Governor Andrew M. Cuomo today announced a comprehensive initiative to target maternal mortality and reduce racial disparities in health outcomes, building on the State's commitment to addressing maternal mortality across the state. The multi-pronged initiative includes efforts to review and better address maternal death and morbidity with a focus on racial disparities, expanding community outreach, and taking new actions to increase access to prenatal and perinatal care, including establishing a pilot expansion of Medicaid coverage for doulas.
"Maternal mortality should not be a fear anyone in New York should have to face in the 21st century," Governor Cuomo said. "We are taking aggressive action to break down barriers that prevent women from getting the prenatal care and information they need. This comprehensive initiative will work to correct unacceptable racial disparities in maternal mortality and help ensure a healthier and stronger New York for all."
The initiative builds on Governor Cuomo's commitment to reducing maternal mortality and addressing racial disparities. While New York State has made improvements in reducing maternal mortality rates since 2010, when it was ranked 46th in the nation for the lowest mortality rate, the state still ranks 30th in the nation. Moreover, racial disparities persist, as black women are almost four times more likely nationally to die in childbirth than white women and three times more likely in New York. Research shows that in New York City highly educated black women still fare significantly worse than white women with less than a high school degree.
To continue to target maternal mortality and reduce racial disparities in health outcomes, the Governor is launching the following initiatives:
Create the Taskforce on Maternal Mortality and Disparate Racial Outcomes: The task force will provide expert policy advice on improving maternal outcomes, addressing racial and economic disparities and reducing the frequency of maternal mortality and morbidity in New York State. The taskforce will comprise OB-GYNs, hospital representatives, Secretary to the Governor and Chair of the New York State Council on Women and Girls Melissa DeRosa, Lieutenant Governor Kathy Hochul, New York City Public Advocate Letitia James and appointees from Senate Democratic Leader Andrea Stewart-Cousins, Assembly Speaker Carl Heastie, Senate Majority Leader John Flanagan and Assembly Minority Leader Brian Kolb, as well as other stakeholders and members of the community. The taskforce will be led by:
- Dr. Howard Zucker, Commissioner of the New York State Department of Health
- Sascha James-Conterelli, DNP, CNM, LM, President of the New York Association of Licensed Midwives
- Danielle Laraque-Arena, MD, FAAP- President of SUNY Upstate
- Wendy Wilcox, MD, MPH, Chairman, Department of Obstetrics and Gynecology, NYC Health and Hospitals, Kings County
Establish the Maternal Mortality Review Board: At the recommendation of the Governor's Council on Women and Girls, the Governor will direct DOH to establish the Maternal Mortality Review Board, composed of health professionals who serve and/or are representative of the diversity of women and mothers across the state, to work in collaboration with the American College of Obstetricians and Gynecologists (ACOG) and the City of New York to review each maternal death in New York State. The Board will also be tasked with making policy recommendations to DOH to improve maternal outcomes by reducing maternal mortalities and morbidities, and recommendations would specifically contemplate racial and economic disparities.
Launch the Best Practice Summit with Hospitals and OB-GYNs: The Governor will launch a summit with the Greater New York Hospital Association, Healthcare Association of New York State, ACOG, and other stakeholders to discuss the issue of maternal mortality and morbidity, including racial disparities. The Summit will address statistics, best practices, community awareness, medical school curricula, graduate medical education, and practicing physician training, with the goal of implementing immediate measures and identifying future action items to improve maternal care and management.
Pilot the Expansion of Medicaid Coverage for Doulas: DOH will pilot the expansion of Medicaid coverage for doulas. Doulas are non-medical birth coaches who assist a woman before, during, or after childbirth if needed. Certified doulas have been shown to increase positive health outcomes, including reducing birth complications for the mother and the baby.
Support Centering Pregnancy Demonstrations: New York will increase support for a program similar to doulas included in the Governor's State of the State First 1,000 Days of Life initiative, known as centering pregnancy. The program is designed to enhance pregnancy outcomes through a combination of prenatal education and social support and has been associated with reduced incidence of preterm birth and low birth weight, lower incidence of gestational diabetes and postnatal depression, higher breastfeeding rates and better inter-pregnancy spacing. Centering pregnancy has also been shown to narrow the disparity in preterm birth rates between black women and white women.
Require Continuing Medical Education and Curriculum Development: The Governor will call on the State Board for Medicine to require appropriate practitioners to participate in continuing medical education on maternal mortalities/morbidities and disparate racial outcomes. Additionally, DOH will work with medical schools, including SUNY's four medical schools, to build materials on maternal mortality/morbidity and disparate racial outcomes into their medical school curriculum, graduate medical education and training for practicing physicians.
Expand the New York State Perinatal Quality Collaborative: The State will expand its collaboration with hospitals across New York State to review best practices to address hemorrhaging and implement new clinical guidelines to reduce maternal mortality. Already over 70 hospitals are engaged voluntarily in this effort.
Launch Commissioner Listening Sessions: Commissioner Zucker will partner with community activists to visit high-risk areas across the state to listen to local stakeholders, including pregnant women. The listening sessions will explore the barriers that women face that make it difficult to obtain routine prenatal care as well as discuss strategies to better increase awareness of the signs and symptoms of pre-eclampsia and other causes of maternal mortality and morbidity.
Lieutenant Governor Kathy Hochul said, "There is no greater reward than being a mother. While New York has made progress to ensure all women have access to quality affordable healthcare to prevent maternal mortality, a vast racial disparity still exists that requires creative solutions and bold action. It is a grave injustice that here in New York State black women are four times more likely to die during childbirth than white women, with even larger disparities in other states. Our new plan will help save lives and expand access to maternal care, including the use of doulas to help counsel through pregnancy, so all New York mothers regardless of race have the same opportunity to live long healthy lives."
DOH Commissioner Dr. Zucker said, "The experience of childbirth is inherently both exciting and frightening. Concerns about fair treatment, quality care, and the survival of the mother should not be part of this experience. The initiatives announced today by Governor Cuomo to reduce maternal mortality and morbidity for all women will begin to address the issues that are causing black women to suffer negative health outcomes disproportionately while giving birth."
Sascha James-Conterelli, DNP, CNM, LM, President of the New York Association of Licensed Midwives, said, "A Maternal Mortality Task Force will be an essential initiative to compliment other statewide efforts to address maternal mortality and disparities statewide."
SUNY Upstate Medical University President and CEO Danielle Laraque-Arena, MD, FAAP., said, “It is an honor to serve as co-chair on the New York State Department of Health Task Force for Maternal Morbidity and Mortality to address the numerous health factors that can lead to the pregnancy-related death of a mother. This is a public health issue in New York and across the nation, and it will take strong coalition and shared resources to solve it. Thanks to Governor Cuomo for leading our efforts here in New York State.”
Wendy Wilcox, MD, MPH, Chairman, Department of Obstetrics and Gynecology, NYC Health and Hospitals, Kings County, said, "As an OB-GYN who has dedicated my career to providing health care to women in New York state, I commend Governor Cuomo for establishing this task force to create concrete solutions to reducing maternal mortality as well as the significant racial disparities that exist in maternal mortality and morbidity for New York's mothers. I am honored to work with Dr. Zucker and my colleagues across the state to focus on health equity and elimination of racial disparities in maternal health."
Bea Grause, President of the Healthcare Association of New York State, said: "HANYS appreciates the Governor's attention to this very important issue. Many of the components of this plan are evidence-based, team-oriented and have strong support throughout the healthcare community. We look forward to working with the administration to reduce health disparities and ensure that pregnant women and new mothers have reliable access to the highest quality care."
Iffath Abbasi Hoskins, MD, FACOG, Chair, ACOG District II said, "As racial disparities in maternal mortality continue to be unacceptably high, ACOG District II stands ready to partner with Governor Cuomo, this Task Force and the Maternal Mortality Review Board to uncover the causes of racial disparities and to identify new strategies for prevention of maternal deaths in hospitals and communities across the New York state. Since 2013, ACOG District II's Safe Motherhood Initiative has worked with providers and hospitals across the state to standardize clinical best practices to reduce maternal deaths and complications. As women's health care providers, ACOG is committed to creating an equitable health care system that serves all women and we thank Governor Cuomo for elevating this critical issue."
Greater New York Hospital Association President Kenneth E. Raske said, "New York's hospitals are extraordinarily concerned about maternal mortality and work on multiple fronts to address it. However, new hope is offered by Governor Cuomo's multifaceted initiative, and we are committed to working with the State to achieve material reductions in maternal mortality. We applaud the Governor for his leadership on this critically important issue."
Maternal Mortality Review Committee
DOH's Maternal Mortality Review Committee, established in 2010, conducts a comprehensive, population-based examination of maternal mortality, to determine trends over time. The Committee recommends areas to focus on for education and materials to use in quality improvement efforts.
DOH is also promoting Well Woman Care through the Every Woman, Every Time campaign, asking healthcare providers to ask all female patients of reproductive age, "Would you like to become pregnant within the next year?" This proactive approach starts a conversation about preparing for a healthy pregnancy, especially for women with chronic conditions that place them most at-risk of pregnancy complications. For women who are not planning to become pregnant, it initiates a conversation about contraception.
The Department also established the Partnership for Maternal Health (PMH), to promote equity in maternal health outcomes within at-risk populations, to reduce ethnic and economic disparities, and end preventable mortality and morbidity in the State. This is a collaboration among public health organizations, professional societies, hospital associations, and providers. The PMH has a webinar for continuing education credits on Well Woman care targeting all healthcare providers under development.