Some legislators and advocates say racial disparities in maternal health services remain, despite a comprehensive bill passed in 2024 to address those issues.
State health officials in early 2025 unveiled expanded maternal health-care services, stemming from that law, based on recommendations issued in 2023.
The controversial closure of Leominster Hospital’s maternity ward in September of that year and worsening health disparities among minorities provided the impetus for the reforms.
Though state lawmakers have yet to give the Department of Public Health more say in closure decisions, they did take a major step in augmenting the present state of maternal-health care.
Thanks to that sweeping maternal-health bill passed a few days beyond the close of the Legislature’s July 31, 2024, formal session, expectant and new mothers began to benefit from expanded physical- and mental-health care options.
The Special Commission on Racial Inequities in Maternal Health advocated for the bill’s components in a May 2022 report, which were also endorsed in a Department of Public Health review following the controversial closure of the Leominster birthing unit.
The legislation aimed to address the rate of severe maternal morbidity in Massachusetts, which nearly doubled from 2011 to 2020.
Despite having some of the best medical centers in the world, this state has one of the highest rates of severe maternal morbidity in the country.
Those rates were also 3.5 times higher for Black women compared to their white counterparts in 2023, according to a Centers for Disease Control and Prevention report released in February.
This startling statistic is at odds with other countries with similar maternal-health policies, which this bill hoped to address.
With these goals in mind, maternal-health priorities for 2025 included finalizing birth-center regulations and incorporating a new classification system into hospital licensing regulations, Elaine Fitzgerald Lewis, director of the Department of Public Health’s Bureau of Family Health and Nutrition, said at the time.
Lewis told the Public Health Council that regulations aimed at reducing barriers to freestanding birth centers, and an alternative delivery setting for lower-risk pregnancies, would take effect in early 2025.
The DPH also created a voluntary certification pathway for doulas, who offer emotional and educational support to pregnant and postpartum individuals.
Other changes affecting doulas now allow them to be eligible for MassHealth reimbursement at non-doula group practices, including in hospital settings.
The MassHealth program previously limited coverage to doulas working independently or in a doula-only group practice.
Yet despite all these initiatives, state Sen. Liz Miranda insists those racial inequities persist.
“We pride ourselves in being this leader, right? And yet we know that too many families and too many Black women and women of color continue to experience these inequitable outcomes,” said Miranda, D-Boston, as reported by the State House News Service recently. “The reality is actually truly unacceptable.”
Advocates for birth centers and midwives say those services improve maternal health outcomes, but the state’s only birthing center is at risk of closing, mainly because of lagging reimbursement rates that are also slowing the opening of new centers.
Among their budget requests are maintaining funding for the Perinatal Mental Health Trust Fund, which was established in the 2024 maternal health law and supports culturally coordinated and community-based support to boost mental health and well-being of new parents.
They’re also asking for investments in the midwifery workforce to boost training and education, enable student loan forgiveness for midwives and diversify the midwifery workforce to boost health equity and economic opportunities.
Advocates say two pending bills would significantly improve working conditions for midwives.
One would ensure that licensed certified professional midwives or certified nurse midwives are paid no less than physicians and hospitals for delivering the same services, while the other would require midwives to get paid equally as licensed physicians offering the same services.
“Every midwife should be getting paid the full value to deliver a baby,” said Rep. Marjorie Decker, D- Cambridge, an original sponsor of both House bills.
She noted that when employees are paid more, there are more opportunities, which can lead to more diversity within the workforce.
She told the State House News Service there is “incredible momentum” surrounding the issue from colleagues in the State House and among advocates.
The News Service reported that the House’s recently unveiled fiscal 2027 budget proposal doesn’t include any maternal health funding, according to House Ways and Means staff.
They indicated there are ongoing talks about funding for maternal health outside the formal budget.
Decker and state Rep. Manny Cruz have said they would consider filing budget amendments related to midwives and birthing centers.
Despite the strides taken to improve overall maternal health, care providers’ standing and eliminating racial disparities, more needs to be done.
Passing those two previously mentioned bills and providing additional funding would go a long way to making that goal a reality.