After decades of decline, maternal mortality in the U.S. and in Illinois has worsened since 2000 and not all pregnant people are equally at risk. Black pregnant and postpartum women die at six times the rate of white women in Illinois. Women on Medicaid during their pregnancy face almost five times the risk of pregnancy-related death that women with private insurance experience. But to call this phenomenon a maternal mortality “crisis” only captures some of the story. While “crisis” captures the sense of urgency needed to address life-threatening conditions, it also implies that this is a new or time-sensitive issue. Medical abuse, coercion, and experimentation against Black birthing parents in the United States is not new. Nor are the solutions that we are suggesting the state use to address it.
Doulas, lay midwives, and trained home visitors have been a part of birthing since ancient times, especially in the Black community. But the professionalization of medicine and birthing has shoved Black birth workers to the side since the 1800’s. Today, birthing in the U.S. is centered around hospital care which drives up costs, limits consumer choice, and leaves pregnant people at increased risk for pregnancy complications compared to other developed countries. Furthermore, the structural racism present in every facet of society, including health care, means providers are implicitly biased against patients who are Black, Indigenous, and People of Color. This bias manifests in the quality of care given to BIPOC people, leading to a lack of support during pregnancy.
History, research and conversations with pregnant people demonstrate the importance of quality health care before, during, and after the pregnancy, as well as access to early interventions and support to keep pregnant people and their babies healthy. The Department of Public Health recommended in 2018 that the state reimburse doulas and home visitors to increase this support as a way to address lack of support for pregnant and postpartum people with Medicaid. Other reports from the Illinois Taskforce on Maternal Mortality and Morbidity and the 2021 IDPH Infant Mortality Report recommend the same. EverThrive Illinois witnesses the need for these interventions every day. The Community Engagement team at EverThrive IL hear stories about the challenges families face in accessing supportive services and listens to solutions they want. Chicago Birthworks Collective, the first collective of birthworkers to specifically serve Black birthing families in Chicago, is already implementing some of these culturally-affirming practices that communities are crying out for.
“As Black doulas serving a large number of families who receive Medicaid health coverage, we see the great potential for change in doula Medicaid reimbursement. State legislature that enables those receiving Medicaid coverage to access very vital extended arms of care in doula support is absolutely essential and shows that our state is thinking intrusively about providing better holistic care for Black families. It is essential that this bill acknowledges feedback from the birthworkers who are most likely to provide this direct support, i.e. community based doulas by including a living wage reimbursement for prenatal care, birth support and postpartum home visits, as well as inclusive eligibility requirements for medicaid reimbursement providers. We are excited to see such an important piece of legislation coming into view to support Black families and hopeful for the fair and equity based execution of this bill.”– Tayo Mbande, co-founder, Chicago Birthworks Collective
EverThrive IL and partners at StartEarly, Nurse-Family Partnership, and the Shriver Center have been working on legislation to implement Medicaid Reimbursement of doulas and home visitors in Illinois. Our efforts have resulted in the inclusion of Medicaid Reimbursement for doulas and home visitors in the Black Caucus Health Pillar, House Bill 158. Earlier this month, the bill passed both houses and now awaits Governor Pritzker’s signature. The bill language intentionally allows for a year of planning before implementation, during which the IL Department of Insurance will seek the input of doulas and home visitors to ensure community voice is represented, especially on important issues like compensation. EverThrive IL is grateful for the legislative champions Reps. Greenwood, Flowers, Lilly, Gabel, and Moeller and Sen. Hunter who worked to successfully pass the bill and now look forward to the bill becoming law, increasing access to these life-affirming and sometimes life-saving services.
Medicaid reimbursement of doulas and home visitors is an important step in increasing choice and access for birthing people. It is not a band-aid, however, for the disparities in birthing, nor for the historical and contemporary harms that the professionalization of medicine and birthing have leveled on the BIPOC community. Illinois needs Medicaid reimbursement for doulas and home visitors as one piece of the puzzle to increase safe, supportive births. EverThrive IL will keep fighting to make Illinois a place where birth is safe no matter your race, class, gender, sexual orientation, immigration status, disability status or religion.