Since then, the legislature has included more Black women and the caucus has grown to five members who use their experiences and expertise to address the disparities.
“We’ve all heard the data that Black women are three to four times more likely to die of pregnancy-related causes. But I think the second half of that data; we don’t hear the fact that more than 80 percent of these deaths are preventable so often,” said caucus chairman, State Representative Ruth Richardson, DFL-Mendota Heights.
Following the passage of the Dignity in Pregnancy and Childbirth Act in 2021, Richardson came up with the idea of starting a Black Maternal Health Caucus. Caucus members have various areas of specialization; for example, the vice president, Rep. Esther Agbaje, DFL-Minneapolis, has experience in family preservation advocacy.
“Minnesota, sadly, is one of the states that has stark disparities in out-of-home placements for children who are not white. Black children account for a large percentage of that, and they are one to three and a half times more likely to be evicted for similar infractions as white children,” Agbaje said.
Her work on family preservation and housing stability ties into maternal health outcomes and reducing inequality for Black families.
“What we know about housing is that primarily single Black women who are breadwinners for their children are most at risk of eviction and therefore housing instability,” she said.
What does the caucus do?
So what’s the difference between having a caucus for a cause and just having people work on these issues separately?
Each person in the caucus has a unique background and experience which they bring to the issue of maternal health. For example, Rep. Hodan Hassan, DFL-Minneapolis, is a mental health professional who offers a health care and provider perspective.
The newest member of the caucus is Rep. Mary Frances Clardy, DFL-Inver Grove Heights, who has a background and interest in education. Representative Athena Hollins, DFL-St. Paul, is also part of the caucus.
During its most recent session, the caucus endorsed one of its priorities: expanding access to postnatal care. That bill got all the insurance, state and private, to cover three visits for a patient within the first 12 weeks after delivery.
“Historically, postpartum, a person would get a visit six weeks postpartum,” Richardson said. “To understand that what they call the ‘fourth trimester’ after delivery continues to be a highly vulnerable period, in which there may be not only mortality risks (for both mother and baby), but also serious morbidity events or those which they call near misses where someone almost dies.
The idea for the law was one of 83 community-led recommendations generated by the House Select Committee on Racial Justice. It officially became law in early 2023, and Richardson has already heard responses from community members.
“I’ve had responses, some on Twitter, people who were moved to tears because they were thinking about their own postpartum experience and knew it may be different now for other people in the future,” Richardson said.
In 2021, the caucus helped expand funding for the African-American subsection of the state’s Integrated High-Risk Pregnancy Care (ICHRP). The program runs parallel to a similar program focused on Indigenous birth outcomes, as much of the work is interrelated, Agbaje said.
“By working together and sharing data, sharing stories, sharing experiences, like this we’re not fighting for crumbs,” Agbaje said. “I think the work we’re doing here in this caucus is very focused specifically on Black women, but it can be extrapolated and applied to Indigenous women, Latina women, Asian women, because maybe they’re not facing exactly the same disparities, but very similar.
Goals for this session
Although the group approved several pieces of legislation in the last session, lawmakers believe there is more to do. Richardson is particularly passionate about something trimmed from the Dignity in Pregnancy and Childbirth Act bill that would have expanded the state’s maternal mortality review board to include morbidity, not just mortality.
“Currently, if someone dies, either while pregnant during childbirth or after childbirth, there is a review of those cases to understand what went wrong and to really understand the prevention points going forward. When we think about what they call cases of morbidity, or where people almost die, these happen much more often than cases of mortality. There are huge lessons to be learned from understanding these morbid events,” Richardson said. “The state of Texas has a morbidity review board and we in Minnesota do not yet have a morbidity review board. one, we can do it too.
Since 2019, Richardson has advocated for a morbidity review.
“It reminds us that even if we make important steps forward, we still have a lot of work to do. There is an irony in that when we look at so many of these cases where Black women have died while crying out for help, and their cries for help have not been acknowledged or heard to be here year after year, begging people to take act that we can do something different to save lives is sad and frustrating,” Richardson said. “The longer we delay this, the more it hurts our communities who continue to experience these death and morbidity events at a rate greater”.
Richardson said that aspect of the bill had bipartisan support, yet, for some reason, it failed to pass.
“I think people hear us. So it just becomes a question of whether they want to do something about it,” Agbaje said.
The caucus wants to prioritize the African American Family Preservation Act and a bill that ensures pregnant patients have access to a “designated support person” while receiving health care services. According to Richardson, he’s a designated companion who can walk people to their appointments, whether it’s for an ultrasound or during delivery. Paid family and medical leave is also something they want to push for and feel confident with the Democratic leadership in this session.
“When you look at the data, states that have access to paid family medical leave, not only have better maternal health outcomes, they also have better child health outcomes. You see a decrease in postpartum depression and preterm births,” Richardson said.
The caucus wants to ensure that women of color are heard, which is especially important in the OBGYN field.
“When you also think about how our OBGYN practice was built in this country, it was built on the brutalization of enslaved Black women. That’s how we arrived at what we know as the current state of OBGYN care,” Richardson said. “I think health care can do the same thing the legislature needs to do … listen to women of color.” .