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Brian Lehrer: Brian Lehrer at WNYC. Now, we continue with issue number 22 in our election-year series, 30 Issues in 30 Days. In fact, today, we conclude a stretch of eight days in a row on racial justice issues facing the country and the candidates, its maternal mortality, and other health disparities. Now, the United States has the highest rate of deaths related to pregnancy and childbirth compared to other developed nations even though it spends more on health care than any other country. Tragically, of the 700 to 900 maternal deaths each year in America, the CDC Foundation estimates that 60% are preventable.

As with so many issues in this country, a stark racial disparity lays at the heart of the overall numbers. Black women are three times more likely to die of pregnancy-related causes than white women. Joining me now to talk about policies, to address the causes, solutions, and where the two presidential candidates stand on these issues, and they do have stands. This is an issue that very rarely gets discussed in the media, which is exactly why we're bringing it on here on non-commercial WNYC is Jamila Taylor, director of healthcare reform and senior fellow at The Century Foundation. Dr. Taylor, thanks so much for coming on. Welcome to WNYC.

Dr. Jamila Taylor: Thank you so much for having me.

Brian: Let me start like this. People don't know that in April, you responded to a request for information from the US Senate Committee on Finance regarding America's ongoing maternal health crisis. In that letter, you wrote a Black woman with an advanced degree is more likely to die of preventable pregnancy-related causes than a white woman who never finished high school. It makes a powerful point, obviously, to compare by race and education like that. Can you elaborate?

Dr. Taylor: Sure, absolutely. I like to enter into the conversation about the racial disparities that we see in maternal health. Really talking about racism, first and foremost, I think for some that engage in conversations around health disparities is hard for them to understand why a Black woman that has health insurance coverage, who graduated from college, she may even have an advanced degree, be a lawyer or even a medical doctor, is more likely to have harmful pregnancy-related experiences than a white woman.

The fact of the matter is that in this country, we have deep roots in racism. We were built upon the foundations of racism and so what we see is that racism manifests in various forms. It manifests structurally within our institutions and the healthcare system is not separated from that. The reason why we see Black women with poor maternal health outcomes is because they do experience racism in the healthcare system. They do experience unequal treatment when it comes to healthcare providers. Oftentimes, they are not listened to by their medical providers when they express pain or discomfort.

This is even something that we saw with a Black woman as famous as Serena Williams. She wrote candidly about her own experiences telling her healthcare providers that something didn't quite feel right after the birth of her daughter and because she had an advocate. Within herself, within her husband, and her network of folks, she got the health care that she needed. Too often than not, this doesn't happen for the everyday Black women that are trying to navigate the healthcare system. Those racial disparities that we're seeing are the result of an unequal healthcare system and structural racism.

Brian: Something that happened two years ago that didn't make much news, which is why we want to center it in this series, is that in December of 2018, Congress and President Trump saw-- Congress passed and President Trump signed the Preventing Maternal Deaths Act of 2018. Can you break down what was in that Act and whether it's made an impact on racial disparities and maternal mortality two years later?

Dr. Taylor: Sure. What the Preventing Maternal Deaths Act does is it allocates grant funds to save in order to support Maternal Mortality Review Committees, also known as MMRCs. What those bodies do is they assess deaths that are the result of pregnancy-related causes within states. They also come up with recommendations to healthcare systems, public health, and cities.

They also have a very important hand in coming up with the data that we need that is used by the CDC and others to get a full picture of the sense of the racial disparities that we're seeing in maternal mortality. From what we know, funding has been going to states. More states are developing these bodies that are critically important in terms of what we need to know, the research behind this issue, but we need more, right?

In order to adequately address this issue, we need a multifactorial approach. We need better data, which is what these review committees do. We need better assessments of the deaths, but then we also need to make sure that women have coverage. We also need to make sure that we're ridding our healthcare system of inequities. We also need to make sure that Black women and Black families have the resources they need to thrive and be healthy.

Brian: Vice President Biden also addresses the issue of maternal mortality and the racial disparity in that directly on his campaign website. As a solution, the website states, "California came up with a strategy that halved the state's maternal death rate as President Biden will take the strategy nationwide." Are you familiar with the California strategy, Dr. Taylor? Can you break it down?

Dr. Taylor: I am familiar with the California strategy and lots of experts in the maternal health space certainly look to California as a model. Certainly, we should be celebrating any States that can have their maternal mortality rates considering what the national picture looks like. Although I will say that one of the issues with California is that, whereas they did halve their overall maternal mortality rates, they still have vast racial disparities in maternal mortality.

They did put more funding into the maternal mortality review process, having better measures in terms of data around maternal mortality, as well as morbidity. They have better access to health care than a lot of other states. At the same time, we're still seeing those vast disparities. From my perspective, I really think that, whereas we're supporting models for change in this era, we also cannot divorce the issue of racism in the healthcare system. That means we also need to be thinking about how we can make sure that all healthcare providers and personnel have anti-racism training.

That's first and foremost. We can't divorce that from the conversation around coverage and healthcare quality. I do think that that is an area for growth for California. To my knowledge, I think that they did end up passing state-based legislation. I think it was last year that focuses on this training on implicit bias for providers. They are moving forward to think through how they can do better to address the racial health disparities, but that is something that we don't talk about enough when we talk about the California model.

Brian: Another thing that people probably did not hear about when it happened is that in May of last year, Senator Kamala Harris, obviously, now running for vice president, introduced legislation in the Senate that would tackle the Black maternal mortality rate explicitly. Her proposal includes $25 million aimed at fighting racial bias in maternal care by directing grants to medical schools and other training programs intended to improve care for Black women. Do you happen to know if that bill has bipartisan support?

Dr. Taylor: To my knowledge, that bill does not have any Republicans on it at this time, so it does not have bipartisan support. I also follow up with that and say it's a very important piece of legislation. It was the first time that we saw an approach to addressing the issue around maternal mortality and morbidity that really centered what we need to do to address the bias and discrimination in the healthcare system.

I'll also add to that in addition to supporting better training within medical schools across the country, there is an explicit focus on HBCUs, which I think is also an important piece to lift up, the fact that we do want to support having healthcare providers, physicians that look like us. I'm a Black woman. I can say for my own personal experience that it is important for me to have healthcare providers that look like me, that look like my child. I also want to look that up as an important piece of the conversation and something that is important to Black women that we hear directly from them having providers of color.

Brian: Because Senator Harris' bill does target training so much. Do you think in addition to diversifying the field as you were just talking about that the American medical establishment can train themselves out of racial bias?

Dr. Taylor: I think that training will help, right? I think that my perspective on this is that if you are in a position where you're providing health care to people, you have an obligation to provide them with compassionate care that is void of bias, that is void of discrimination, that is rooted and centered in quality. I think that all healthcare providers should be doing their work in that way.

There's no reason why this is not something that we should do and focus on. It's not only essential to how we approach the vast disparities in the turn of mortality in this country, but it's also important to how we address the vast disparities in COVID19, in heart disease, in diabetes across a host of chronic health issues. I think it's extremely important that this is something that we focus on, particularly in this moment of racial justice, the reckoning around racial justice in this country.

Brian: Before you go and we just have a minute or so left, I want to come back to the letter that the Senate Finance Committee invited you to write to them as an effective witness in April on these issues. I saw that you wrote the overuse of Caesarean sections has been a concern in the United States for decades due to the danger they can pose to mothers. I see the rate of C-sections is six times what it was 50 years ago according to the National Institutes of Health. Today, one in three babies according to this is born via C-section according to the CDC. My question for you about that is, do you also see racial disparities with respect to that and is that something that needs to be addressed?

Dr. Taylor: Yes, absolutely. We know that, actually, for Black pregnant women that they're more likely to have infections than white women even for low-birth pregnancies. Again, I think this also fits within the conversation around how we see this unequal treatment and the healthcare system, even in the context of Caesarean sections. Look, having a Caesarean is a surgical procedure.

It's serious. It's more invasive than having a birth vaginally. It could lead to complications both in the delivery process as well as during the postpartum period. It's absolutely something that needs to be a part of our strategies in order to address, I think, maternal mortality and morbidity as a whole in this country, but we're really centering on the racial disparities as well.

Brian: Jamila Taylor, director of healthcare reform and senior fellow at The Century Foundation. Dr. Taylor, thank you so much for coming on with us in our 30 Issues in 30 Days series.

Dr. Taylor: Thank you so much for having me, Brian.

Brian: That wraps up a stretch of eight days in a row on racial justice issues in the presidential campaign. Tomorrow, we start eight days in a row on the pandemic. Meanwhile, more to come today. Brian Lehrer on WNYC. Stay with us.

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