With the outbreak of the COVID-19 pandemic, expectant mothers of color in California now face two battles at once: potential exposure to a deadly virus, and long-standing inadequate access to the best prenatal and maternal healthcare. And as the Black Lives Matter protests and national conversations around racial injustice continue to spread across California, it is more important than ever that California lawmakers address the systemic racial health disparities that plague our communities and give rise to this lack of access.
The damage that maternal and prenatal care disparities bring isn’t hypothetical.
The latest figures from the U.S. Centers for Disease Control and Prevention (CDC) indicate that the maternal mortality rate for Black women, 37.1 deaths per 100,000 live births, is more than double the rate for white women at 14.7. In addition, the Black infant mortality rate, at 11.4 per 1,000 live births, is also more than double the white infant mortality rate, 4.9.
A 2015 study published in the New England Journal of Medicine showed that 21 percent of Down Syndrome cases pregnancies were missed with traditional screening compared with NIPT.
It is clear that not every expecting mother in California has access to the safest, most accurate and effective maternal and prenatal care.
Recent data from the California Department of Public Health identified one specific and stark gap in the area of prenatal care, for screening tests that help expectant mothers identify a baby’s likelihood to have certain genetic disorders. These tests include traditional and less accurate options like serum or combined screening, and newer, noninvasive prenatal testing (NIPT) options that use fetal cell-free DNA in the mother’s blood to analyze the baby’s DNA.
Guidelines from the American College of Obstetricians and Gynecologists call for NIPT be offered to all pregnant women, as existing research has proven NIPT to be the most accurate and effective screening option for common chromosomal abnormalities.
A 2015 study published in the New England Journal of Medicine showed that 21 percent of Down Syndrome cases pregnancies were missed with traditional screening compared with NIPT. Older screening methods also resulted in 95x increase in false positive results for common chromosomal abnormalities, which can cause undue additional stress on mothers and families, as well as additional costs and unnecessary referrals to specialists for in-person, diagnostic testing.
Additionally, because NIPT only requires a blood sample, NIPT allows pregnant women to forego physically visiting a doctor’s office and risking contact with COVID-19, and instead can be performed in the comfort and safety of her own home – clearly a safer alternative during this pandemic.
Despite the clear superiority of NIPT, the California Department of Public Health data revealed that white women who opted out of California’s state-funded prenatal screening program were more than twice as likely to gain access to NIPT as Black women (39 percent to 17 percent).
There are many reasons that could help explain this disparity, including different levels of awareness of and access to education about prenatal screening options, varying levels of mistrust with the medical system, religious beliefs, and more.
One significant and clear reason, however, rests in inadequate health insurance coverage. NIPT is currently only available through Medi-Cal as a second-tier test, putting many pregnant mothers in California and their babies’ lives at risk. And large insurance companies including Aetna and UnitedHealthcare, which provide insurance for some of California’s largest employers, continue to refuse to cover NIPT for all pregnant women.
Racial disparities are a public health crisis in California and the COVID-19 pandemic is only exacerbating the existing disparities that communities of color face within our state’s healthcare system.
Increasing accessibility to safer and more effective prenatal options for all of California’s expecting mothers is one important step that we can take now to continue the work of uprooting the systemic factors that have affected marginalized communities for so long. We were encouraged to see 35 California lawmakers recently sign onto letters calling for Aetna and United Healthcare to permanently cover NIPT for all pregnant women, but we can’t stop there.
We need our lawmakers to act on the racial disparities in California’s healthcare—and they should begin by tackling the disparities in maternal and prenatal care.
Editor’s Note: Felica Jones is the executive director at Healthy African American Families II (HAAF).