Blueprint Delivers for Women, Mothers, and Families,” June 24, 2022, https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/24/fact-sheet-president-bidens-maternal-health-blueprint-delivers-for-women-mothers-and-families/.
[2] The White House, “White House Blueprint for Addressing the Maternal Health Crisis,” 17.
[3] The White House, “White House Blueprint for Addressing the Maternal Health Crisis.”
[4] The White House, “White House Blueprint for Addressing the Maternal Health Crisis,” 3.
[5] Laura G. Fleszar et al., “Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States,” JAMA 330, no. 1 (July 2023): 52–61, 58, https://doi.org/10.1001/jama.2023.9043.
[6] Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, “The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison,” To the Point (blog), Commonwealth Fund, December 1, 2022, https://doi.org/10.26099/8vem-fc65.
[7] Pien Huang and Jane Greenhalgh, “U.S. Maternal Deaths Keep Rising. Here’s Who Is Most at Risk,” National Public Radio (NPR), July 4, 2023, https://www.npr.org/sections/health-shots/2023/07/04/1185904749/u-s-maternal-deaths-keep-rising-heres-who-is-most-at-risk.
[8] Gunja, Gumas, and Williams.
[9] Fleszar et al., “Trends in State-Level Maternal Mortality.”
[10] Fleszar et al., “Trends in State-Level Maternal Mortality,” 53.
[11] Susanna Trost et al., “Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–19,” Centers for Disease Control and Prevention of Reproductive Health, 2022, https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html; Centers for Disease Control and Prevention (CDC) Newsroom, “Four in 5 Pregnancy-Related Deaths in the U.S. Are Preventable,” news release, September 19, 2022, https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html.
[12] Elleni M. Hailu et al., “Structural Racism and Adverse Maternal Health Outcomes: A Systematic Review,” Health & Place, 78 (November 2022): 1–12, https://doi.org/10.1016/j.healthplace.2022.102923.
[13] The White House, “White House Blueprint for Addressing the Maternal Health Crisis.”
[14] Centers for Medicare and Medicaid Services (CMS) Innovation Center, “Transforming Maternal Health (TMaH) Model,” December 15, 2023, https://www.cms.gov/priorities/innovation/innovation-models/transforming-maternal-health-tmah-model. For a summary fact sheet of the TMaH model, see CMS Innovation Center, “Transforming Maternal Health (TMaH) Model Overview Factsheet,” https://www.cms.gov/files/document/tmah-fact-sheet.pdf.
[15] CMS Innovation Center, “Transforming Maternal Health (TMaH) Model.” For a visual representation of and more information on the TMaH model’s structure, see CMS, “Transforming Maternal Health (TMaH) Model: Overview Webinar,” February 28, 2024, slides 11 and 20, https://www.cms.gov/files/document/tmah-overview-slides.pdf.
[16] CMS Innovation Center, “Transforming Maternal Health (TMaH) Model.”
[17] See Vu-An Foster et al., “Reimagining Perinatal Mental Health: An Expansive Vision for Structural Change,” in “Perinatal Mental Health & More,” special issue, Health Affairs 40, no. 10 (October 2021): 1592–6, , https://doi.org/10.1377/hlthaff.2021.00805.
This issue brief is the first of a six-part series that will provide details about the Biden-Harris Blueprint for Addressing the Maternal Health Crisis (Blueprint). The next five issue briefs in the series will describe each priority of the Blueprint to be undertaken through a comprehensive, “whole-of-government” strategy.
This material may be quoted or reproduced without prior permission, provided appropriate credit is given to the author and Rice University’s Baker Institute for Public Policy. The views expressed herein are those of the individual author(s), and do not necessarily represent the views of Rice University’s Baker Institute for Public Policy.