Landmark Maternal Health Bill Passes in Mass!

By Marissa Jones

Every birthing person deserves a healthy birth to embrace a new bundle of joy into their lives enthusiastically. In Massachusetts, many birthing persons do not experience that. Pregnancies resulting in deaths (maternal mortality) and pregnancies causing short or long-term health consequences (severe maternal morbidity) still plague and haunt the residents of Massachusetts. 

From 2018 to 2021, 15.3 per 100,000 deliveries resulted in the death of a birthing person in Massachusetts compared to 23.5 per 100,000 deliveries resulting in death nationwide. While Massachusetts is below the national rate of maternal mortality, the issue is still significantly higher than other countries with a similar GDP compared to the United States. For example, Canada has a maternal mortality rate of 8.4 per 100,000 deliveries. 

In less than a decade, severe maternal morbidity (SMM) rates in Massachusetts almost doubled from 52.3 per 10,000 deliveries resulting in a negative health consequence in 2011 to 100.4 per 10,000 deliveries in 2020. The effect and nuances surrounding racial disparities must be considered as well. Racism, not race, has exacerbated negative health outcomes among birthing persons. In 2020, Black non-Hispanic birthing persons had an SMM rate almost double the average SMM rate in MA (190.8 per 10,000 deliveries). White persons experienced SMM rates approximately 56% lower than their Black non-Hispanic counterparts (AAPI with 48% lower and Hispanics with a rate 44% lower). 

Secretary of Health and Human Services, Kate Walsh, stated that “[w]hen we look at maternal health outcomes through a lens of race and ethnicity, we see a different picture of our healthcare system…[b]irthing people, particularly women of color, face devastating levels of risk. We have a lot of work to do to improve outcomes.” And now Massachusetts has created an opportunity to improve health outcomes for birthing persons with the state legislature passing bill H.4999, “An Act promoting access to midwifery care and out-of-hospital birth options”.

Thanks to the untiring efforts of maternal health advocates, Bill H.4999 passed within the Massachusetts state legislature on August 15, 2024, and was signed by Governor Maura Healey on August 23, 2024. Emily Anesta, President of the Bay State Birth Coalition, declared that this bill “has the potential to significantly improve access to high-quality, personalized maternity care for countless families across our state.”

Here are some highlights of the bill:

  • Establishment of state licensure for Certified Professional Midwives (CPMs)  and lactation consultants.
    • Midwives are essential in providing a healthy and safe environment for birthing persons and their infants. According to the World Health Organization (WHO), the presence of midwives can prevent up to 80% of maternal deaths, neonatal deaths, and stillbirths. 
  • Encourages free-standing birth centers and the disruption of grants to address maternal mental health and substance abuse. 
  • Allows CPMs and Nurse Midwives to serve as clinical directors for freestanding birth centers (previously, only physicians could hold this role).
  • Will enable CPMs to serve as birth attendants in freestanding birth centers (previously, only Nurse Midwives or physicians could hold this role).
  • Requires that the Medicaid agency, MassHealth, reimburse Nurse Midwives at the same rate as physicians for the same services.
  • Mandates that insurers, including MassHealth, provide coverage for postpartum depression.
  • Expansion of a universal postpartum home visiting program statewide that will support birthing persons during this new chapter in their family.

It did not, however, include private payer reimbursement equity, but maternal health advocates vow to continue to push for that in the coming session.

This historic bill is a step towards addressing and ameliorating maternal and perinatal disparities throughout the Commonwealth.

 

Letter: How our state Legislature has failed us

Norman Daoust, “How our state Legislature has failed us,” Cambridge Day, September 3, 2024.

How has our state Legislature failed us? Let us count the ways.

Failed to include the local option transfer fee, the tenant opportunity-to-buy policy and a rent control local option in the Affordable Homes Act.

Failed to pass an economic development package, clean-energy siting bill and halt on gas infrastructure expansion; a bill to allow supervised drug-consumption sites; and a ban on the sale of cellphone location data.

Failed to include voter access reform to delink a municipal census from voter registration in the state budget (even though it passed in the Senate).

Never made it out of committee: same-day voter registration; Make Polluters Pay legislation; and Medicare for All in Massachusetts.

Failed to pass bills out of conference committee so they could be voted on by the entire body: hospital oversight (given the Steward hospital fiasco, how could they fail to bring this to a vote?); a climate bill; drug pricing bill; a Raise-the-Age juvenile for possession of a firearm; and a Plastics Reduction Act.

Stuck in Ways and Means are a moratorium on construction of prisons and jails and expanding the public-records law called the Sunlight Act to cover the governor and state Legislature.

It’s guaranteed that other bills you care about also were never passed.

By effectively taking the final five months of the legislative session off, the likelihood of additional bills passing is minimized.

If you believe our state Legislature has failed you, contact the speaker of the house and president of the Senate as well as your state representative and senator and let them know the bills you want passed.

Norman Daoust, Raymond Street, Cambridge

Letters: Mass. lawmakers need something: a shove? a prod? a heave-ho?

“Letters: Mass. lawmakers need something: a shove? a prod? a heave-ho?,” Boston Globe, August 31, 2024.

That ‘special session’ can’t come soon enough

Massachusetts is one of the few states that has a full-time, year-round legislature. So why does that elected body repeatedly leave everything for the last minute? Perhaps it’s that the hyper-centralized power of the leadership means that everything gets decided by such a small number of people that things move very slowly. Perhaps it’s that the Legislature’s rules make it almost impossible for the public to know what is going on in committees, so inter-chamber negotiations are able to stall in the shadows. Perhaps it’s because the power brokers in each chamber place the securing of leverage over the other above getting needed legislation passed.

It’s good that there will probably be a “special session.” Hopefully lawmakers, in addition to the long-delayed economic development bill to improve our competitive position, will also pass measures to help keep juvenile offenders who are the age of high school seniors out of adult prisons and to strengthen our public health infrastructure. We also need to see the climate bill pass: Mother Nature doesn’t wait, and neither should the Legislature. We need robust legislation that centers environmental justice and includes a clear plan to transition away from gas.

Come on, lawmakers, do your job!

Steven E. Miller

Cambridge

Give lawmakers deadlines, spread over the session, for each bill

The conclusion of the Legislature’s formal session a month ago left me in some distress. So many good bills were left unfinished. The Legislature failed to complete its actions on climate (clean energy development), economic development, hospital oversight, and drug prices.

Although majorities in both the Senate and House wanted the bills to pass, differences between the versions passed by the Senate and House had to be hammered out in conference committees.

Usually the existence of a deadline, like July 31, would concentrate legislators’ minds and be a spur to action for getting the bills passed. In this case there were multiple bills, all with the same deadline, and with only two main decision-makers, the Senate president and the speaker of the House. It was impossible for the bills to make timely progress through these bottlenecks.

To avoid this, it would be sensible to assign each bill an individual deadline. Bills go through several stages before they become law, including committee hearings and three separate readings in both the House and Senate. The assignment could be made when the bill is first reported out of committee, when the complexity of the issue and possible points of conflict will have been identified.

Each deadline should be reported publicly, and residents, advocates, and lobbying groups could push the legislators to meet that deadline. Deadlines should be spread out so that the Legislature has a good chance of meeting them all.

Martin G. Evans

Cambridge