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April 8, 2022
By Myechia Minter-Jordan, MD, MBA, president and CEO, CareQuest Institute for Oral Health
Uncertainty. Anticipation. Fear.
These are just a few of the emotions that run through the minds of almost every expecting parent. And for many expecting Black parents, those feelings are more acute.
This Black Maternal Health Week, we are reminded that Black women in the US are three times more likely to die from a pregnancy-related complication than their white counterparts and twice as likely to lose an infant to premature death. This is the result of generations of structural racism and inequitable access to high-quality, comprehensive care.
Facing Discrimination and Health Disparities
Health systems rooted in decades of discriminatory policies and narrow, culturally incompetent views of health and wellness are not equipped to address these disparities or adequately support Black parents. In fact, existing systems simultaneously devalue and exacerbate the pain experienced by Black mothers. (Editor's note: Black Mamas Matter Alliance, the founder of Maternal Health Week, uses the term "Black Mamas" to represent birthing persons (cis women, trans folks, and gender-expansive individuals) that are of African descent across the diaspora (Afro-Latinx, African-American, AfroCaribbean, Black and African immigrant). Wherever possible, we strive to use inclusive language in our communications at CareQuest Institute.)
From higher rates of chronic conditions — like heart disease and diabetes — and oral health issues to lack of access to care and explicit bias within health settings, Black women, in particular, too often find themselves in challenging circumstances when it comes to maintaining their health and the health of their children. Oral health, too, is often overlooked but has a critical impact on maternal and early childhood health.
Breaking Black Maternal Health Barriers
As we recognize Black Maternal Health Week, this is an opportune time for all of us to recognize this crisis and engage in the national conversation about dismantling the systemic barriers to care for pregnant people of color. It’s also time to recognize the importance of providing comprehensive care — including oral care — to all.
Fortunately, our nation’s policymakers signed into law a mechanism to expand maternal health coverage that went into effect on April 1, 2022. The change, a provision in the American Rescue Plan, allows states to extend postpartum Medicaid benefits from the current 60 days to 12 months.
Expanding the breadth and duration of maternal health care covered by Medicaid — especially preventive care, including oral health care — is a critical part of the fight to improve health outcomes for parents and children. While states need to take action to extend this coverage, this new provision creates a new pathway to help address health equity among pregnant people and their babies. And while coverage alone will not address all the ways in which systemic racism in health care results in worse outcomes, including higher Black maternal mortality rates, access to affordable health coverage is essential.
The American Rescue Plan’s postpartum provision recognizes that oral health plays an essential, but underappreciated, role in protecting the health of babies and their mothers. Approximately 4 in 10 of all pregnant women — and the percentage is even higher for expecting Black women — experience oral health issues that raise the likelihood of poor birth outcomes and exacerbate underlying conditions that can lead to major complications and even death. Poor oral health raises a pregnant person’s risk of high blood pressure, a precursor to preeclampsia, which can lead to major complications and even death. And children are three times more likely to have dental disease if their parent was not able to receive dental care during pregnancy. These kinds of preventable complications and poor health outcomes place additional financial stress on individuals, the health care system, and state budgets.
A safe and healthy pregnancy should be a fundamental human right, not a privilege, but far too many people still find themselves without the care they need for themselves and their babies. As we work toward a more equitable recovery from the COVID-19 pandemic, we must transform our health care systems to ensure that comprehensive pre- and postpartum care is universally available. Continuing to expand access to oral and overall health care before, during, and after pregnancy will change lives and bring us closer to real health equity.