CHICAGO — Acknowledging that structural racism and bias negatively impact maternal health care in the United States, physicians at the Special Meeting of the American Medical Association (AMA) House of Delegates adopted new policy to promote equity in maternal health care and expand access to insurance for groups experiencing disproportionate rates of maternal morbidity and mortality.

Today’s vote laid foundational priorities for ongoing AMA efforts to address the maternal health crisis and the complex, multifactorial challenges that drive an overall increase in pregnancy-related morbidity and mortality in the United States – the only industrialized country with a rising maternal mortality rate.

“The AMA is committed to being a leader on maternal mortality prevention, and the nation’s physicians have charged the AMA to prioritize the elimination of racial and ethnic inequalities in maternal health care while increasing access to affordable health insurance for new mothers,” said AMA Immediate Past President Susan R. Bailey, M.D. “As a first step, the AMA acknowledges the roles that structural racism and bias play in negatively impacting health care, including maternity care.”

Efforts to promote maternal health equity for racial and ethnic minority groups have been constrained by a lack of reliable data. To allow for greater understanding of the root causes of materteral morbidity and mortality and the stark racial and ethnic inequities in maternal health, additional research is essential, and accurate, standardized data are needed.

To promote equity in maternal health care, some of the key action items the AMA will pursue include:

• A greater emphasis on research to examine the multiple barriers to optimal care that contribute to inequities in maternal health outcomes, as well as research testing the effectiveness of interventions to address each of these barriers.
• The adoption of federal standards for clinician collection of patient-identified race and ethnicity information in clinical and administrative data to better identify inequities.
• The development of a standardized definition of maternal mortality and the allocation of resources to states and Tribes to collect and analyze maternal mortality data.
• The need for physicians and care teams to embrace educational opportunities on equitable, patient-centered, maternal health care and develop the awareness needed to eliminate racial and ethnic inequities and promote an environment of trust.

To strengthen trusting patient-physician relationships and reduce health inequities, the medical profession should hear and amplify the voices of patients and families, and partner with communities where disproportionate rates of maternal mortality exist. The AMA is calling for greater collaboration with non- clinical community organizations with close ties to minoritized and marginalized groups to identify opportunities to best support pregnant persons and new families. The AMA also encourages funding and development of outreach initiatives to promote comprehensive pre-pregnancy, prenatal, peripartum, and postpartum care.

Access to affordable health insurance is also needed to reduce inequities in maternal health care, and the AMA believes adequate coverage under Medicaid and State Children’s Health Insurance Program (CHIP) is critical since the two programs cover nearly half of all deliveries. However, access to pregnancy-related coverage under Medicaid and CHIP ends at 60 days postpartum, disrupting continuous insurance coverage for maternal health care. In general, one in three women in the U.S. experiences discontinuous insurance coverage before, during, or after pregnancy.

The AMA believes continuous insurance coverage for new mothers is important to decrease inequities in maternal health care and will support an extension of Medicaid and CHIP coverage to at least 12 months after the end of pregnancy and expand eligibility for pregnant and postpartum non-citizen immigrants. The AMA will also support inclusion of pregnancy as a qualifying life event for special enrollment in the health insurance marketplace established by the Affordable Care Act.

In the last year since the AMA recognizes racism as a serious public health threat that is a barrier to appropriate medical care, the AMA has made the elimination of racial and ethnic inequities in health care an issue of high priority. Through our research, collaborations, advocacy and leadership, the AMA is working to enhance the diversity of health care teams, strengthen patient-physician trust, promote safety and quality initiatives, improve communication, and support evidence-based guidelines for equity of care.