New California Law Aims to Help More Black and Indigenous People Survive Childbirth

Updated Oct. 4, 2021, 2:30 p.m.

Gov. Gavin Newsom signed a bill into law on Monday that aims to improve the survival rates of Black and Indigenous people and their babies during childbirth in California.

Black people were six times more likely to die within a year of pregnancy than white women from 2014 to 2016 and had a higher rate of death than Black women nationally from 2014 to 2017.

In California, Black and Native American babies die at a rate more than double the state average. Black birthing people die at more than three times the state average.

Senate Bill 65, also known as the California Momnibus Act, will collect more details about pregnancy-related deaths, diversify the experts looking at that data and require them to recommend ways to reduce racial and socioeconomic gaps. It also would expand access to doulas and midwives, whose presence can drive better care.

"Every individual deserves to have a healthy pregnancy and birth, and this bill will help make this a reality for more California families,” Newsom said in a press release. “It is unacceptable that the maternal and infant mortality rate among Black and Indigenous communities remains significantly higher than the state average."

SB 65, co-authored by Democratic state Sen. Nancy Skinner, D-Berkeley, formalizes a committee that is tasked with investigating every death of a birthing person and allows for voluntary interviews of family members to better understand what happened. It also looks into pregnancy-related deaths among members of the LGBTQ+ community.

"Gov. Newsom’s signing SB 65, the California Momnibus Act, represents a significant victory for Black maternal and infant health. Despite our medical advances, more U.S. babies and mothers die during birth than in all other high-income countries, and these preventable deaths are disproportionately higher for Black families,” said Skinner, who is also vice chair of the Legislative Women’s Caucus. “With the enactment of SB 65, California will help close racial disparities in maternal and infant deaths and save lives."

The bill also increases Medi-Cal coverage to a full year postpartum. Previously, birthing people in lower-income families were kicked off Medi-Cal, California's version of the federal Medicaid program, two months after giving birth.

"This bill affirms here in California these kinds of disparities in our maternal and infant outcomes will no longer be tolerated," said state Assemblymember Dr. Akilah Weber, D-San Diego, another co-author of SB 65.

See the signing below:

Original post: Sept. 27, 2021

California has among the lowest death rates nationally among pregnant and birthing people, but the numbers for Black people in those populations tell a different story.

They were six times more likely to die within a year of pregnancy than white women from 2014 to 2016 and had a higher rate of death than Black women nationally from 2014 to 2017, the most recent time frame for which data is available.

A bill before Gov. Gavin Newsom aims to change that. Nicknamed the “Momnibus” bill, it would collect more details about pregnancy-related deaths, diversify the experts looking at that data and require them to recommend ways to reduce racial gaps. It also would expand access to doulas and midwives, whose presence can drive better care.

“If you really want to address the issue, it is going to take a serious investment and resources, whether that means providing every Black mother a doula or really investigating what’s happening when Black mothers die,” said Jen Flory, policy advocate for the Western Center on Law and Poverty, which supports the bill.

Newsom backed past efforts to improve care for Black pregnant people by requiring implicit bias training for health care workers involved in perinatal care, and he’s made support for women and new birthing people a priority for his administration. But his Department of Finance opposes the bill because the $6.7 million price tag for expanded data collection wasn’t included in the state budget. Newsom hasn’t said whether he’ll sign it.

Among wealthy nations, the United States ranks poorly in death rates of birthing people, and California’s effort is part of a national push to improve outcomes. Back in 2020, Democratic legislators on Capitol Hill introduced the Black Maternal Health Momnibus Act, which received the support of then-Senator Kamala Harris. But the bill never got a vote.

During his campaign, President Joe Biden lauded California’s efforts to reduce deaths, and in April he recognized Black Maternal Health Week.

There are two ways to track deaths: The mortality rate for birthing people, used globally, counts deaths during pregnancy and within 42 days of giving birth. The pregnancy-related mortality rate, used in California and some other states, tracks deaths within a year of giving birth. The Centers for Disease Control and Prevention looks at both, though data lags and isn’t available to compare across states for the latter measure.

Earlier this month, the California Department of Public Health released a report tracking California’s outcomes from 2008 to 2016. Deaths of birthing people within a year of pregnancy hit a low in 2012, with fewer than 10 per 100,000 live births. It ticked up to about 14 deaths in 2016, slightly behind the national rate of almost 17 deaths. Using the mortality rate of birthing people, California ranked only behind Illinois for lowest death rates in 2019.

But the rate for Black birthing people was far higher. From 2014 to 2016 in California, about 56 Black birthing people died per 100,000 live births, compared to 13 Asian, 11 Latina and fewer than 10 white birthing people. Nationally, Black birthing people died at a rate of nearly 42 per 100,000 live births from 2014 to 2017. California’s Black birthing people died at six times the rate of white birthing people, up from three times the rate in 2008.

“The reality is there is a disparity between Black and white women and it’s not getting better,” said Kimberly D. Gregory, director of maternal fetal medicine at Cedars-Sinai Medical Center in Los Angeles and a former member of California’s pregnancy surveillance committee.

The committee plans to release data on pregnancy-related deaths through 2020 by next year. It relies on grant funding.

SB 65, authored by Democratic state Sen. Nancy Skinner, aims to write the committee into state law and strengthen its data collection and duties. It would require the committee to have 13 members, including doctors, midwives, doulas and community advocates and would include a tribal representative. According to the bill's text, California’s Native American infant mortality rate is 11.7 deaths per 1,000 live births, which is far above the state’s average of 4.2 deaths per 1,000 live births.

Most of the committee's current members are doctors.

The committee would investigate every death of a birthing person and allow for voluntary interviews of family members to better understand what happened. The committee would have to publish its findings and recommendations every three years. It would also look into pregnancy-related deaths among members of the LGBTQ+ community.

“We can make better decisions about prevention, intervention, systems changes, not only at the hospital level but at the community level,” said Mashariki Kudumu, director of maternal and infant health initiatives for the March of Dimes, Greater Los Angeles, which is a co-sponsor of the bill. “What comes with diverse and different perspectives are better changes to systems that improve care.”

Kudumu is also trained as a doula. Newsom in his state budget made doulas a covered benefit under Medi-Cal, the state’s health insurance program for lower-income people, following states including New York and Illinois. Doulas are trained to assist and advocate for birthing people in pregnancy and during and after birth. Research shows their presence reduces pregnancy complications and low birthweight in babies.

The benefit takes effect next year, and the bill before Newsom would establish a group to study its use. The proposal also expands training for midwives.

Kudumu said she’s helped birthing people stick to their birthing plans in the face of pressure from doctors and provided them with nursing and lactation support.

She knows the value from personal experience. When Kudumu delivered her son prematurely, she felt disrespected by the doctor because she’s a Black woman who was on Medi-Cal at the time while she was in graduate school.

Kudumu had to fight to ensure her son got breastmilk instead of formula while he was in the newborn intensive care unit. She remembers the doctor’s attitude changing when another doula at the hospital came up to greet her.

“We want to make sure that this resource, that evidence shows improves health outcomes, is more accessible to people,” she said.

Original reporting for this post was from Kathleen Ronayne of the The Associated Press. KQED's April Dembosky contributed reporting to the updates.