Changes to Michigan’s maternal health policy could save black women’s lives

Elon Geffrard was five years old when she saw her mother give birth with the help of a midwife. She said she wanted to pursue a career in “baby catching” from then on.

After years of caring for black and brown women in metro Detroit as a doula and co-founder of Birth Detroit, she has a deeper understanding of how a community’s health can be reflected in the women and children within it.

If you looked at the women and children here in Michigan, “Michigan is not doing well,” she said.

Birth justice advocates like Geffrard say racial disparities in Michigan’s maternal health care system are creating a crisis for black mothers and laborers. These advocates, as part of a coalition called the MI State of Birth Justice, intend to bring the issue to state legislatures in the form of a comprehensive legislative package.

The package, aptly named “Momnibus” — a combination of the terms “mother” and “omnibus” — would increase access to alternative midwifery services across the state, such as birth centers and midwives, while also tackling systemic racism to impact outcomes for black people to improve mothers .

Related: Black birth outcomes lag behind white families in Michigan, a fact black doulas are trying to change

Nationwide, black women are more likely to die from pregnancy-related causes compared to white women. In Michigan specifically, those odds are three times more likely, according to the latest data from Michigan’s Maternal Mortality Surveillance Program.

Racism is embedded in the history of women’s health, Geffrard said. She referred to Dr. J. Marion Sims, “the father of gynecology” who used unethical experimentation to study enslaved black women in the 19th century.

“Racism is an ideology. It’s a belief that people who belong to certain groups are worth less or become dehumanized,” Geffrard said. “We see that showing up very easily in institutions like healthcare systems and hospitals, because that’s how medical education was shaped.”

Nicole White, a board-certified midwife and co-founder of Birth Detroit, said racism is why some women still don’t have a safe midwifery option, and eradicating this damaging factor is one of the important messages of the momnibus.

“I think we will look back on this time in history with embarrassment and shame,” White said.

The proposal would require the use of the PREM-OB scale, a tool used to measure Black mothers’ experience in hospitals across the state. It also proposes the creation of a formal complaints system to the State Health Commission specifically for racism in midwifery.

Tatiana Omolo, director of government and policy affairs at Mothering Justice, a Detroit-based political advocacy group, said supporters wanted to make sure the momnibus was as comprehensive as possible to cover many multi-faceted inequalities in maternal health.

“We wanted to be really careful about who we involve, how we involve them, and make sure we don’t forget who this bill is really for, and it’s for communities of color,” Omolo said.

The Michigan Momnibus builds on similar federal and state legislation. The Black Maternal Health Momnibus Act was introduced in the US House of Representatives in 2021, and Colorado also passed its own Birth Equity Bill Package that same year.

A key component of the Michigan Momnibus proposal is licensing birthing centers and paying midwives to increase access to care statewide.

Michigan is one of 10 states that do not license free-standing maternity centers — a non-hospital childbirth health facility where midwives provide care. Without a birthing center license, midwives working in these facilities are not reimbursed by Medicaid.

Birth Detroit has campaigned for the opening of Detroit’s first freestanding birth center since its inception, White said, but coverage that would improve staff development and midwife retention is not yet available.

“We wanted to build a birthing center, and then when we realized we couldn’t get paid for the care we’re providing at the birthing center, that’s just sustainability,” White said. “We need to break down these legal barriers so that we can provide this quality care for years and years to come.”

Potential birth center expansions would also benefit low-income families by reducing birth costs to about $4,000, a significant difference compared to hospital births, Geffrard said. “Obstetric deserts” such as those in the Upper Peninsula or in rural areas where families have to travel long distances to be cared for can also benefit.

Related: Borgess Hospital in Kalamazoo has cut its midwifery staff. Now we are rethinking.

The package focuses on several other areas such as diversifying data collection to include LGBTQ people and people with disabilities, and integrating healthcare systems to better move patients from birth centers to hospitals.

Currently, proponents are working to finalize the details before the bills are ready to be presented to lawmakers.

Some Democrat lawmakers, Omolo said, are reluctant to back the package for fear it might seem too radical or unappealing to their base.

Shanayl Bennett, a doula and maternal health and black reproductive justice organizer at Mothering Justice, said some of these feelings may stem from a lack of understanding of alternative birthing practices.

A doula is a person who provides emotional and physical support before, during, and after childbirth. Doulas are not medical professionals but provide services such as birth plan development, breastfeeding education, and more Help the family as a whole navigate life with a newborn.

Like doulas, midwives provide prenatal care to families, but they also have the medical training needed to assist during labor and delivery.

“I think the thought of midwifery is still very common for some people,” Bennett said. “You just can’t figure out why people don’t just go to a hospital.”

Sen. Erika Geiss, D-Taylor, who identified Omolo as a key partner in the legislature, said it could be a matter of time before lawmakers learn about these issues given that the new term has only just begun and the Democrats familiarize themselves with their role as the new majority. She hopes her fellow congressmen will start providing the people of Michigan with the kind of mothering care they want and need.

“I’m hopeful and cautiously optimistic that we can now have these very real conversations about how we can move some of these policies forward,” Geiss said.

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Changes to Michigan’s maternal health policy could save black women’s lives

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