Key maternal health legislation marked an otherwise sleepy informal legislative session in Massachusetts this summer. The August 1 deadline for lawmakers on Beacon Hill to reach agreement on bills during the formal session had come and gone, leaving a number of bills at a standstill with unresolved differences. Still, continued closed-door negotiations yielded agreement on an omnibus bill aimed at improving maternal health care. With the unanimous support required for advancement during informal sessions, the sweeping legislation moved onward to Governor Healey’s desk for her swift signature.
The bill’s clearance of these procedural hurdles is indicative of just how urgent the maternal health emergency is in the Bay State and the attention that this issue has captured among its leaders. Even in a state recognized for its world-renowned hospitals and health care, the maternal mortality rate in Massachusetts is 15.3 per 100,000, and the preterm birth rate is 9.1 percent, up from 9 percent in 2022. The preterm birth rates are worst for birthing people who are American Indian/Alaskan Native (11.7 percent) and Black (11 percent). In at least four counties in the commonwealth, this rate has worsened since last year, and preterm birth and low birthweight rates are highest in the state’s most rural region. A 2023 report by the Massachusetts Department of Public Health (DPH) revealed that the rate of severe maternal morbidity nearly doubled statewide from 2011 to 2020.
The Black maternal health crisis is caused first and foremost by structural racism that is pervasive in medicine and results in medical professionals’ minimization of the pain and health concerns experienced by Black women and birthing patients.
Despite boasting some of the best hospitals in the world, Massachusetts is not immune to the national trend of maternity ward closures and the spread of maternal care deserts. Just over a year ago, UMass Memorial Health shuttered its maternity ward in Leominster despite protests and outrage from the community. Hospital leadership cited inadequate obstetrical coverage as inhibiting the ward’s ability to meet the demand for services—another emerging trend that is even worse in states with heavy reproductive health care restrictions.
Fortunately, Massachusetts took concrete steps toward improving maternal health care and outcomes for women, birthing people, and infants in the state. In the face of maternity ward closures like the one in Leominster, the bill creates a pathway for midwives and lactation consultants to obtain licenses and establishes a new Board of Registration in Midwifery within DPH to regulate this. To address maternal care deserts, the legislation removes barriers to opening birth centers and expands the statewide universal postpartum home visiting program. Maternal mortality rates include pregnancy-related deaths within one year postpartum, and under the new law, MassHealth will now cover doula services for patients during that critical period. It also mandates insurance coverage for postpartum depression and major depressive disorder screenings for perinatal individuals. The state will conduct a public awareness campaign on perinatal mood and anxiety disorders, accompanied by publicly available digital resources.
Substance use also contributes to the national maternal health emergency for birthing patients of all races, and Massachusetts law now provides for grants to community-based health centers addressing substance use disorders, specifically in perinatal individuals.
This landmark legislation takes a holistic approach to maternal health and ultimately expands bodily autonomy and birthing options for families in Massachusetts. Katherine Rushfirth, midwife and policy director at Neighborhood Birth Center, describes the passage of this legislation as “the beginning of a time in Massachusetts where birth centers, especially those led by and anchored in communities of color, can open and thrive.” When pregnant people have convenient and affordable access to essential care during pregnancy and throughout the critical year postpartum, outcomes improve for women and their infants.
Nearly all states now have a maternal mortality review committee tasked with reviewing pregnancy-related deaths and collecting important maternal health data, but states must take urgent legislative action to reverse the concerning nationwide rise in maternal mortality and morbidity, especially among Black women. A comprehensive approach like the measures adopted in Massachusetts marks an important path forward for state policy interventions to address the alarming public health emergency impacting women and families across the country.
