A growing number of non-white women are resorting to alternatives to hospitals for labor and delivery in the US, a new report has revealed.
According to the National Partnership for Women and Families, a nonprofit organization that focuses on public policies surrounding women and families, community births – births carried out at home or in community birthing centers – increased by 20% from 2019 to 2020, with the spike largely situated among communities of color.
The increase for Black, non-Hispanic women was 30%, followed by 26% among Native Americans, 24% for Hispanic women, and 18% for both Asian and white women. Community births among native Hawaiian or Pacific Islander women rose by 13%.
The report also found that in recent years, severe maternal morbidity (SMM), which the Centers for Disease Control and Prevention defines as unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health, increased overall and especially among people of color.
From 2014 to 2017, Black women were three times more likely to experience pregnancy-related deaths compared to white, non-Hispanic women. For Native women, the rate is twice as likely.
In its report, the NPWF cited various obstacles that limit access to care in community birth settings, including barriers to the growth of midwifery workforce, costs needed to establish and operate birth centers, inconsistent reimbursement of Medicaid and other reimbursement of midwifery and birth center services, as well as failure to license and regular birth centers across all states.
The report proceeded to cite a list of policy considerations for state and federal policymakers to expand access to community birthing, saying: “Birth centers and home births are safe options for essentially healthy birthing families in the context of policies and practices that integrate community birth providers into the maternity care system.”
“Care in these settings that is led by Black, Indigenous, People of Color is a crucial approach for meeting the needs of communities affected by structural racism and other forms of discrimination,” it added.
Policy recommendations include ensuring coverage of birth center services and their midwives by all federal providers and payers of maternity services, as well as including funds in appropriation bills to increase the supply of midwives who hold three nationally recognized credentials.
The report urged state and territorial policymakers to enact birth center licensure without unnecessary legal restrictions that limit access in the states that currently do not have regular birth centers. It also urged private sector decision makers to educate employed and beneficiaries about the benefits of midwifery-led care in community birth settings.
“Now, more than ever, it’s important to find ways to support these choices in many ways that could be lifesaving,” Sinsi Hernández-Cancio, a co-author of the report and the NPWF’s vice president for health initiatives, told the Washington Post.
“Most birthing people can safely give birth in a birthing center or at home, but the availability is very limited,” she added.
