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.

 

Let’s Learn from the Pandemic and Pass the Community Immunity Act.

Vaccination

Wednesday, July 26, 2023

Dear Chair Cyr, Chair Decker, and Members of the Joint Committee on Public Health: 

My name is Jonathan Cohn, and I am the Policy Director of Progressive Massachusetts, a statewide grassroots advocacy group committed to fighting for an equitable, just, democratic, and sustainable Commonwealth.

We urge you to give a favorable report to H.2151/S.1458: An Act promoting community immunity.

If we want to be ready for the next pandemic, or even just ready for the next outbreak of a disease we thought we were decades past, we need to be strengthening and standardizing our infrastructure for immunization. We need to leave the past three years with lessons borne out in policy.

A look at our current immunization infrastructure leaves much to be desired. We currently lack full and accurate reporting on vaccination rates among young people, relying instead on voluntary surveys of schools, summer camps, colleges, and daycares. The limited data available show alarming rates of under- and unimmunized children in communities across the Commonwealth. To put that into perspective, in the current school year, more than 200 high schools, more than 200 middle schools, more than 200 elementary schools, and more than 1,600 child care centers and preschools failed to report any immunization data to state public health officials. Of the kindergarten programs that submitted data, 152 lacked herd immunity to protect against the spread of measles, and 15 lacked herd immunity to protect against the spread of polio.  

We cannot fix a problem without a full and accurate read of it, and the Community Immunity Act’s data reporting requirements are a key first step. But the bill, as necessary, goes further, with targeted education and outreach about vaccine safety and efficacy and standardization and centralization of vaccination protocols. Standardized state-level policies determined by public health officials are crucial when determining exemptions if we are to make sure that medical and religious exemptions are not abused and that local superintendents are not overburdened.

We ask that you swiftly advance the Community Immunity Act out of the Public Health Committee with a favorable report. Please help to keep all of us safe and healthy, particularly people who are immunocompromised and rely on community immunity.

Thank you for your consideration and your service to the people of the Commonwealth.

Sincerely,

Jonathan Cohn

Policy Director

Progressive Massachusetts

TAKE ACTION: MA Should Prioritize Public Health

Public health image

In 2020, Massachusetts passed a police reform bill that created a standards and accreditation commission, put limits on the use of force, and took other steps to address systemic racism in law enforcement. But left out of the police reform bill was a simple realization: the best way to reduce the incidence of police brutality is to limit the scope of policing.

Too often, armed police officers are called in to respond to situations that they are not equipped to handle, situations that are better handled by someone with an expertise in social work or mental health or someone from the community itself. Shifting such calls away from police and towards alternative response programs ensures that situations do not escalate and that people can best be connected to the services that they need.

The ACES bill — An Act to Create Alternatives for Community Emergency Services (S.1552 / H.2519), filed by Sen. Sonia Chang-Diaz and Rep. Lindsay Sabadosa — would direct the Executive Office of Health and Human Services to establish and oversee the Alternatives for Community Emergency Services Grant Program (A.C.E.S.) to increase the availability of non-law-enforcement, unarmed community-based response options for calls to 911.

Can you email your state legislators in support of the ACES bill? 

Want to learn (or do) more? Check out our guide at https://progressivemass.com/aces2021.

Suppor the Community Immunity Act!

Yesterday, the Joint Committee on Public Health held a hearing on legislation to improve vaccination rates. 

Over 15+ hours, the Committee heard from literally hundreds of individuals, including licensed medical professionals at Mass General Hospital and Tufts Medical Center, who espoused toxic disinformation about the safety and efficacy of vaccines, grossly distorted and flatly misstated the content of the Community Immunity Act, and personally attacked the character of any legislators and public health professionals who care about strong immunization policy and infectious disease prevention. 

We need to make sure that the Legislature hears the voices of people who support science and public health. Here’s what you can do. 

Copy the list of members of the Joint Committee on Public Health and send them an email like the one below — Or send a pre-filled email here.

Jo.Comerford@masenate.gov 

Marjorie.Decker@mahouse.gov 

Becca.Rausch@masenate.gov 

Julian.Cyr@masenate.gov 

Patrick.OConnor@masenate.gov 

Susan.Moran@masenate.gov 

Harriette.Chandler@masenate.gov 

Brian.Murray@mahouse.gov 

Brian.Ashe@mahouse.gov 

Paul.Schmid@mahouse.gov 

Kay.Khan@mahouse.gov 

Jack.Lewis@mahouse.gov 

Andy.Vargas@mahouse.gov 

Vanna.Howard@mahouse.gov 

Hannah.Kane@mahouse.gov 

Shawn.Dooley@mahouse.gov 

Jon.Santiago@mahouse.gov 

Dear Chair Comerford, Chair Decker, and Distinguished Members of the Joint Committee on Public Health:  

I write to express my strong support for S.1517/H.2271, the Community Immunity Act, filed by Senator Rausch and Representatives Donato and Vargas. You heard testimony on this critical legislation on Monday, July 12.As we endeavor to emerge from a global pandemic, I urge you to expediently advance the Community Immunity Act with a favorable report.  

We need only look around to see the importance of widespread herd immunity (both localized and statewide) and the need to improve our public health infrastructure. Unfortunately, our current infectious disease prevention provisions leave gaping holes in our public health protections. Every corner of our Commonwealth faces a concerningly high rate of under- or unimmunized youth, threatening our communities’ health and safety. (Please consider these maps: https://www.beccarauschma.com/communityimmunitymap.) 

The Community Immunity Act fixes the holes by creating the statutory immunization infrastructure our Commonwealth needs, without mandating vaccines or striking the religious exemption. I support this comprehensive bill because [insert your reasons here].  

As our elected leaders, please embrace this once-in-a-generation moment to protect generations to come. I ask that you swiftly advance the Community Immunity Act out of the Public Health Committee with a favorable report. Please help to keep all of us safe and healthy, particularly people who are immunocompromised and rely on community immunity. 

Thank you for your consideration and your service to the people of the Commonwealth. 

Sincerely, 

[your full name] 

[your phone number (optional)] 

[complete address – street, city, state, zip] 

“The COVID-19 pandemic has shined a light on the weaknesses of Massachusetts’s public health infrastructure.”

Vaccination

Monday, July 12, 2021

Chair Comerford, Chair Decker, and Members of the Joint Committee on Public Health:

My name is Jonathan Cohn, and I am the Chair of the Issues Committee of Progressive Massachusetts, a statewide grassroots advocacy group fighting for a Massachusetts that is more equitable, just, sustainable, and democratic.

I am here today to testify in support of S.1517 / H.2271 (An Act promoting community immunity, or the Community Immunity Act) and S.1515 / H.2370 (An Act effectuating equity in COVID-19 vaccination, or the Vaccine Equity Bill).

The COVID-19 pandemic has shined a light on the weaknesses of Massachusetts’s public health infrastructure, and these bills are essential to both our short-term recovery and long-term stability and public health.

Although Massachusetts has vaccinated a greater share of our population than most other states, we still see wide regional discrepancies. As of last week, the percentage of eligible residents with at least one dose of the vaccine varied from a low of 62% in Hampden County to more than 100% in Dukes and Nantucket Counties, with sometimes wide gaps by race and ethnicity. [1] We see such gaps most strikingly in Hampden County, where there was a 20% gap between white and Latinx residents (with both numbers below the state average).

The Commonwealth’s Vaccine Equity Initiative is clearly not doing enough to close these gaps. Although parts of the Vaccine Equity Bill (S.1515/H.2370)’s goals may have been incorporated in part by now, its ambition and comprehensiveness have not, and we urge swift passage of the bill in order to strengthen our commitment toward public health, especially as new COVID-19 variants are on the rise.

As we work on the recovery to the current pandemic, it is vital for us to ensure a stronger and more stable public health infrastructure for the challenges to come. The Community Immunity Act will help us to do that. 

We currently lack full and accurate reporting on vaccination rates among young people, relying instead on voluntary surveys of schools, summer camps, colleges, and daycares. The limited data available show alarming rates of under- and unimmunized children in communities across the Commonwealth.

We cannot fix a problem without an accurate read of it, and the Community Immunity Act’s data reporting requirements are a key first step. But the bill, as necessary, goes further, with targeted education and outreach about vaccine safety and efficacy and standardization and centralization of vaccination protocols.

Please give a favorable report to S.1517 / H.2271 (An Act promoting community immunity, or the Community Immunity Act) and S.1515 / H.2370 (An Act effectuating equity in COVID-19 vaccination, or the Vaccine Equity Bill).

Sincerely,

Jonathan Cohn

Chair, Issues Committee

Progressive Massachusetts

[1] https://www.mass.gov/doc/weekly-covid-19-vaccination-report-july-8-2021/download