Black Maternal Health Caucus pushing for change in new Minnesota legislative session

Almost two years ago, the few Black women in the Minnesota Legislature recognized a need to address the growing disparities Black mothers and babies face, so they formed the Black Maternal Health Caucus.

Since then, the Legislature includes more Black women, and the caucus has grown to five members who use their experiences and expertise to address disparities.

“We’ve all heard the data that Black women are three to four times more likely to die from pregnancy-related causes. But I think the second half of that data; we don’t hear as often, the fact that more than 80% of those deaths are preventable,” said the caucus chair, state Rep. Ruth Richardson, DFL-Mendota Heights.

After the Dignity in Pregnancy and Childbirth Act passed in 2021, Richardson got the idea to start a Black Maternal Health Caucus. Members of the caucus have various specialty areas; for example, the vice-chair, Rep. Esther Agbaje, DFL-Minneapolis, has experience advocating for family preservation.

“Minnesota, unfortunately, is one of the states that has high disparities in out-of-home placements for children who are not white. Black children account for a large percentage of that, and they are anywhere from one to three and a half times more likely to be taken out of the home for similar infractions as white children,” Agbaje said.

Her work on family preservation and housing stability ties into maternal health outcomes and reducing disparities for Black families.

“What we know in housing is that primarily, single Black women who are the head of household for their children are most at risk for eviction and thus, housing instability,” she said.

What does the caucus do? 

So what’s the difference between having a caucus for a cause and just having people who work on those issues separately?

Each person in the caucus has a unique background and expertise that they bring to the issue of maternal health. For example, Rep. Hodan Hassan, DFL-Minneapolis, is a mental health practitioner, bringing a provider and health care perspective.

The newest member to the caucus is Rep. Mary Frances Clardy, DFL-Inver Grove Heights, who has a background and interest in education. Rep. Athena Hollins, DFL-St. Paul, also serves on the caucus.

During the most recent session, the caucus passed one of its priorities: expanded access to postnatal care. That bill got all insurance, state and private, to cover three visits for a patient within the first 12 weeks after childbirth.

“Historically, after giving birth, a person would have one visit six weeks after giving birth,” Richardson said. “Understanding that what they call the ‘fourth trimester’ after giving birth continues to be a highly vulnerable period, where there can be not only risks of mortality (to both mother and child), but severe morbidity events or what they call the near misses where someone almost dies.”

The idea for the law was one of 83 community-driven recommendations generated by the House Select Committee on Racial Justice. It officially became law at the beginning of 2023, and Richardson has already heard responses from community members.

“I have had responses, some on Twitter, people who were moved to tears because they were thinking about their own experience after giving birth and knowing that it can now be different for other people within the future,” Richardson said.

In 2021, the caucus helped expand funding for the African American subsection of the state’s Integrated Care for High Risk Pregnancies (ICHRP). The program works alongside a similar program focused on Indigenous birth outcomes, since much of the work relates to one another, Agbaje said.

“Working with each other and kind of sharing data, sharing stories, sharing experiences, so that way we’re not fighting for crumbs,” Agbaje said. “I think the work we’re doing here in this caucus is very much focused specifically on Black women, but it can be extrapolated and applied to Indigenous women, Latinx women, Asian women, because they’re facing maybe not the exact same disparities, but very similar.”

Goals for this session

While the group passed several pieces of legislation this past session – the legislators believe there’s more to do. Richardson is particularly passionate about something that got carved out of the Dignity in Pregnancy and Childbirth Act bill that would have expanded the state’s maternal mortality review committee to include morbidity, not just mortality.

“Currently, if someone dies, either during pregnancy while giving birth or within postpartum, there’s a review of those cases to understand sort of what went wrong and to really understand the prevention points going forward. When we think about what they call morbidity cases, or where people almost die, those happen much more often than mortality cases. There are tremendous learnings to be had from understanding those morbidity events,” Richardson said. “The state of Texas has a morbidity review committee, and we in Minnesota still do not have a morbidity review committee. Surely if Texas can have one, we can, too.”

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Since 2019, Richardson advocated for a morbidity review.

“It’s a reminder that even as we make important steps forward, we still have a lot more work to do. There is an irony in the fact that when we look at so many of these cases where Black women have died as they’ve called out for help, and their cries for help have not been acknowledged or heard to be here year after year, begging people to take notice of the fact that we can do something different to save lives, is sad and frustrating,” Richardson said. “The longer that we delay on this, the more it’s hurting our communities who continue to experience these deaths and morbidity events at a greater rate.”

Richardson said that aspect of the bill has had bipartisan support, yet still, for some reason, it hasn’t passed.

“I think people hear us. It then just becomes a matter of will if they want to do something about it,” Agbaje said.

The caucus wants to prioritize the African American Family Preservation Act and a bill ensuring that pregnant patients have access to a “designated support person” while receiving health care services. According to Richardson, its a designated companion who can accompany people to their appointments, whether it be an ultrasound or while giving birth. Paid family and medical leave are also something they want to push for – and feel hopeful about with Democratic leadership this session.

“When you look at the data, states that have access to paid family medical leave, they have not only better maternal health outcomes, they also have better infant health outcomes. You see a decrease in postpartum depression and preterm births,” Richardson said.

The caucus wants to ensure Black women are heard, which is especially important in the OBGYN field.

“When you even think about how our OBGYN practice was built in this country, it was built on brutalizing enslaved Black women. That’s how we got to what we know as the current state of OBGYN care,” Richardson said. “I think health care can do the same thing that the Legislature needs to do … listen to Black women.”