Addressing Maternal Health Challenges: Massachusetts Leads with Landmark Legislation

The United States continues to grapple with a maternal health crisis, marked by rising mortality rates and stark racial and socioeconomic disparities . In 2021, the national maternal mortality rate reached 32.9 deaths per 100,000 live births, significantly higher than rates in other developed countries. Black women face a maternal mortality rate nearly three times that of white women, highlighting systemic inequities in healthcare access and quality.

Despite its reputation for high-quality healthcare, Massachusetts reflects these national challenges. From 2018 to 2021, the state’s maternal mortality rate stood at 15.3 per 100,000 deliveries. More concerning is the rise in severe maternal morbidity (SMM), which nearly doubled from 52.3 per 10,000 deliveries in 2011 to 100.4 in 2020. Black non-Hispanic birthing individuals in Massachusetts experienced an SMM rate of 190.8 per 10,000 deliveries in 2020, almost double the state average.

An Act promoting access to midwifery care and out-of-hospital birth options.

In response, Massachusetts enacted “An Act Promoting Access to Midwifery Care and Out-of-Hospital Birth Options” in August 2024. This comprehensive legislation aims to enhance maternal health outcomes through several key initiatives:

Licensure and Regulation: Establishes state licensure for Certified Professional Midwives (CPMs) and lactation consultants, creating a Board of Registration in Midwifery to oversee practice standards.
Expanded Access to Care: Mandates that MassHealth (Medicaid) covers midwifery and doula services for up to 12 months postpartum, ensuring broader access to essential maternal health services.
Support for Birth Centers: Encourages the development of freestanding birth centers and allows CPMs and Nurse Midwives to serve as clinical directors, expanding birthing options for families.
Mental Health and Substance Use Support: Allocates grants to address maternal mental health and substance use disorders, recognizing the importance of comprehensive care during the perinatal period. Health Policy News recently covered .
Postpartum Support: Expands a universal postpartum home visiting program statewide, offering continued support to birthing individuals during the critical postpartum period.

PCG is proud to partner with Massachusetts in advancing these initiatives. Our collaboration includes programming support for the doula certification program and the implementation of universal postpartum home visiting through the Welcome Family Statewide System Design Support.

Maternal Health Policy Initiatives Across the States

Massachusetts’ legislative efforts align with broader national movements to address maternal health disparities. As all states confront a maternal health crisis marked by rising mortality rates and significant racial disparities, many are proactively implementing policies to enhance maternal care. These initiatives often share common themes aimed at improving access, equity, and outcomes.

Medicaid Coverage for Doulas and Midwives

Recognizing the positive impact of doulas and midwives on maternal outcomes, several states have integrated these services into their Medicaid programs:

Michigan: Under the “Healthy Moms, Healthy Babies” initiative, Michigan covers doula services for Medicaid recipients, aiming to address preventable maternal deaths and reduce racial disparities in maternal health.
Illinois: The state has expanded Medicaid to include perinatal doula and lactation consultant services.
California: As of January 2023, offers comprehensive doula services, including support for various pregnancy outcomes, regardless of immigration status. The state also increased reimbursement rates to encourage provider participation.

Extension of Postpartum Medicaid Coverage

To address health challenges that arise after childbirth, many states have extended Medicaid coverage beyond the traditional 60-day postpartum period:

Texas: Implemented a policy allowing low-income mothers to receive Medicaid for a full year postpartum, aiming to improve access to medical and mental health services.
Alabama: Passed legislation enabling “presumptive eligibility” for Medicaid, providing immediate outpatient care for pregnant women while their applications are processed.

Integration of Mental Health and Substance Use Support

Addressing the full spectrum of maternal health includes mental health and substance use services:

Pennsylvania: In October 2024, Governor Josh Shapiro signed legislation mandating the Department of Health to create and distribute resources on perinatal and postpartum mood and anxiety disorders. This initiative is part of the “Momnibus” package aimed at improving maternal health and addressing disparities, particularly among women of color.

4. Support for Community-Based Maternal Health Services

New York: States are investing in community-based approaches to maternal care. New York recently launched the Doula Expansion Grant Program, providing $250,000 to community organizations for the recruitment and training of doulas, aiming to improve access in underserved areas.

As maternal health challenges persist nationwide, states across the nation are leading the way with bold policies that expand access and improve outcomes. Through innovative legislation and collaborative efforts with partners like PCG, the path toward safer, more supportive care for all birthing individuals is becoming clearer. Continued investment and cross-state learning will be key to sustaining this momentum.