New York City Public Advocate Jumaane D. Williams today released a report on maternal health inequities, analyzing systemic issues and outlining potential policy solutions. It details issues of maternal morbidity and the pervasive but underdiscussed healthcare disparities that contribute to the problem both nationally and locally.

The report, Equitable Pregnancy Outcomes for Black and Brown New Yorkers, comes as the Public Advocate has been advancing city legislation on maternal health outcomes, and after he and his family shared their personal story and struggles with maternal healthcare inadequacies and inequities. 

"When I first began working on issues of Black and Brown maternal health, and on these bills, I had no idea how personally it would affect my family– but I knew, I had met and spoken with, the families of so many who had experienced inequity and tragic loss.” said Public Advocate Jumaane D. Williams on the release of the report. “This report details the causes of maternal morbidity, the deep disparities in who receives adequate care and who faces greatest pain and tragedy. It tells the stories behind the statistics, and highlights solutions that can save lives. It is critical, it is urgent, that we pass these bills in the City Council, and continue the work on a state and federal level, to help promote health and prevent tragedy from pre to post-pregnancy."

Maternal health inequities are a national issue, and that disparity is magnified and exacerbated in New York. Nationally, Black and Native American women are three times more likely than white women to die from a pregnancy related case – while in New York City, Black women are 8 times more likely than white women to die from a pregnancy-related cause, and nearly 3 times more likely to experience severe maternal morbidity than white women. In 2017, Black women gave birth to 23% of New York City babies, yet accounted for 55% of maternal deaths. Black women continue to have worse outcomes than their white counterparts regardless of insurance or socio-economic status. 

These inequities, and the tragic losses they represent, stem from a number of factors detailed in the report. Causes identified include access to care, quality of care, prevalence of chronic illness, structural racism, socioeconomic inequities, and implicit biases within the healthcare system.

To begin to address these inequities, the report includes the following recommendations:

• The New York City Council needs to pass the Public Advocate’s maternal health legislative package, including bills to establish a maternal health bill of rights and require employers to hold an onboarding meeting to discuss an employee's reintegration back into the workplace after parental leave, as well as a resolution calling for passage of the federal Black Maternal Health Momnibus Act of 2021.
• New York City needs to expand its comprehensive plan to reduce maternal death from 5 years to 10 years.
• New York City’s Health + Hospitals Corporation needs to incorporate the World Health Organization’s recommendations for improving outcomes of preterm births.
• New York City Health + Hospitals needs to include information on maternal mortality rates and the number of severe maternal morbidity cases in its annual Community Health Needs Assessment report.
• New York State must enact legislation to require public and private health care facilities to incorporate a biannual anti bias training for women and birthing people of more color, as well as a training focused on creating trans-inclusive, gender affirming environments for TGNC patients.
• The state must also enact legislation that would require health insurance plans to provide free coverage of midwifery and doula services to expectant persons at a liveable wage.
• The U.S. Congress needs to pass and the President needs to sign the Black Maternal Health Momnibus Act. 

After having worked on addressing Black maternal health throughout his first two years in office, and introducing legislation on the issue this summer, the Public Advocate and his wife, India Sneed-Williams, publicly shared their personal experiences with health inequities earlier this week. After struggles with fertility, miscarriage, cancer diagnosis, and healthcare providers who failed to listen to or provide crucial options for the couple, they announced Monday that they are expecting a ‘miracle baby.’ Learn more about their journey here.

They hope that by sharing their story, they can help empower individuals to self-advocate for and receive more culturally responsive, equitable reproductive healthcare, and help to advance systemic change to confront ongoing inequities in New York City and beyond through solutions detailed in this report.

View and download the full report here.

"Too many Black women and Black birthing individuals have died senselessly as a result of years of racism in our healthcare industry and we cannot afford to wait for yet another preventable death before taking action to address this public health crisis. Black birthing individuals deserve culturally competent, patient- centered care from healthcare providers that are attuned to their unique needs before, during and after childbirth. Policy makers, medical professionals and advocates must continue to work together to push for systemic changes and Public Advocate Jumaane Williams’ Black Maternal Health/Birthing Rights Justice package is a step in the right direction. I look forward to our continued work together with my sisters in the Women’s Caucus fighting for birth justice in New York City and across the country," said Council Member Vanessa L. Gibson, Co-Chair of the NYC Council Women's Caucus.

"Community Voices Heard is thankful to the Public Advocate's Office for the publishing of a white paper that advocates for more Equitable Pregnancy Outcomes. It is an outrage that in 2021, Black women in NYC are still 8 times more likely to die of pregnancy-related causes than white women. The policy recommendations made forth in this document are a starting point to creating a more equitable healthcare system that centers the livelihood of Black and Brown mothers in New York State," said Juanita O. Lewis, Executive Director of Community Voices Heard.

"As a community we must continue to center community care frameworks and policies that will uplift the pregnant people and parents throughout NYC. This report highlights the effects of why our maternal mortality rate is so high when we continue to dismiss the effects of racism and implicit bias, inadequate access to culturally humble and congruent care that fails to take an intersectional approach to centering patients. Now is the time for CHANGE! Let's activate and mobilize policy for the people, by the people. This report is one of those steps in creating equitable change through a reproductive justice lens," said Chanel L. Porchia, Founder and CEO of Ancient Song Doula Services.

"Black Women's Blueprint is pleased to see these birth equity efforts coming out of the OPA. This white paper is not only timely, but incredibly urgent. Collectively, this moment not only calls each of us to radically reimagine our approaches, but to creatively strategize. Our steps toward creating birth equity requires that we advocate for all stakeholders to provide the respectful, culturally safe, and compassionate care that all laboring people need and deserve," said Sevonna Brown, Co-Executive Director, Black Women's Blueprint.

"We applaud the Public Advocate's release of this report and continued attention to the maternal health crisis, which disproportionately impacts Black and Latina women in New York City. We are proud to have worked with the Public Advocate's office on this critical issue, in particular on Intro 2370, which will ensure that pregnant people receive information about their workplace rights when they receive care at Health and Hospitals locations. This report makes clear the urgent need for policy changes ensuring that pregnant people, especially Black and Latina people, in New York City are able to meaningfully access the workplace rights that will keep them safe and healthy during and after pregnancy," said Meghan Racklin, Staff Attorney at A Better Balance.

"I want to thank the Public Advocate for his ongoing efforts to ensure that women have access to fair and equitable quality of services during their pregnancy. The maternal health of women of color in this state can have better outcomes and the state of New York has rightfully taken the lead to ensure better outcomes and healthier mothers and babies," said Carine Jocelyn, Chief Executive Officer of Diaspora Community Services.

“New York’s maternal mortality rates are abysmally high, ranking thirtieth in the nation. The racial disparities are stark and unacceptable; Black women are significantly more likely than white women to die of causes related to pregnancy or childbirth. We are heartened that Public Advocate Williams is shedding light on this racial and economic injustice as we strive towards equitable pregnancy outcomes for all New Yorkers,” said Katharine Bodde, Assistant Policy Director at the New York Civil Liberties Union.