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Improving maternal health is a key issue for Democrats and Republicans as the Virginia General Assembly prepares to get to work Monday in the opening of this year’s legislative session.
Policymakers say expanding access to care for mothers and infants is a bipartisan effort.
“Anyone who’s passionate about maternal health is excited about this General Assembly,” said Kathryn Haines, health equity director at the Virginia Interfaith Center for Public Policy.
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Scope of the issue
In 2024, March of Dimes, a maternal health nonprofit, assigned Virginia a grade of ‘C’ on key indicators, particularly the rate of preterm births, that impact maternal and infant health. Preterm births can be risky and account for more than a third of infant deaths nationwide.
Chronic health conditions, like hypertension and diabetes, can be risk factors for preterm births. But social factors, like late or no prenatal care, poverty, chronic stress and lack of social support can also play a significant role.
Last year, 9.8% of births in Virginia were preterm, or born before 37 weeks of pregnancy. That’s about half a percentage below the national average, but experts say there’s more to be done to lower the rate.
“Virginia has basically pockets of wealth and prosperity and access to care, but also many areas that have very low access to care,” said Elizabeth Kielb, March of Dimes director of maternal and infant health care for the D.C. region. “We did see some increases in preterm birth this year, also some decreases in things like prenatal care and slightly increasing levels of infant mortality.”
The impact was disproportionately high among Black mothers, whose preterm birth rate was 1.4 times higher than all other preterm birth rates. Likewise, the infant mortality rate among babies born to Black mothers was 1.8 times higher than the state rate.
The numbers in Hampton Roads are particularly jarring and have worsened since 2022. Virginia Beach received a grade of D+ with a preterm birth rate of 10.6%. Chesapeake and Norfolk received failing grades, with preterm rates of 11.5% and 13.3%, respectively.
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Workforce expansion
Part of the problem, Kielb said, is an insufficient workforce. March of Dimes and other organizations advocate for an expansion of the obstetrics workforce — OB-GYNs, but also midwives and doulas, which experts say can improve birth outcomes.
Gov. Glenn Youngkin’s proposed budget includes $2.5 million for perinatal health hubs, $1 million to support doulas and community health workers in localities with high maternal mortality rates, and increased payments for psychiatric and obstetric-gynecological graduate medical residencies.
“When we started on our journey, we knew that we needed to approach the problem in a new way, our overall guiding principle was this: We will see every mother and work collectively to provide the care she needs to deliver a healthy, thriving baby,” Youngkin said in statement last month about the proposal.
The Virginia Senate Republican Caucus also listed maternal health among their priorities for the legislative session.
Sen. Emily Jordan, R-Isle of Wight, cited her own experience with maternal health care at a press conference last week.
“Just a couple months ago, I actually almost wasn’t here and able to be here during this General Assembly session, because I had an unexpected consequence of preeclampsia,” Jordan said of the potentially dangerous pregnancy complication associated with high blood pressure. “Oftentimes in the maternal health process, women aren’t sure what our resources are. That’s why I’m very pleased that this caucus and Governor Youngkin are stepping up to have a meaningful conversation about maternal health and how we can save the lives of women and babies as well.”
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Cultural bias
Democrats have proposed their own slate of legislation, nicknamed the “Momnibus,” to address maternal health issues. They say a key component is acknowledging the unconscious bias medical providers have in caring for Black women, who have disproportionately worse maternal health outcomes. Black women are three times more likely to die during pregnancy or delivery than white women nationwide, according to the Centers for Disease Control and Prevention.
“It’s going to take significant training for individuals to understand that what you’re doing to African American women is pretty much learned behavior that you one, have to be aware of, and two, unlearn when you’re dealing with patients that are not like yourself,” said Sen. Mamie Locke, D-Hampton.
Locke has proposed legislation that would require unconscious bias and cultural competency training as part of the continuing education requirements for medical professionals to renew their licenses. Similar legislation was proposed last year, but it was vetoed by Youngkin.
This year, advocates have come back with research from the Humanitas Institute that suggests that practitioners from across the political spectrum benefited from implicit bias training.
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Medicaid expansion
PUSH, a coalition of 40 organizations advocating for maternal health legislation including the Virginia Interfaith Center, also supports legislation from Locke that calls for the implementation of “presumptive eligibility” for pregnant women to enroll in Medicaid, with the goal of reducing application barriers.
“I think a lot of people don’t realize that not everybody has the luxury of prenatal care,” said Haines, the health equity director with the Virginia Interfaith Center. “This would immediately enroll you into care, and then you have 60 days to then go through the formal process from Medicaid. But it allows you to have that immediate enroll into Medicaid, and that is critical when you’re talking about a pregnancy.”
Locke has also sponsored a bill that would ask the Department of Medical Assistance Services to apply for a Medicaid waiver to provide pregnant and postpartum care for incarcerated women.
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Other initiatives
Legislators are also aiming to tackle issues like maternal health deserts and cardiac issues during pregnancy.
“Over the last few years, Virginia has done so much work to expand access to doulas with Medicaid expansion and with getting people services, but the numbers are still too high when it comes to maternal mortality, especially Black maternal mortality,” said Del. Candi King, D-Prince William County.
To that end, King and Sen. Louise Lucas, D-Portsmouth, are introducing a bill to establish a commission on women’s health policy. Other legislation would fund a pilot program that would include remote monitoring for high risk pregnancies to provide moms in rural communities with remote equipment and virtual assistance to monitor their babies and their health.
Kate Seltzer, kate.seltzer@virginiamedia.com
