By Brianna Wetherbe
Communities of color continue to bear the brunt of COVID-19’s devastation. Recent federal data on the pandemic from the Centers for Disease Control and Prevention indicates that African Americans in the United States have been three times more likely to contract the disease than white Americans.
But even before the pandemic, there was ample evidence that racism and discrimination were baked into the health care system that leads to these large health disparities — and they are particularly evident in maternal and prenatal care outcomes.
The maternal mortality rate for Black women is more than twice the rate for white women, and the Black infant mortality rate is also more than double the rate of non-Hispanic white infants. These differences may stem from discriminatory levels of post-pregnancy coverage and care, but disparities in coverage also exist well before delivery, during prenatal care.
Screening tests, like traditional serum or combined screening, help pregnant women identify genetic disorders in their babies and are a critical component of prenatal care. Newer screening options available—noninvasive prenatal tests, or NIPT — use a mother’s blood sample to analyze a baby’s DNA for genetic abnormalities. These tests give more accurate results than traditional screening methods like maternal serum screening.
Women who use those older testing methods are also 95 times more likely to be unnecessarily referred to a specialist than women who use NIPT. NIPT is also safer for both the mother and the baby, as they eliminate any potential harm that invasive procedures may cause the fetus.
The simple and sad reality is that Black women in this country have less access to the safest, most effective maternal and prenatal care. Data from California’s Department of Public Health showed that white women were more than twice as likely to gain access to NIPT as Black women, when measured among women who opted out of the state-funded prenatal screening program and instead chose private payer or other plans that enabled them to use NIPT as a first-tier test.
A broad range of systemic factors and players are responsible for this gap in access, including failure by large insurers like United Healthcare and Aetna to cover NIPT. They had previously taken cover under American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine’s ambivalent stances in recommending and advocating broad access to NIPT. However, those medical organizations have recently updated their guidelines to fully recommend NIPT for all pregnant women.
But Congress also has an important role to play to begin dismantling the systemic racism and discrimination within America’s health care — and in particular, maternal and prenatal care.
The Black Maternal Health Momnibus Act of 2020 tackles the large existing gap in this country’s maternal health care outcomes by requiring Health and Human Services and other federal agencies to address the social determinants of health, including workforce issues, data collection issues, mental health, and more. The Cures for the 21st Century Act — CURES 2.0 — is another opportunity to include policies that can improve access to high-quality maternity care for women and their newborns.
An additional critical step that Congress can take to address the racial disparity in maternal and prenatal care is to federally mandate NIPT coverage in Medicaid for all pregnant women. NIPT is currently unavailable for younger women on Medicaid in 37 out of 50 states and is not available for any women in nine of these states. To help protect Black mothers during the COVID-19 pandemic, all state Medicaid and Medicare systems should reimburse healthcare providers for NIPT to reduce the risk of exposure to COVID-19 and to reduce strain on the health care system.
I urge Congress to begin knocking down the systemic discrimination and racism in this country’s health care by including Momnibus and CURES 2.0 in the next COVID-19 relief bill and taking steps to guarantee access to non-invasive prenatal screening tests through all state Medicaid programs. All pregnant women should have access to the safest and best maternal and prenatal care both during and after this pandemic.
Brianna Wetherbe is a director and board member at San Diego-based Stand Up for Accurate Prenatal Answers and a health advocate focused on bringing equitable prenatal and maternal health care to all women.