Pittsburgh Review

Washington, D.C. (May 9, 2023)— Congresswoman Summer Lee joined Ranking Member of the Committee on Oversight and Accountability, Rep. Jamie Raskin and  Co-Chairs of the Black Maternal Health Caucus Rep. Lauren Underwood and Rep. Alma S. Adams, Ph.D., C; Chair of the Congressional Black Caucus Health Braintrust, Rep. Robin Kelly; and fellow Oversight Committee Members Rep. Cori Bush, Rep. Shontel Brown, Rep. Jasmine Crockett and Rep. Robert Garcia; along with Rep. Gwen Moore to issue the following statement after the Government Accountability Office (GAO) released a report examining barriers to expanding access to midwifery health care coverage, midwifery education programs, and midwifery workforce effects on the maternal health outcomes in the U.S.:

“Representing Pittsburgh, where Black women are 3 times more likely to die from childbirth than white women, and are more likely to die during pregnancy than in 97% of other cities. These findings make clear the atrocious reality of maternal health in this country and the bold action necessary to end the maternal mortality crisis,” said Rep. Summer Lee.  “Every mother deserves access to safe maternal and reproductive health services, and we must act with urgency because the lives of millions of babies and mothers depends on it.”

“Today’s report sheds light on the various barriers to obtaining midwifery care and education despite the practice’s significant benefits in improving maternal health outcomes.  At a time when maternal death rates are rising across the country, increasing access to midwifery care is vital to keeping patients safe and thriving.  It’s evident from GAO’s report that Congress must invest in affordable, high-quality education, and expand insurance coverage, including Medicaid to ensure midwives can offer the best possible care to patients regardless of race or income,” said Ranking Member Jamie Raskin. 

During the Committee Democrats’ May 6, 2021, hearing examining America’s Black maternal health crisis, then-Chairwoman Maloney announced that the Members commissioned three new GAO studies to examine the effect of the coronavirus pandemic on maternal mortality and morbidity, the state of America’s perinatal workforce, and the disproportionate impact of the Black maternal health crisis on people who are incarcerated.

On October 19, 2022, the Members released the first of three GAO reports that examined the impact of COVID-19 on maternal health, showing COVID-19 contributed to more than one-quarter of maternal deaths during 2020 and 2021.

 According to this week’s new GAO report, midwives provide a range of health care services and can serve a critical role in improving the negative maternal care outcomes like those outlined in previous reports.

Below are findings from GAO’s new report:

Health Care Coverage and Challenges to Obtaining Midwifery Care

• Insurance companies and Medicaid reimburse midwives at a lower rate than physicians who provide the same services.  As a result, low rates of reimbursement make it more difficult for midwives to serve low-income communities.  In addition, Medicaid’s low payment rates for midwives can force them to take on more clients than desired just to maintain their practices.
• A 2014 study of insurance companies found that 47% of insurers did not cover birthing centers, leaving pregnant people to pay high out-of-pocket costs or to seek other forms of birthing care. 
• The same study found that 20% of insurance plans did not include certified nurse-midwives, 60% of plans did not include certified midwives, and 65% of plans did not include certified professional midwives in their provider networks.
• In addition to financial barriers, GAO’s report cites lack of knowledge, limited location access, and lack of diverse providers as challenges to obtaining midwifery care.

Midwifery Education Barriers

• Despite an increase in midwifery students from 2016 to 2021, GAO’s report shows that cost is a challenge to students pursuing a career in the field.  According to a survey of underrepresented people wishing to become midwifes, 58% of respondents reported the cost of tuition as a barrier to completing their studies.
• As a result of limited federal funding, the insufficient number of training centers and educators was also cited as a barrier to meeting education requirements.  One director told GAO that enrolled students can wait up to one year for a clinical spot, delaying their graduation date and causing financial hardship.
• A survey of underrepresented people who were interested in becoming midwives reported that 38% of respondents felt discouraged from entering a training program because of the lack of midwives matching their racial identity.

Barriers to Measuring the Quality of Midwifery Care

• The same challenges to tracking the quality of maternal care in general also apply to assessing the quality of midwifery care, including attributing care to a specific provider and lacking patient experience measures.
• Throughout pregnancy and delivery, a patient will interact with multiple providers, including a midwife.  This makes it challenging to attribute specific health and maternal outcomes to a specific provider.  This challenge is exacerbated when a birth takes place outside of a traditional hospital setting.
• According to researchers interviewed by GAO, maternal quality measures do not account for patient experience, including whether the patient was treated with dignity and respect.

Original source can be found here.