The U.S. has the highest maternal mortality rate of any developed country with 17.4 deaths per 100,000 live births. And the CDC has reported that close to 60% of these deaths are preventable.
In the U.S., Black women are three times as likely to die during pregnancy as white women. But in Illinois, the stats are even worse where Black women are six times more likely to have a pregnancy-related fatality.
In another study, over 27% of women of color with low socioeconomic status reported mistreatment during maternity care compared to 18.7% of white women with similar socioeconomic status.
This public health crisis has been going on for some time and, finally, there’s traction to do something about it — at least at the legislative level.
On the federal level, Illinois Congresswomen Lauren Underwood and Robin Kelly among others are working on a set of bills to improve maternal care in the U.S., especially for birth givers of color.
In the meantime, there are several bills moving through the state-level legislature that could dramatically improve options for maternity care and childbirth, especially for Black folks.
In this piece, we offer an overview of the different Illinois bills and where they are in the legislative process.
New Illinois Law Adds Doula Services and Home Nurse Visits to Medicaid and Requires Implicit Bias Training for HCPs
Status: New law as of 4/27/2021
Research has shown that doula care can result in higher breastfeeding latching rates and fewer low-birth-weight babies. And having a doula present during birth can result in shortened labor, fewer operative deliveries, less need for analgesia, and more satisfaction with the birthing process.
Especially for many Black women, doula care is a way to take back control over pregnancy and childbirth.
However, doula services are not covered by Medicaid in most states leaving most birthing parents to pay out-of-pocket.
The Illinois House Bill 0158, signed into law in April, adds coverage for doula services and home nurse visits to Medicaid. This bill is part of a set of bills proposed by the Illinois Legislative Black Caucus to improve the lives of African Americans in the state. The new law also creates a new required implicit bias training for interns, residents, and physicians and creates a pool of $50 million to expand women’s reproductive health services in the state.
Toni Taylor, a co-founder of Chicago Birthworks Collective, which offers doula services that center Black birth givers in Chicago, explained that this legislation is long overdue.
“We have over 20 years of statistics about Black mortality, and it’s one thing to say, ‘I have all this statistics, and I know all this information. It’s another thing completely to just not do anything with it,” Taylor explained in a Zoom interview. “I’m really happy about the fact that there’s an opportunity for reconciliation and to actually show Black women that we are valued.”
New Funding Extends Medicaid Coverage 12 Months After Delivery
Status: Funding now available for those insured by Medicaid
In 2019, a new act was created that changed Medicaid coverage post-birth from 60 days until 12 months. The problem was that the funding for this coverage needed to be approved by the federally-run Centers for Medicare and Medicaid Services in the form of a waiver. Under the Trump administration, nothing happened.
This year, President Biden added language in the latest COVID relief plan that made it easier to expand Medicaid coverage, and HHS approved the waiver, making Illinois the first state to extend full Medicaid coverage to postpartum individuals for 12 months.
New Bill Would Expand Postpartum Care In Several Ways
Status: Passed in the Senate and sent to the House
This week, Senator Cristina Castro is planning on calling an amendment to SB 967 for a vote. The amendment would expand Medicaid’s postpartum care in many ways that could reduce the racial health disparities and reduce maternal deaths following birth. According to Senator Castro’s office, the amendment would:
- Cover perinatal depression screenings for a year after birth and would pay for case management and outreach to high-risk birth givers.
- Revise the High-Risk Infant Follow-Up Program to expand services to treat any pregnant or postpartum person determined to be high risk.
- Mandate private insurance plans to cover pregnant and postpartum individuals for up to one year after giving birth to treat mental, emotional, nervous or substance use disorder or conditions, cover case management and outreach for individuals with high-risk pregnancies, among a few other conditions.
- Require Medicaid to cover a universal postpartum visit within the first three weeks after childbirth.
The bill would require the Illinois Department of Public Health to make best practices available to hospitals on how they should assess pregnant and postpartum individuals. The hospitals would be required to incorporate those best practices into their written policies, including offering coordination of a postpartum visit after discharge from the hospital.
“While the health care reforms led by the Black Caucus this past year and the recent expansion of Medicaid for new mothers are a good start, I am determined to keep up my work to reduce the number of preventable postpartum deaths in Illinois,” Senator Castro explained in a press release.
New Bill Would Allow For More Freestanding Birthing Centers In Areas of Need
Status: Passed in the House, assigned to Senate committees
A freestanding midwife-run birth center acts as an alternative to hospital maternity wards and offers birth givers more comfortable surroundings during labor. Birth centers are connected to lower rates for preterm birth and low birthweights, and lower rates of C-section births. They’re also cheaper.
In 2013, the first free-standing birth center in Illinois was opened in Berwyn, a south suburb of Chicago. This birth center, found at the PCC South Family Health Center in Berwyn has acted as a successful pilot program in the Chicago area.
But the pilot program was just that: a pilot program.
“Hospitals saw it as a threat to the number of births happening in hospitals,” Representative Gabel explained. “And they wanted [births] to be safe. So they set up some pretty stringent guidelines about how birth centers had to be set up, like windows a certain distance apart and a lot of stuff that really is not important.”
These guidelines made it more difficult for new birth centers to be opened under the pilot program.
This year, two new bills — Illinois House Bill 738 and Illinois House Bill 3995 creates guidelines to establish new birthing centers in areas of need, especially the south side of Chicago where birth givers have fewer options. The new legislation would also enable birth center services to be covered by Medicaid.
Two African American midwives are spearheading the next birth center project which would serve Chicago’s South Side.
Two New Bills Would Make Home Births More Accessible
Status: HB 3401 passed in the house and referred to a Senate committee; SB 1826 assigned to a Senate committee
Similar to birth centers, home births have been tied to lower rates of maternal morbidity (physical or mental illness or disability directly related to pregnancy and/or childbirth) and lower rates of interventions like cesarean births. Individuals who give birth at home also report higher rates of satisfaction and feelings of control over the birthing process.
(On average, nearly 14 newborns per 10,000 live births died following a planned home birth, a rate that’s four times as high as that of newborns delivered in a hospital.)
And yet, with all of these benefits, it is incredibly difficult and expensive to have a home birth in Illinois because there are few professionals that are licensed to assist with home births. In addition, most home birth expenses are not covered by insurance. Two new bills could change this.
The Illinois House Bill 3401, which is over ten years in the making, creates a state license for Illinois midwives which allows them to assist in home births. More licensed midwives means more options for home births.
At the same time, the Illinois Senate Bill 1826 would create a pilot program that would offer folks more maternity care and labor choices through Medicaid including planned home birth services and in-home perinatal and postpartum care services.
State Representative Robyn Gabel, who spent 22 years as the Executive Director of the Illinois Maternal Health and Child Coalition (now known as EverThrive Illinois) is a sponsor for many of the House bills involving maternity health, including the midwives licensing act.
She expressed the importance of changes to healthcare legislation in a phone interview, “We’re a state that strives for justice and equity, it’s just not right that people should die just because of the color of their skin.”