At a time when policymakers are debating the future of Medicaid, it’s critical to remember what’s at stake. Medicaid is not just a budget line—it is a lifeline for maternal health, particularly for Black, Latino, and Indigenous communities. Proposed cuts to Medicaid could jeopardize the very solutions that are proven to save lives and advance maternal health equity.

The maternal health crisis in the United States remains one of the most urgent, public health challenges of our time.  America continues to rank at the bottom among the world’s industrialized nations in maternal health outcomes. One of the wealthiest countries in the world should be capable of delivering thriving babies to well-supported mothers.

The annual recognition of Black Maternal Health Week (April 11-17th) was created to draw attention to the alarming disparities in outcomes for black women in particular. The research is disturbing.

Black women are three times more likely to die from pregnancy-related complications than white women, and are twice as likely to experience severe health complications during or after childbirth, even after adjusting for maternal age, education, and pay parity.

While the Affordable Care Act (ACA) has expanded health coverage, significant gaps in maternal care remain. In addition to issues around access to comprehensive care, there are systemic and social barriers that hinder optimal maternal health outcomes for our country’s most vulnerable communities.

But solutions exist. Targeted policy changes and community-led approaches can help improve outcomes and reduce disparities.

Policy Solutions That Can Improve Maternal Health Exist

While policymakers debate costs and cuts, research and community voices continue to point to clear, actionable solutions that can improve maternal health and elevate America’s healthcare system to be on par with industrialized nations around the world. Here are a few ways to address the systemic barriers to optimal birth outcomes. 

  1. Invest in Community-Based Midwifery Models

    Community-rooted care models, especially those led by Black midwives, have demonstrated better birth outcomes, better birth experiences for Black women, and lower costs. Yet, too often, these models face unnecessary policy and Medicaid reimbursement barriers. Investing in midwifery-led birthing centers and expanding access to doula services can help close racial gaps in maternal care and outcomes.

  2. Expand Medicaid Coverage Before and After Pregnancy

    Medicaid plays a critical role in our country’s maternal health outcomes, covering nearly half of all births in the U.S.  Medicaid also provides important pre-conception and post-natal care for women of reproductive age.  Our researchers noted that 10 states still have not expanded their Medicaid program under the ACA, which provides important pre-conception care, and that 45 percent of black women of reproductive age live in these states.  Researchers also noted the importance of maintaining the option for states to expand Medicaid to include 12 months of coverage after birth providing coverage which could lower maternal mortality. All but one state had expanded such coverage. Cuts to Medicaid that are currently being considered could reduce this coverage. 

  3. Invest in Career Pathways for Black Maternal Health Clinicians

    Black women are more likely to feel heard and respected in medical settings when cared for by clinicians who reflect their communities.  Black and Hispanic physicians are more likely to provide services in underserved communities and diverse health teams have been associated with better decision making and health outcomes.  Investing in career pathways for Black maternal health clinicians—including midwives, doulas, nurses, and doctors—is a critical step toward building a more representative, culturally competent maternal care workforce.

  4. Train All Providers in Cultural Humility and Implicit Bias

    In a nation as diverse as ours, medical providers must be equipped to deliver high-quality care across cultures and experiences. Cultural humility and implicit bias training can improve communication and understanding between health care providers and patients, and are widely thought to be an important part of a comprehensive approach to improving health outcomes for Black women. This training should be included in both clinical education and ongoing professional development, for all providers.

  5. Center the Voices of People Affected by Maternal Mortality

    During our recent maternal health event, we learned powerful lessons from Omari Maynard and Bruce McIntyre III, two fathers who lost their partners due to preventable childbirth complications. Their stories, also featured in the documentary Aftershock, underscore why maternal health reform is urgent for mothers, families and communities.  Their advocacy calls for:

    - Listening to Black mothers and families to improve patient care and safety.

    - Respecting and supporting the bodily autonomy of the women giving birth, and fully engaging them and their families in the decisions about the birthing process.

    - Improving data collection and greater accountability, inside and outside of healthcare systems, to prevent avoidable maternal deaths.

Turning Research Into Actionable Policy

Research, policy, and community action must work together to drive change.

We know what works: eliminating barriers, expanding Medicaid, investing in community-led care, and ensuring that Black families’ voices and experiences are centered in clinical care and policymaking. If we act on these solutions now, we can take meaningful steps toward a future where all mothers receive the care, dignity, and support they deserve.

Policymakers who value human life, American excellence and global leadership would be wise to invest where the future begins.

For more information about our research and to watch clips from our maternal health event, click here.

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