On April 15, Representative Ayanna Pressley (D-MA) introduced the COVID-19 Safe Birthing Act. The legislation aims to provide protections and access to vital health care for birthing people during and after the COVID-19 pandemic. Its introduction comes at a critical time: not only does the virus present a severe health risk for pregnant women, but also, for pregnant women of color, it has exacerbated an already raging maternal health crisis in this country. Thankfully, policymakers are starting to embrace bold action to support individuals and families who have struggled due to both the economic and health impacts of COVID-19.
The Pregnant Women of Color Most at Risk
According to the Centers for Disease Control and Prevention (CDC), pregnant people with COVID-19 are at increased risk of severe illness and death as a result of the virus when compared to non-pregnant people. And while the CDC asserts that transmission among pregnant people is generally uncommon, Black, and Hispanic/Latina pregnant women are disproportionately impacted by COVID-19 infection, as well as grave illness associated with the virus, when compared to pregnant women from other racial/ethnic groups. (See Figure 1.)
There are various reasons for the higher risks for pregnant women of color. Black and Hispanic women are more likely to work in low-wage, frontline jobs that put them at increased risk for COVID-19 infection. These jobs also tend to lack paid leave, which would afford them opportunity to take off of work if they fall ill and not have to forgo the wages they need to support themselves and their families. Furthermore, women of color face the multiple oppressions of racism and sexism, which can stifle economic opportunity and advancement in the workplace, as well as contribute to poor mental and physical health. Becoming infected with COVID-19 during pregnancy compounds these challenges and has serious implications for mothers of color and their families. The height of the pandemic even sparked a slew of hospital procedures that required women to go without a support person or loved one during the birthing process over concerns for COVID-19 safety. While at face value this may seem reasonable, the approach is counter to respectful maternity care models that center birthing people and fails to acknowledge the unique needs of women of color who are already disproportionately impacted by maternal mortality and morbidity in this country.
What the COVID-19 Safe Birthing Act Would Do
The COVID-19 Safe Birthing Act would help address the many challenges that pregnant women of color face, as well as a host of other issues unique to pregnant and birthing people grappling with the health impacts of the virus. Here’s an overview of key provisions in the bill:
- It would ensure that pregnant and birthing people are permitted to have a support person or loved one with them in hospitals and health care settings. Provisions in the legislation also support the addition of a doula or other birthing support person. A doula is a trained professional who provides continuous physical, emotional, and informational support to pregnant and birthing people. Studies show that support of a trained doula not only helps women communicate more effectively in health care settings, including voicing their unique needs, it also leads to positive health outcomes for both mother and infant. The benefits associated with the support of a doula are even more pronounced for low-income women, single women, and those experiencing other social and structural determinants of maternal health inequities.
- It would expand access to maternal telehealth services for Medicaid recipients. During the pandemic, access to telehealth services has been more critical than ever. This has been particularly true for patients living in rural areas and other hard-to-reach communities. Telehealth has been heavily relied upon not only for convenience, but also for safety reasons, since it has been a safer alternative to going into hospitals and health facilities during the height of COVID-19 spread. Pregnant women have particularly benefited from telehealth, as it provides them remote access to a number of pregnancy-related services, including lactation support, mental health care, parenting courses, and routine screenings. And while demand for telehealth services has increased quickly, insurers have had the play catch up. The COVID-19 Safe Birthing Act helps ensure that mothers on Medicaid can get their telehealth prenatal and postnatal care covered, just like many women with other insurance sources.
- It would extend Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage to a full year. Medicaid and CHIP are important sources of health insurance coverage for low-income individuals and families. Both are essential in supporting pregnancy-related care for millions of people, and women of color are disproportionately served by these publicly funded programs. Unfortunately, for new mothers enrolled in either CHIP or Medicaid, pregnancy-only coverage ends just sixty days after giving birth. Continuous coverage is vital to ensure positive birth outcomes and social supports for mothers and families in need. Furthermore, because the majority of maternal deaths occur up to a year after giving birth, extending postpartum coverage to a full year would have major returns on the investment by helping to save women’s lives, promote infant health, and curb the vast racial disparities seen in the U.S. maternal health crisis.
- It would ensure that all pregnant women and birthing people, regardless of insurance status, have access to free COVID-19 testing, treatment, and vaccination during and after the pandemic. With millions of Americans experiencing job loss—and in turn, the loss of employer-sponsored health insurance—access to free COVID-19 testing, treatment, and vaccines for pregnant women and birthing people is critical for true recovery. Women in particular have left the workforce in droves—some on their own accord, due to lack of child care and ensuing demands in the home, while others have experienced layoffs. These trends are even more pronounced among women of color. Even before the pandemic, uninsurance and underinsurance posed as major challenges for low-income people and people of color. All people who become pregnant during the pandemic, particularly those who fall ill due to COVID-19, should have access to the health care they need without the burden of high out-of-pocket costs.
The COVID-19 Safe Birthing Act is bold legislation aimed at ensuring that pregnant and birthing people have the protections and health care access they need during the pandemic and beyond. It helps to fill gaps where COVID-19 recovery efforts to date have fallen short. With both the economic and health impacts of the pandemic burdening women and families the most, recovery efforts must be intentional in support of pregnant women and birthing people. On the second Mother’s Day under the cloud of COVID-19, let’s support legislation dedicated to the health and well-being of the most vulnerable moms among us.