My second column is up at RHRC, an expansion on my thoughts about the new census numbers and maternal health.
The Center for Medicaid and Medicare Innovation just announced 43 million in funding for new approaches to prenatal care that address the problem of premature births — something that leads to much higher mortality rates, and a host of other complications for newborns. But once again it looks like midwifery will be kept out of this discovery process — the only eligible providers are those who see at least 500 births per year — something that few midwifery practices or birth centers do. These requirements are based on the desire for statistically significant findings, but they might just exclude those who can actually produce the results they are seeking.
It’s hard to imagine that a medical provider who is forced to carry a high volume of clients will be able to provide the care necessary to eliminate race-based health disparities. If Medicaid doesn’t make room for alternative, potentially life-saving maternal health models, we risk endangering the health of generations to come. The challenges are clear, what we require are the innovative solutions. Our nation’s health depends upon it.
I also owe a big thank you to Claudia Booker, who got in touch after I wrote this post, to talk with me about the challenges of making a living as a midwife who serves mostly low-income women of color. Much of our conversation didn’t make it into my column, but it’s an absolutely crucial conversation for us to have: how can midwives make a living and still serve low-income women? Medicaid, only an option in a portion of states, makes it extremely difficult to make a living and stay true to the midwifery model.
Without it, midwives have little chance of reaching women of color, and midwives who want to work exclusively with low-income populations will have to make a living through alternate means. Our providers have to make a living, and if they can’t make a living serving low-income women, we’re screwed.
Thank you Claudia, for pointing out that making midwifery accessible to communities of color also means making the midwifery profession accessible to those who want to serve communities of color. That’s going to require an innovative business model for midwifery.
One thing we talked about was having a diverse clientele–for each midwife to serve clients who can pay the full fees (either through private insurance or out of pocket) and low-income clients via Medicaid or a sliding scale.
The challenge, she said, is racism. Namely that it can be difficult for midwives of color to attract clients who can pay (who are more likely to be white), and these biases make it difficult for all midwives to have a diverse client base. She pointed out that we all want providers who look like us.
I have a lot more to say on the subject. For now, you can read my column, and stay tuned for more.