Reproductive health advocates are seizing the presidential transition as an opportunity to tackle the nation’s stark pregnancy-related death crisis. And they think they’ll have an ally in a senior member of the incoming administration: Vice President-elect Kamala Harris.
As a California Senator, Harris was known as one of Washington’s most prominent advocates for addressing the nation’s epidemic of pregnancy-related deaths, spearheading legislation on the issue in 2018 and this year, and highlighting the issue on the campaign trail. Her 2020 “Momnibus” is, advocates say, a framework for how the new administration could tackle the crisis.
Per government data, Black and Native women are two to three times more likely than White, Latina and Asian-American women to die within a year of childbirth. Most of those deaths are preventable, according to the federal Centers for Disease Control and Prevention. The United States’ rate of pregnancy-related death is more than double that of many other wealthy nations, per research compiled by the nonprofit Commonwealth Fund.
It’s a crisis that has only recently begun to receive attention from the Trump administration, but one that Harris emphasized on the campaign trail. And advocates and experts think they’re facing a historic opportunity, especially as the Biden-Harris administration builds out its new health team.
“It is a really powerful moment, and a powerful opportunity,” said Alexis McGill Johnson, the president and CEO of Planned Parenthood.
“We are so excited,” said Joia Crear-Perry, an OB/GYN and the president of the National Birth Equity Collaborative, an advocacy group. “We can look forward to really transformational change.”
Crear-Perry’s organization has put out a list of demands for the Biden-Harris administration, including establishing a White House “Office of Reproductive Wellbeing” to coordinate national efforts across various government agencies that would address numerous issues, including pregnancy-related health.
The incoming administration has been receptive to that proposal, she said, though a Harris spokesperson said it’s too early to know how the new White House will address pregnancy-related deaths. It’s also difficult to know whether or how the need to address the coronavirus pandemic — which is expected to be at disastrous highs by January — might affect other health care priorities.
Additionally, it’s unclear who will steer the new health care agenda, since President-elect Joe Biden hasn’t announced his picks to head the Department of Health and Human Services, or other key leadership roles.
“It’s difficult not knowing who the folks are going to be at HHS,” said Katy Kozhimannil, an associate professor at the University of Minnesota and director of its rural health research program. “Those will have a huge impact on what direction [they take], and also whether there is a specific focus on mothers and infants.”
Planned Parenthood has spoken with the incoming administration about “their desire to have sexual and reproductive health champions throughout the board,” McGill Johnson said.
Meanwhile, advocates and pregnancy-health researchers are pushing for changes that could dramatically undercut the national mortality crisis. They are calling on lawmakers to close insurance gaps affecting people who have recently given birth, and to invest more in prevention and implicit bias training for health care professionals. They also point to the “Momnibus,” which Harris sponsored in the Senate, as a blueprint for systemic change under the next administration, though it hasn’t advanced in either chamber of Congress.
Among other changes, that bill would put money into addressing issues like housing, transportation and nutrition — all of which influence birth outcomes — fund community-based organizations that work with Black pregnant people, incorporate implicit bias training for health care professionals who treat pregnancy and advance mental health and substance use disorder treatment for people who are pregnant or postpartum.
Some changes, advocates argue, are ripe for bipartisan support, and could cross the finish line if made a priority by the new administration. One: leaning more on Medicaid, the public health insurance plan for people with lower incomes, which covers about half of the nation’s pregnancies.
Currently, people who are pregnant can more easily qualify for Medicaid. But they lose that coverage 60 days after giving birth, even though research shows that many pregnancy-related deaths occur after that those two months have elapsed. Advocates for pregnancy-related health are pushing for Medicaid eligibility to last for a full year after giving birth.
“That would save lives. Our greatest chance of reducing mortality is [extending] coverage postpartum,” said Lindsay Admon, an OB-GYN at the University of Michigan who researches pregnancy-related health care and outcomes.
Lawmakers in the House of Representatives unanimously passed a bill this fall that would enable states to extend eligibility for pregnancy Medicaid, so that it includes the full postpartum year. The bill hasn’t been taken up in the Senate.
It’s still unclear which party will control the Senate next year, and the results of January’s Georgia special elections could stymie legislative reform.
“This isn’t something that has to be created out of the woodwork. There are bills in existence that we can support and move forward,” said Jamila Perritt, an OB/GYN and president of Physicians for Reproductive Health. “I would hope … we’d be able to move this forward.”
But if the administration leads on the issue, pregnancy-related death could become an area of bipartisan agreement, especially since some Senate Republicans have also expressed interest in addressing the crisis, Kozhimannil said.
“The strategies around having access to birth support — that’s not controversial,” Crear-Perry said.