Overview

Following the closure of the maternity ward at Leominster’s UMass Memorial Health HealthAlliance-Clinton Hospital in late September 2023, rapidly increasing rates of closure of maternity wards in Massachusetts have come under public scrutiny. In an article titled “Maternity units in Mass. keep closing. But is that harming care?” the Boston Globe analyzes the state of Massachusetts maternal healthcare but fails to fully capture the impact of maternal unit closures on already vulnerable populations such as low-income communities, rural communities, and parents of color.

Introduction

The distinction between a birthing center and a maternity ward plays a key role in understanding their necessity for Massachusetts birthers. According to a report issued by the Massachusetts Department of Health, birth centers are “home-like facilities” for low-risk pregnant individuals with normal and uncomplicated pregnancies to give birth in a safe and controlled environment. These centers provide professional midwifery practices from licensed individuals and have access to acute care obstetric and newborn services.

These centers differ from maternity wards in more traditional hospital centers primarily in their catering towards one-on-one care in a home-like environment. Maternity wards are more procedural and clinical-based, with multiple regulatory agencies to abide by, as well as easier access to acute care if needed.

Low-risk pregnant individuals who hope to have fewer interventions such as medical procedures during their births are more likely to opt to give birth in a birthing center, where the standard of care aligns with their wants and needs. Higher-risk pregnant individuals and those who wish to have medical intervention such as an epidural are better fits for maternal wards in hospital settings. While these options for maternal care differ significantly in who they are catered towards, access to both types of care is essential in providing the most possible positive outcomes for Massachusetts birthers.

Despite their clear necessity, the Globe reported that eleven maternity units have closed in Massachusetts since 2010––a trend that is reflected in the 217 maternal unit closures nationwide since 2011. According to a September 2023 report by AP News, devastating financial troubles are the primary reason for closures across the country. These financial issues––caused by decreasing numbers of births, issues with hiring and staff retention, low Medicaid and federal-state health insurance reimbursement, and general financial distress––make it impossible for birth centers and maternity wards to operate in the black. Despite calls from state and local legislators to keep maternity units open, community action and protests, and recommendations from the Massachusetts Department of Health, increasing rates of closure are expected to continue in coming years.

State of Birth Centers and Maternity Wards in Massachusetts

According to data provided in the Globe article, all counties in Massachusetts have at least two birthing centers and no maternity deserts, as defined as areas where maternal care may be critically limited or entirely absent. Massachusetts also boasts a ratio of sixty or more obstetrics providers for every 10,000 births––only half of the United States counties meet these requirements. Despite these statistics appearing positive, they may not provide a full picture of the standard of care provided to expectant parents.

Massachusetts birthers travel an average of 13.8 minutes by car to birthing centers or maternity wards, according to the Globe report. The report also indicates that 95% of brothers live within a half-hour drive from a birthing center, and none live more than 1 hour away. These statistics fail, however, when traffic is taken into consideration, as well as for those who rely on public transportation. One Swedish study also indicates that even a 13-minute commute by car may be detrimental to expectant parents.

In addition to concerns with transportation to birthing centers and maternity wards, thirty-one percent of women in Massachusetts have chronic health conditions that put them at higher risk of conditions such as pre-term birth. Additionally, there are disparities across the state in the concentration of individuals with high chronic health burdens.

Furthermore, the promise of “full access to maternity care,” as indicated in the March of Dimes’ report on maternity desserts, does not take into account waiting times in overcrowded maternity wards. As more maternity wards close down in Massachusetts, individuals who are expecting will be forced to visit the same hospitals, creating the potential for increased waiting time and patient-to-doctor and nurse ratios. These increased ratios can also lead to a worsening standard of care. While on its face, birthing center statistics indicate a high standard of care and excellent access, adding context to these statistics adds a layer of nuance necessary to properly analyze the state of birth centers in Massachusetts.

Case Study: UMass Memorial Health HealthAlliance-Clinton Hospital

UMass Memorial Health HealthAlliance-Clinton Hospital, formerly known as Leominster Hospital, closed its maternity ward on September 23, 2023, despite the recommendation from the Massachusetts Department of Public Health indicating that its services are necessary to expectant parents in northern Worcester County. Due to the closure of the maternity ward, Leominster and Fitchburg residents are now forced to drive twenty or more miles south, east, or west for maternity care. This closure is an apt case study for the challenges facing Massachusetts maternity healthcare providers.

Prior to closure announcements, hospital officials reported a steadily declining employment rate in their maternity unit, despite offering a hiring bonus and using the services of a recruiting firm. The officials also noted that their last full-time OB-GYN was hired in 2021, and their contract would expire just before the closure of the maternity unit. By the end of September, the ward expected to be employing just two full-time OB-GYNs, two family medicine practitioners, and one nurse midwife. The ward was experiencing a decline in births in their unit as well, dropping from 762 births in the fiscal year of 2017 to just 511 in the fiscal year of 2022. Additionally, two-thirds of pregnant individuals in the Leominster area were already driving thirty or more minutes to give birth elsewhere.

UMass Memorial reported that they made efforts to increase birth numbers in their maternity ward by sending high-risk patients to sub-specialists in Leominster to help support healthy births. Advocates for the necessity of the maternity unit, however, argued that the hospital encouraged expectant individuals to give birth at the UMass Memorial Branch in Worcester, therefore discouraging birthers from using their own facilities. In addition to the complaints from advocates on UMass Memorial’s methods for saving the maternity ward before shutting it down, the closure sparked two protests, a Facebook group, and hours of testimony in front of the Department of Public Health. Also among those opposed to the closure are Leominster Mayor Dean Mazzarella, State Senator John Cronin, and many nurses formerly employed in the ward.

Communities Affected by Birth Center and Maternity Ward Closures

The closure of UMass Memorial Health HealthAlliance-Clinton Hospital primarily affected communities of color, lower-income communities, and those who do not have access to a car. According to the Massachusetts Nurses Association, these are the communities most affected most significantly by all maternity ward closures. People of color are statistically more likely to have limited access to prenatal care and a higher likelihood of living in under-served communities. Similarly, low-income parents are more likely to have limited resources in their pregnancy and delivery care, an issue only magnified by the shutdown of their local maternity wards.

Birthing people who do not have access to cars or prompt ride-share services also experience an increased risk of infant or parent complications. Longer travel times caused by the need to find suitable public transportation to maternity care may lead to delayed intervention in certain medical crises, therefore increasing the risk of sickness or injury. This is particularly true for birthing people who live in areas with inaccessible or nonexistent public transportation to medical care. There is often overlap between low-income communities, communities of color, and those without access to personal cars, rideshares, or suitable public transportation, compounding equity issues in receiving maternal care.

Proposed Legislative Solutions

There are currently three bills on the docket for the 2023-2024 Legislative Session which could preserve or even improve birthing parents’ access to essential healthcare services in Massachusetts.

Bill H.2143/S.1406: An Act preserving access to hospital services creates a process for the Massachusetts Department of Public Health to grant state receivership to certain hospitals and free-standing clinics. While state receivership––the process of granting the state permission to assume control of an underperforming asset until conditions of the receivership are met––is generally seen as a last resort, it may allow struggling hospitals the grace to regain the financial stability needed to continue regular operation.

Bill H.1223/S.736: An Act to ensure access and continuity of care to specialist and hospital services for dual eligibles makes it law that Commonwealth citizens eligible for both Medicare and MassHealth are able to receive care at any facilities that participate in these programs, regardless of any and all preexisting network or member benefit plan conflictions. In the case of non-participant healthcare providers, dually eligible citizens will still be entitled to care, and the provider will be reimbursed as appropriate. This system will eliminate the risk of dually eligible citizens being turned away from maternal healthcare services they cannot afford.

Bill H.1175/S.736: An Act relative to the closing of hospital essential services provides strict guidelines for the process in which a hospital may close an essential service such as a maternity unit, including but not limited to providing at least one year’s notice. This bill provides two major fail-safes for pregnant people: a more community-involved and proof-driven standard for closing down an essential care facility and the time to find an alternative option before giving birth. While limiting access to care is never beneficial, it’s feasible that this act will limit occurrences of maternal unit closure.

Conclusion

Despite the Boston Globe’s claim that maternal healthcare is unharmed by the increasing rates of closure of maternal wards in Massachusetts, adding nuance and perspective to the statistics presented in the article makes it clear that the standard of maternal healthcare and access is quickly decreasing. Perhaps more alarming, these decreasing standards primarily affect already marginalized communities.

The three bills described above can preserve the maternal healthcare Massachusetts currently has, but true improvement will come from advocacy from those in power for solutions to the financial crises maternal units are facing that will allow them to remain in control of their facilities and continue to serve vulnerable populations. In addition to preserving convenient access to maternity wards and birth centers, it is imperative that access to birth control, abortion, and postpartum mental health care remain part of the discussion about the state of maternal care in Massachusetts.

For source list, please contact site owner.

Overview

In February 2023, the non-profit organization Urban Institute prepared a report with the U.S. Department of Labour Women’s Bureau entitled “Lifetime Employment Related Costs to Women of Providing Family Care.” This report, written by Richard W. Johnson, Karen E. Smith, and Barbara A. Butrica, utilizes dynamic microsimulation techniques to project lifetime employment-related costs of providing unpaid family care by women born between 1981 and 1985. Their calculations determine earnings lost per year due to caregiving activities, summed over a lifetime, and added to the related lifetime loss of retirement income from Social Security and employment-based retirement plans due to unpaid caregiving. The report found that the total lifetime employment-related costs to women of unpaid care average $295,000 as adjusted for 2021 inflation rates.

Introduction

Caregiving––a term describing activities that range from tending to the basic personal needs of children or those with health problems to providing stimulation and companionship––poses a significant and persistent economic burden to working women in the United States. Often, caregivers have to reduce their hours or even stop working completely in order to care for children or adults with care needs. As a result of this absence from work, they may have missed potential promotions, seen slowed wage growth, lost their tenure, or otherwise failed to keep pace with their peers. Furthermore, this gap in work often results in limiting their potential retirement income both from Social Security and from workplace retirement plans; the economic burden of unpaid familial care persists long after the care itself ends.

The Urban Institute calculated the lifetime employment-related cost of familial care using a microsimulation model entitled Dynamic Simulation of Income Model 4. This simulation uses estimates based on household survey data from the Health and Retirement Study (HRS) and the Survey of Income and Program Participation (SIPP) and calculates lost income estimates only based on women who care for biological or stepchildren under age 18 and dependent adults with care needs over age 51. Under the aforementioned conditions, the model estimated that an average of 80%, or $237,000, of lost earnings over a lifetime are attributable directly to lost income, and an average of 20%, or $58,000, of lost earnings are due to losses in Social Security payout or workplace retirement plans.

The report focuses on women, as they are more likely to have unpaid family care responsibilities than men. About 30% of American women ages 18 and older live with one of more of their own minor children, and 36% live with at least one of their own minor children or provide care to family members or friends with health problems, as compared to 25% and 29% of men with the same responsibilities. American women are also statistically less likely to be able to participate in the labor force when they have children under age 6––in 2021, just 66% of women with children under age 6 were part of the workforce, as compared to 94% of men in the same circumstances. About 1 in 6 adults over age 55 provide care to spouses, parents, in-laws, or unmarried partners, including 17% of women and 16% of men. The following figure illustrates the disparity between men and women who are responsible for the unpaid care of dependents.

Impact of Race, Age, and Education on Lost Earnings Due to Familial Care

In addition to gender, demographic qualities such as race, age, and education impact the severity of lost earnings due to familial care. Caregiving responsibilities for both women and men peak between the ages of 25 and 44, and then decline steadily as caregivers age. Even so, about one in six adults over age 55 provide unpaid care for elders including parents, in-laws, partners, and spouses. With these statistics in mind, lost earnings peak between ages 25 and 44, but continue to impact caregivers over age 55 as their responsibilities shift from caring for children to caring for adults with care needs.

Lost dollars are also higher for parents with multiple children, people of color, and for “well-educated” mothers who earn more on average than less-educated mothers. On average, those with college degrees or higher lose an average of $420,000 in income as a result of caregiving responsibilities, while those with a high school diploma and no high school diploma lose $202,000 and $122,000 respectively. Although the lost dollars themselves are higher for well-educated parents, the percentage of lost income as compared to total lifetime earnings is higher both for less educated mothers and for Hispanic mothers. Although not as drastic, the percentage of lost income as compared to total lifetime earnings is also higher for Black mothers, as they are paid lower on average than their white counterparts.

The COVID-19 pandemic also severely impacted, and continues to impact, women who provide unpaid familial care. With the closure of schools and daycares due to the risk of COVID-19 exposure beginning in March 2020, childcare responsibilities and adult care responsibilities fell back on familial caretakers. Not all familial caretakers had the opportunity to work from home in order to provide care for their dependents––less educated workers and workers of color were less likely to have the option to work from home, and were more likely to be forced to take leave from their jobs. The burden placed on less educated workers and workers of color by the COVID-19 pandemic continues to be prevalent as of June 2023, as many of the daycare and outpatient care facilities that were functional before the pandemic have not yet reopened or have not yet met previous capacities.

Long-Term Economic Cost of Providing Familial Care

The level of long-term impact is relevant with respect to whether the caregiver is responsible for children or adults with care needs. The average lifetime cost to mothers associated with providing care to children younger than age is $145,000. For children ages 6 to 17, an age range almost three times as large, the average cost is just $107,000. The projected average lifetime cost of providing care to parents, in-laws, partners, and spouses is $43,000. Therefore, the older the person who needs caregiving is, the less the projected cost is to the caregiver.

Nearly two-thirds of Social Security beneficiaries receiving Social Security income below the federal poverty level spent five or more years out of the labor force caring for children. This shocking statistic proves the economic impact of childcare and other unpaid familial caregiving lasts far longer than the caregiving itself. Additionally, care-related employment losses may contribute to the high old-age poverty rates experienced specifically by Black and Hispanic adults and by adults with more limited education.

Potential Solutions

In the 2023-2024 legislative session, the Massachusetts Caucus of Women Legislators made H.2163/S.1375: An Act supporting parents running for public office one of their legislative priorities. This bill would allow parents running for office to delegate some of their campaign funds to pay for campaign-related childcare expenses. The passage of this bill would ease the economic burden of childcare on those running for public office, and encourage those who may not have considered candidacy an option the opportunity to run.

Other bills that have the potential to reduce the economic burden of unpaid childcare include H.2059/S.1291: An Act promoting a foundation for universal childcare, H.2968: An Act to incentivize employer-provided childcare, and S.1863: An Act to make preschool more affordable for working families.

Conclusion

As opportunities for employment for women have increased and become more consistent since World War I, care-related employment losses for women have more and more often involved a reduction in work hours or complete withdrawal from the workforce. Urban Institute’s report covers a nationally representative sample of mothers and aims to account for the wide diversity in women’s employment and caregiving activities. Even accounting for these challenges and differences, the scope of the report does not cover out-of-pocket expenses such as paid child care, summer camp and after-school programs, supplemental paid care for older adults with care needs, and home modifications to accommodate children and adults with disabilities. As said in Urban Institute’s “Lifetime Employment Related Costs to Women of Providing Family Care” report, “true equity requires looking beyond purely monetary considerations to include caregivers’ available leisure and self-care time and the distribution of chore burdens within a household.”

Overview

Over half of Massachusetts families live in a childcare desert. One third of these families rely on multiple types of childcare providers, including licensed childcare and Family, Friend, and Neighbor (FNN) care. Despite such a large percentage of Massachusetts citizens who utilize the childcare system, it is one of the most under-funded and inaccessible resources in the state.

The following memos synthesizes information from the University of Massachusetts Boston’s report titled “Estimating the Impacts of Legislation to Expand Affordable Quality Child Care and Early Education in Massachusetts,” a Care That Works organization report titled “Family, Friend, and Neighbor Child Care in Massachusetts,” and a Boston Globe article titled “‘We could start to move the needle’: Iowa offers model for fixing Mass. child-care crisis.”

Introduction and State of Childcare Affordability in Massachusetts

Every year, Massachusetts loses approximately $2.7 billion dollars in earnings for employees, experiences reduced productivity and heightened turnover, and sees decreased tax revenue due to inadequate childcare options for Massachusetts families. According to the Special Legislative Early Education and Care Economic Review Commission, chaired by Senator Jason Lewis and Representative Alice Peisch, “28 to 40% of employees reported they or someone in their household left, changed, or did not accept a job due to challenges accessing child care.”

These statistics ring true across the country. Over a million women are missing from the workforce compared to pre-COVID pandemic numbers, and over a third cite lack of childcare as a major burden for returning to work. These inequities exist for two primary reasons––extreme cost burden and lack of access. The average Massachusetts family spends more on childcare annually than comparable families in any other state, with infant care costing approximately $20,000 a year. Childcare cost estimates do not take into account time and energy spent traveling to and from childcare facilities––over half of Massachusetts families live in childcare deserts, so these costs could be significant.

Many families who are otherwise unable to afford childcare rely on FFN childcare. This is particularly true of low-income, Black, brown, and immigrant communities––in Massachusetts, Black and Hispanic children are four times more likely than white children to live in extreme child care deserts. Another compounding factor is that 46% of families eligible for subsidies work nontraditional hours, primarily between the hours of 6-7 am and 6-8 pm, meaning FFN is the only childcare option available to them.

Proposed Legislation

H.489/S.301: An Act providing affordable and accessible high quality early education and care to promote child development and well-being and support the economy in the Commonwealth provide two important investments in increasing access to quality early education and childcare in Massachusetts. The first investment comes by way of providing grants to childcare providers, which will allow them to increase their compensation for employees, provide more extensive training, better the safety and quality of physical childcare establishments, and overall stabilize the system. The proposed legislation would also provide financial assistance for families to improve affordability of childcare and increase access.

H.456: An Act to expand access to family, friend, and neighbor-provided childcare is intended to provide critical and immediate support to families who utilize FFN care through two improvements to the current subsidy system. First, this act would increase payments to FFN care providers to no less than state minimum wage. It would also amend the current childcare voucher system to allow families to utilize the full ten daily hours of pay allotted for a combination of licensed and FNN care that their work schedules require. Furthermore, H.456 would create a FFN Advisory Council intended to recommend further policies, programs, and practices to support and expand access to high-quality FFN care for Massachusetts families.

H.1934: An Act to encourage employer supported childcare is a bill modeled after a successful childcare equity initiative implemented in Iowa. If implemented, the state would match half of all costs associated with creating more childcare slots, modifying already existing buildings to support childcare facilities, and building on-site childcare facilities. The bill would also establish a commission to determine the appropriateness of implementing a state employer tax credit or requiring businesses to provide childcare as part of their benefit packages.

Impact of Proposed Legislation on Licensed Childcare

According to UMass Boston’sreport, just over half of Massachusetts families with children under age 14 or special needs children under age 17 meet eligibility requirements for grants under H.489/S.301. This percentage includes 36% of two-parent households and 87% of single-parent households. Of all eligible families, the UMass Simulation model predicts that 128,500 families will use the allotted financial assistance, amounting to coverage for 47% of people who pay for care. The average family is predicted to use $13,260 a year, costing the state of Massachusetts $1.7 billion dollars.

The overarching impact of the grant program is a more just and level playing field for childcare and early childhood education. According to the UMass Boston report, this goal will be met by allowing families to utilized licensed childcare, reducing childcare-related cost burdens, increasing parental employment, and reducing poverty. Low-income families are more likely to use parental or FFN care––the state stipend program would allow those families the option to utilize licensed childcare, such as preschool programs, daycares, and nanny services.

The program would also significantly reduce childcare-related cost burdens from an average of 17.2% of total parental income to 4.3%. For single-parent families, that percentage is reduced from 24.7% to 3.7% of total parental income. This cost burden reduction is also impacted by parents’ ability to increase employment hours. Under this legislation, percentage of employed mothers is projected to rise from 72.4% to 76%, and 21,000 currently employed parents are expected to increase their hours. The combination of lower cost burden and higher employment rates will significantly reduce poverty rates. The single-parent family poverty rate is expected to drop by 3.1 percentage points, the two-parent family poverty rate is expected to drop by 0.7 percentage points, and the overall family poverty rate is expected to drop 1.3 percentage points to 14.1%.

Impact of Proposed Legislation on Unlicensed (FFN) Childcare

According to the Care That Works report, 233,000 children under age twelve are eligible to receive a care subsidy through the Massachusetts Department of Early Education and Care (EEC). These subsidies can be used to reimburse FFN caretakers––with the passage of H.456, this subsidy would equate to minimum wage for hours worked.

The most significant current obstacle for FNN childcare providers is being paid less than minimum wage, if they are paid at all. Just 0.2% of Massachusetts’ $778 million dollar childcare subsidy budget is allotted to supporting FFN care. Additionally, only 1% of childcare providers are paid with subsidy funds, with approximately 580 Massachusetts families using vouchers to reimburse FFN care. Further complicating access to subsidy funds, FFN providers must first complete a complicated application, background check, and annual health and safety inspections to be eligible to receive funds. For undocumented individuals, those who speak little or no English, and many others, these requirements are just not possible to meet. The implementation of H.456 would immediately and completely eliminate each of these barriers to equitable access to minimum wage pay.

Finally, and perhaps most importantly, over 96% of FNN care providers are related to the children they take care of, which has been shown to promote healthy relationships with children's’ race, culture, first language, and familial tradition. FNN care also provides a childcare solution for rural families living in childcare desserts.

The Iowa Model

In 2020, nearly a quarter of all Iowa families lived in childcare deserts. This percentage was even higher for families with toddlers and infants. According to governor Kim Reynolds, the state lost an average of $935 million dollars in tax revenue per year due to parents being forced to drop out of the workforce to care for children. A 2021 policy initiative, however, radically changed the state of childcare in Iowa.

After major economic setbacks due to the COVID-19 pandemic, Iowa launched a policy initiative spearheaded by Republican Governor Reynolds that matched any amount a business was willing to spend on funding new slots for their employees at local childcare centers or on building on-site childcare facilities. In the two years since this policy was implemented, Iowa has given out $745 million dollars in matched funds, and over 11,000 new slots were created for children in need of care.

Implemented similar policy in Massachusetts could have similar results in the expansion of childcare, primarily for those looking for licensed care options.

Several other states have launched childcare incentive programs, including Kansas, New Mexico, and South Carolina. These states’ policies provide tax incentives, as opposed to grants, but participation rates are low, and the tax incentives themselves are relatively small. While these programs have made a dent in their states’ childcare crisis, each has proven to be less successful than the Iowa model.

Conclusion

The state of childcare in Massachusetts is at a critical juncture, with over half of families living in childcare deserts and facing significant affordability and access challenges. The proposed legislation, including H.489/S.301, H.456, and H.1934, represents a comprehensive and strategic approach to address these issues. By investing in both licensed and unlicensed childcare options, the state has the potential to create a more inclusive, affordable, and robust childcare system.

Overview

In 2014, the Massachusetts legislature passed a law that requires law enforcement to keep all reports and arrest records relating to instances of domestic violence secret and confidential. This law, which expands upon a 1974 law protecting the confidentiality of sexual assault records and arrests, was meant to encourage victims to contact the police without fear of being publically identified. Instead, it has had the unintended consequence of protecting abusers, impairing victims’ ability to obtain necessary legal records, and empowering law enforcement to avoid scrutiny.

Introduction

Beginning in August 2022, WBUR’s Ally Jarmanning published a series of articles that investigated the Massachusetts domestic violence report confidentiality legislature and its impact on domestic violence victims and their families. According to the articles, the law, intended to protect the privacy of victims, instead (a) protects the identities of abusers from public scrutiny; (b) harms victims by making it nearly impossible to obtain records needed for restraining orders, custody battles, and other legal matters; and (c) allows police officers to avoid scrutiny by keeping their actions secret, particularly those which may have put the public in danger.

The original article uses case studies of recent incidences of domestic homicide in Massachusetts to illustrate the consequences of the report confidentiality law. The recurrent themes throughout these examples are police secrecy and familial frustration.

This is exemplified in one of the cases showcased by WBUR’s investigation––the murder of Groton resident Mary Fairbairn by her husband. According to prosecutors in the case and the family of the victim, police had been informed on multiple occasions of threats made against Fairbairn by her husband, including two 911 calls in the week leading up to her death. Massachusetts’ sweeping privacy laws allowed the Groton police to keep the information about what they did and failed to do entirely secret from the public. This case, among hundreds of other Massachusetts domestic violence cases that are kept confidential by this law, exemplifies the danger posed to both victims of abuse and to the public by the all-encompassing nature of this privacy law.

Current Legislative Measures

In the 2023-2024 legislative session, action is being taken to evaluate and potentially rectify the unintended consequences of the standing law in the form of S.1136, An Act relative to domestic violence reports and confidentiality. This bill, sponsored by Senator Velis, calls for the formation of a task force to assess the adequacy of the law as it stands, identifying and reviewing the impact of said law, and reporting findings and recommendations to the Joint Committee on The Judiciary.

According to the bill, this task force would ensure that the law effectively protects victims of domestic violence, without protecting their abusers. Despite recognizing one of the three primary issues with the law as it stands, the bill makes no mention of rectifying victims’ difficulties in obtaining records, or of ensuring that police officers are accountable for their actions in handling domestic violence cases. This bill fails to address another issue mentioned in the WBUR article series––victims and their families are calling for survivors' voices to be included on the task force, while the current task force indicated by the bill includes only legislators.

Alternative Legislative Solutions

One potential pathway to ensuring that the law meets the needs and concerns of victims and their families is to move forward with the formation of a task force, but amend the wording of the current version of the bill. These changes could include the addition of survivors and their families to the task force, conditions required for victims to access applicable records, and the explicitly stated intentions of investigating police response to domestic violence calls as effected by this law.

Another option for improving the law would be to propose a bill that would change the way confidential domestic violence records are dealt with in Massachusetts, modeled after the systems used in other states. One such option would be to model report confidentiality after Connecticut law. Instead of keeping all records secret, all domestic violence records are publically available, but the names and addresses of all victims are redacted. This solution would grant victims the privacy and security they deserve while holding perpetrators and police officers accountable for their actions. The public nature of the records would also ensure their accessibility for use in other cases, such as custody battles or restraining orders.

Alternatively, legislators could opt to propose a bill that keeps all domestic violence records secret and confidential, but available upon specific request. This method would not guarantee the same degree of privacy for victims, but would still offer the potential to hold abusers and police officers accountable while ensuring records’ accessibility for use in other court cases.

Overview

The Massachusetts Department of Public Health released a data brief entitled “An Assessment of Severe Maternal Morbidity in Massachusetts: 2011-2020” on July 12. The study found that instances of SMM increased from 52.3 deliveries per 10,000 births in 2011 to 100.4 deliveries per 10,000 in 2020, at an annual percentage change of 8.9% per year.

Introduction

Severe Maternal Morbidity (SMM) is defined as “unexpected complications of labor and delivery that result in significant short- or long-term consequences to the birthing person’s health.” These complications include life-threatening health conditions such as acute kidney failure, sepsis, heart attacks, eclampsia, and disseminated intravascular coagulation, as well as life-saving procedures such as hysterectomies and intubation. According to the American College of Obstetrics and Gynecologists, there are two criteria for determining instances of SMM: (a) a transfusion of four or more units of blood, and (b) admission of a pregnant or postpartum individual to an intensive care unit. “An Assessment of Severe Maternal Morbidity in Massachusetts: 2011-2020” analyzes the rising instances of Severe Maternal Morbidity (SMM) in Massachusetts over the course of nine years using data from the public health data warehouse (PHD). SMM is a health phenomenon heavily impacted by social determinants of health, so PHD data utilizes sources that consider health, social, and demographic sources. SMM occurred in 4,092 of 678,382 deliveries among 283,699 individuals in Massachusetts between 2011 and 2020.

Affect of Race, Age, and Weight, and Other Factors on SMM Rates

The likelihood of SMM in an individual is heavily affected by their race, age, and weight. Black people have consistently had the highest instances of SMM of any racial group, with a rate 2.3 times higher than White non-hispanic individuals with the same set of circumstances. Asian/Pacific Islander and Hispanic people also experience high instances of SMM, with rates 1.2 times higher than that of their White non-Hispanic peers. The rate of SMM increase over the 10-year period of study also differs depending on race––White non-Hispanic birthing people experienced an increase of 7.8% per year, while Hispanic birthing people experienced a rate of 8.2% per year, Black birthing people experienced a rate of 10.1% per year, and Asian/Pacific Islander birthing people experience a rate of 10.4% per year.

Age while giving birth also has an impact on rates of SMM. SMM rates are highest overall for birthing people over 40 with a rate of 153.1 births per 10,000, or 1.53%. Black people experienced the highest rate of SMM occurrences across all age groups. Among those 40 and older, Black people again experienced the highest rate of SMM occurrences, with a rate of 238.6 births per 10,000, or 2.89%. The figure below illustrates the impact of maternal age, race, and Hispanic identity on occurrences of SMM.

Also notable, Body Mass Index (BMI) before pregnancy is statistically significant regarding its impact on SMM outcomes. For White non-Hispanic and Black birthing people, the risk of SMM increases alongside BMI. For Hispanic and Asian/Pacific Islander birthing people, rates were equivocal across BMI groups. Again, Black birthing people had the highest rates of SMM across all BMI groups, suggesting environmental factors may be contributing to the SMM inequity in races.

Several extenuating life circumstances are also shown to statistically affect rates of SMM in birthing people. The circumstances measured are: Opioid Use Disorder with an occurrence rate of 1.13%, any mental health disorder with a rate of 1.06%, history of homelessness with a rate of 1.02%, foreign-born birthing parents with a rate of 1%, history of incarceration with a rate of 0.97%, any disability with a rate of 0.89%, and veteran status with a rate of 0.83%. Notably, these groups are not mutually exclusive, which may affect the statistical accuracy reported.

Proposed Solutions

A birthing individual’s race is the most statistically significant factor in determining their likelihood of SMM. A birther’s race has a more significant impact on their likelihood of SMM than their age, BMI, disability status, or any other environment or life circumstance studied in the Massachusetts Department of Health’s study, effectively indicating severe historical racism in healthcare. In order to reduce SMM rates in people of color, it is essential that obstetric and gynecologist doctors and nurses, as well as all other healthcare professionals involved in pre- and postnatal care, be trained in the ways in which their care may affect a person of color’s birthing outcome. This includes dispelling the myth that black people have higher pain tolerance, working to ensure the wishes and traditions of religious individuals are respected and followed, and undergoing training that identifies and investigates internal biases and their effect on the quality of care people of color are offered.

According to Representative Brandy Fluker Oakley in an intern seminar series, one potential support mechanism for black birthing people is expanded access to midwives. Due to trends of historical racism in healthcare, black birthers experience higher levels of stress while giving birth, which leads to more negative outcomes. The presence of a midwife with racial sensitivity training could be crucial to reducing stress levels and improving outcomes in people of color. Similarly, the aforementioned racial awareness and myth-busting regarding the pain tolerance of black people should become a mandatory part of doctor and nurse training. The Patient-Centered Outcomes Research Institute is currently conducting a study regarding the effect of black midwifery programs on maternal outcomes for black birthers.

Conclusion

Severe Maternal Morbidity is a serious and pervasive issue for birthing individuals in Massachusetts, and one that can be significantly reduced by simple healthcare training and policy measures. Because people of color are most likely to experience SMM, these policy changes can begin with access to midwifery and racial training for doctors, nurses, and other healthcare providers who deal with pre- and postnatal care.

According to a May 2022 report from the Massachusetts Special Coalition on Racial Inequities in Maternal Health, “racial inequities are present at multiple levels (i.e. within communities, public health, and in healthcare settings); thus, the achievement in reducing SMM and maternal mortality will be dependent upon the redesigning of health delivery infrastructures and the standardization of collaboration within and across community settings, education, mental health assistance, housing, support of doulas and certified nurse midwives, improved competency among providers, improved access for birthing moms, and enactment of laws pertaining to maternal health delivery.”

Social Media Post

@MassDPH released a report stating that the Massachusetts severe maternal morbidity rate has nearly doubled in the last 10 years. 🧵1/5

Severe Maternal Morbidity (SMM) refers to complications from delivery or birth that can be life-threatening and extremely serious. In MA, they are increasing by 8.9% per year. 2/5

Black non-Hispanic women face rates of SMM two times higher than that of White non-Hispanic women. According to the DPH Commissioner, "it is really racism, not race, that is driving most of these inequities." 3/5

Asian/Pacific Islander and Hispanic people also experience higher rates of SMM. Disability, age, and other life circumstances also affect SMM rates. Read the full report here: https://www.mass.gov/doc/an-assessment-of-severe-maternal-morbidity-in-massachusetts-2011-2020/download 4/5

One of the MCWL’s strategic priorities is addressing racial and gender disparities in health care, including those experienced before and during childbirth. Learn more here: http://www.mawomenscaucus.com/strategic-priorities 5/5

Social Media Post: https://twitter.com/MAWomensCaucus/status/1679605212091236355?s=20

Introduction & Overview

The Center for Women and Politics, a unit of the Eagleton Institute of Politics at Rutgers, The State University of New Jersey, released a report detailing new records regarding racial and ethnic data of women in state legislators on June 14. This data, which was gathered after the 2022 election cycle, reports an uptick in the numbers of women legislators in nearly all racial and ethnic groups and relies on self-reported data.

Both this report and its findings align with the Center for American Women and Politics’ mission, which their website states is to “promote greater knowledge and understanding about the role of women in American politics, enhance women’s influence in public life, and expand the diversity of women in politics and government.”

The Massachusetts Caucus of Women Legislators strives to foster opportunities for legislators and female-identifying staffers in the state house, as well as identify and address the hurdles they face. These goals fall under the 2023-2024 strategic priority of empowering women in government and serve to increase the number of women legislators and staffers in Massachusetts state government.

Women in State Legislature Nationally

The data released by the Center for American Women and Politics following the 2022 election cycle accounts for the following racial identity groups: Asian American and Pacific Islander women, Black women, Latinas, Native American Women, Middle Eastern or North African women, While women, and women who identify solely as multiracial. White women remain the largest racial or ethnic group serving in state legislature nationwide, followed by Black women, with 1,728 and 372 constituents respectively. Women who identify solely as multiracial and Middle Eastern or North African women are the least represented in the United States state legislature, with 2 and 13 constituents respectively. Full data concerning the racial and ethnic make up of women state legislators can be found via the Center for American Women and Politics’ press release.

Every ethnic and racial category showed growth as compared to previously set records. Notably, racial and ethnic data could not be gathered for 25 state legislators, and the Middle Eastern or North African women category was created in 2019, meaning there are only four years of available data. Also of note, adding the stated numbers in the press release will not yield the accurate number of women state legislators nationally, as legislators who identify as more than one racial or ethnic category would be counted twice. As of June 2023, there are 2,412 women serving as state legislators in the United States, equalling 32.7% of the total legislature.

Women in State Legislature in Massachusetts

Massachusetts ranks number 28 in the United States in terms of percentage of women legislators as compared to the total legisalture. Just 31.5% of the Massachusetts state legislature identifies as women, including 12 of the 40 state senators and 51 of the 160 house representatives. Of the 63 women legislators counted in the Center for Women and American Politics’ data, 62 are current members of the Massachusetts Caucus of Women Legislators.

The Center for American Women and Politics also has racial and ethnic reporting information specific to the state of Massachusetts. Currently, 50 white women, 4 black women, 6 Latinas, 2 Asian American or Pacific Islanader women, and 1 women who identifies as solely multiracial serve in the Massachusetts state legislature. There are no Native American or Middle Eastern or North African women currently serving.

The Massachusetts Caucus of Women Legislators’ 2023-2024 strategic priority of empowering women in government has the potential to increase women representation in state legislature. The Caucus’ mentorship and networking programs for women staffers in the State House are particularly promising in terms of increasing women candidates for office and overall civic engagement.