Executive Budget Invests $8 Million to Begin Implementing Recommendations
Recommendations Developed and Will be Implemented in Close Coordination with Impacted Communities
Governor Andrew M. Cuomo today received the report by the New York State Taskforce on Maternal Mortality and Disparate Racial Outcomes. The report's recommendations, included in the Governor's Women's Agenda, build on the multi-pronged initiative the Governor announced last April to target maternal mortality. The Taskforce's recommendations aim to improve maternal outcomes, address racial and economic disparities and reduce the frequency of maternal mortality and morbidity in New York. Direct engagement by community members was critical to the Maternal Mortality Taskforce recommendations, and the Governor will continue to incorporate the voices of the communities most affected as part of this process.
"Every woman deserves high quality health care before, during and after childbirth," Governor Cuomo said. "We are taking aggressive action to break down barriers that prevent women from getting the prenatal care and information they need, and the findings and recommendations from this report bolster our efforts to reduce racial disparities and combat maternal mortality."
Though New York State has drastically reduced maternal mortality rates over the past eight years, black women in New York are still two to three times more likely to die in childbirth than white women. The Taskforce undertook a six-month-long examination of the issue and developed the following 10 recommendations:
- Establish a Statewide Maternal Mortality Review Board in Statute
- Design and Implement a Comprehensive Training and Education Program for Hospitals on Implicit Racial Bias
- Establish a Comprehensive Data Warehouse on Perinatal Outcomes to Improve Quality
- Provide Equitable Reimbursement to Midwives
- Expand and Enhance Community Health Worker Services in New York State
- Create a State University of New York (SUNY) Scholarship Program for Midwives to Address Needed Diversity
- Create Competency-Based Curricula for Providers as well as Medical and Nursing Schools
- Establish an Educational Loan Forgiveness Program for Providers who are Underrepresented in Medicine and who Intend to Practice Women's Health Care Services
- Convene Statewide Expert Work Group to Optimize Postpartum Care in NYS
- Promote Universal Birth Preparedness and Postpartum Continuity of Care
The Report's Key Findings:
- In 2016, New York State was ranked 30th in the nation for its maternal mortality rate, with clear racial disparities.
- The number of reported maternal mortalities in New York increased over time from 15.4 deaths per 100,000 live births in 2001-2003 to 19.6 deaths per 100,000 live births in 2014-2016. The United States rate more than doubled during this time.
- In 2012-2014, 66% of prenatal related deaths in NYS involved a cesarean section, which increases the likelihood of complications like any other surgery.
- In a review of maternal deaths in NYS between 2012-2014, the top five causes of pregnancy-related deaths were embolism (24%), hemorrhage (16%), infection (16%), cardiomyopathy (12%) and hypertensive disorders (7%). Sixty-five percent of the pregnancy-related deaths occurred within a week of the end of pregnancy.
- The top five causes of pregnancy-associated, but not related deaths in the 2012-2014 maternal mortality review cohort were substance abuse (30%), motor vehicle accidents (22%), suicide (17%), homicide (15%) and cancer (14%).
Governor Cuomo created the Taskforce on Maternal Mortality and Disparate Racial Outcomes, which launched in April 2018, as part of a multi-pronged effort to reduce maternal mortality and racial disparities. The taskforce was convened by Melissa DeRosa, Secretary to the Governor and Chair of the New York State Council on Women and Girls; Kathy Hochul, Lieutenant Governor; Letitia James, Attorney General and then-New York City Public Advocate; and membership was comprised of appointees from the NYS Senate and Assembly, as well as obstetricians, midwives, hospital representatives, doulas and other stakeholders and members of the community. The taskforce was co-chaired by Dr. Howard Zucker, Commissioner of the New York State Department of Health (NYSDOH); Sascha James-Conterelli, DNP, CNM, LM, President of the New York Association of Licensed Midwives (NYSALM); Danielle Laraque-Arena, MD, FAAP, former President of SUNY Upstate; and Wendy Wilcox, MD, MPH, Chairman, Department of Obstetrics and Gynecology, New York City Health and Hospitals, Kings County.
The Taskforce on Maternal Mortality and Disparate Racial Outcomes (the Taskforce) met three times between June and December 2018. During these meetings, the Taskforce heard from state and national experts and community stakeholders on the landscape of maternal mortality in the U.S. compared to maternal mortality in New York State, as well as the impact of racism on maternal health outcomes among black women. Members of the Taskforce submitted recommendations to the Governor on ways to reduce racial disparities and preventable maternal mortality and morbidity.
Recommendations were informed by Taskforce meetings, feedback from statewide community listening sessions lead by Commissioner Zucker and other breakout sessions, and their own expertise. There were numerous proposals, and upon the recommendation of the Taskforce members, the Taskforce is advancing ten recommendations to decrease maternal mortality and morbidity and reduce racial disparities in New York.
In addition, in his 2019 State of the State address, Governor Cuomo committed to immediately implementing the top recommendations of the Taskforce, including launching a Maternal Mortality Review Board, creating an implicit racial bias training and education program for hospitals, investing in community health worker programs and creating a data warehouse on perinatal outcomes. The Governor also committed $8 million over two years in the 2019-2020 Executive Budget to fund these important initiatives.
Additionally, the Governor is directing the Department of Health in partnership with the American College of Obstetricians and Gynecologists, to convene an Expert Workgroup on Postpartum Care to develop recommendations targeting the critical time immediately after birth. The members are in the process of evaluating long-term implementation plans for the remaining recommendations.
All of these proposals will be coordinated with local community members, and DOH will continue this partnership through ongoing community forums on maternal health and adverse birth outcomes.
Moreover, the Governor will direct DOH to explore additional multi-year interventions to address maternal mortality, including the adoption of maternity care value-based payment arrangements, examining insurance reimbursement rates for providers, expanding effective community-based services, and promoting diverse workforce development initiatives.
"Despite the medical advances our nation has seen over the last century, there is still an unconscionable number of black women who die during childbirth, and we are determined to correct this injustice and save the lives of mothers across New York State," said Lieutenant Governor Kathy Hochul. "With our Maternal Mortality Task Force, we are examining this issue from every angle, and putting forth bold proposals to address the crisis. By implementing these recommendations, we are taking action to end structural racial disparities in our society that all too often lead to tragedy."
Melissa DeRosa, Secretary to the Governor and Chair of the Council on Women and Girls, said, "Reproductive health is fundamental to women's equality -- it affects our families, our careers, our health and our entire lives. We should be doing everything we can to provide high quality health care and support to new and expecting mothers in New York. This year, as a critical component of the Women's Justice Agenda, we must take these new actions to reduce racial disparities in maternal mortality and help all New York mothers."
"It is a sad truth that black women in New York are four times more likely to die during childbirth than white women. While important strides have been made to combat maternal mortality, it is deeply disturbing that such vast racial disparities continue to exist in this state," said Attorney General Letitia James. "We must be bold in our efforts to ensure that women have access to quality, affordable healthcare regardless of race or socioeconomic status."
"The release of this task force report is a vital step forward in addressing racial disparities in the care of women of color, particularly African-American women, that have taken so many lives," Assemblywoman Latoya Joyner said. "I applaud the recommendations of Governor Cuomo's task force, appreciate its support for establishing a statewide Maternal Mortality Review Board in law and look forward to working with my partners in government as we seek to eliminate the implicit racial bias in healthcare that has so adversely impacted the quality of care received by New York's women of color."
New York State Health Commissioner Dr. Howard Zucker said, "Childbirth should be a joyous time for families, unblemished by fear and implicit racial bias. These recommendations, coupled with actions we have already taken, will go a long way toward levelling the playing field, so all women are treated equally."