Attorney general grants $1.5 million to expand maternal health workforce, access to care

Alarmed by "devastating statistics" of worsening severe maternal morbidity rates, particularly among Black people during labor and delivery, Attorney General Andrea Campbell announced $1.5 million in grant funding to 11 community organizations and health centers Tuesday in a bid to tamp down on racial disparities.

The money will support programs aimed at growing the doula and perinatal mental health workforce, training more multilingual caregivers, and expanding lactation services, among other initiatives. Campbell said her office is committed to using every tool it has to close gaps in maternal health care and partnering with other organizations, noting "no one entity can solve this crisis by themselves."

"The goal is to make sure we are reaching the organizations that are doing the work and touching real patients, and frankly doing it in a way that is inclusive," Campbell said Tuesday during a roundtable discussion with grant recipients at Whittier Street Health Center in Roxbury.

Officials from Campbell's office told the State House News Service it's difficult to gauge, for now, whether another round of grant money will be available in the future. This distribution of maternal health equity grants comes about a month after the Department of Public Health released a report that found the number of people experiencing complications from pregnancy or delivery in Massachusetts nearly doubled from 2011 to 2020.

The severe maternal morbidity (SMM) rate increased from 52 per 10,000 deliveries to 100 per 10,000 deliveries, with Black non-Hispanic people recording the highest rates within that 10-year period.

Cambridge Health Alliance (CHA), which already employs nine doulas, plans to hire 11 more doulas to provide "culturally and linguistically competent care" for people through their pregnancy and postpartum period, said Dr. Melissa Ethier, director of labor and delivery. CHA received grant funding of about $149,000, according to Campbell's office.

Nearly half of CHA's patients don't speak English, and recruiting doulas who speak their native languages and are potentially from the same countries could help break down that barrier, Ethier indicated in an interview with the State News Service.

"Doulas will accompany birthing people when they enter the hospital during labor, and they're providing emotional, physical support to the patient," Ethier said, using the inclusive term for someone who gives birth to a newborn. "They're not doing medical care, they're not doing nursing care. They're there for that support as someone who knows you and understands where you're coming from, and who is helping you interface with this health care system."

Expanding access to doula care was a top recommendation in a report from the Special Commission on Racial Inequities in Maternal Health. Doulas empower pregnant people to advocate for their needs, and the care model is linked to decreased risks of C-sections and postpartum depression, according to the May 2022 report.

Yet with limited health insurance coverage for doulas, birthing people for now struggle to pay for their services, which can cost between $800 to $2,000, according to the report.

That could change as the Executive Office of Health and Human Services is proposing new regulations tied to reimbursement rates for doulas services, as well as establishing a new provider type and outlining the "conditions" and "limitations" for doula services covered by MassHealth.

Virtual public hearing on the regulations, which could take effect on or after Oct. 30, are slated for Aug. 25, according to a notice.

MassHealth plans to cover doula services during pregnancy, labor, delivery and through 12 months of the postpartum period in late 2023, an EOHHS spokesperson said.

As MassHealth rolls out its reimbursement model, Tufts University's Center for Black Maternal Health and Reproductive Justice received a grant of about $103,000 from Campbell's office to develop a toolkit for doulas, said postdoctoral research fellow Erin George.

The goal is to create a digital, multilingual resource to help doulas become enrolled as MassHealth providers, George said, and to track their experience to understand whether the reimbursement structure is generating more income and expanding the availability of doula care.

"We want to make sure that this is something that is as accessible as possible to all doulas who would be serving MassHealth members," George, who is also a certified nurse-midwife, said in an interview.

Meanwhile, Whittier Street Health Center secured a $150,000 grant to establish a parenting program that encompasses prenatal and postpartum care, breastfeeding support and mental health services, Campbell's office said.

The center, which serves vulnerable communities like immigrants and refugees, will also hire more bilingual staff to boost outreach and education efforts. Dr. Adrienne Headley stressed the importance of building trust with patients at the center, who may need more time with medical professionals to ensure all their concerns are addressed.

"We are committed here to improving the health equity for the women in our community who are truly struggling to have their needs met and their voices heard," she said.