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https://youtu.be/6IpNeSiYgT4?si=o2Ye8wCMpQDpk0iu

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https://youtu.be/mxXKJX_R-Xw?si=e2B2fHm_h0ENxqIU

High School Musical. (2022, June 21). Ryan’s Best Moments | High School musical [Video]. YouTube. https://www.youtube.com/watch?v=mxXKJX_R-Xw

Ryan in High School Musical is the gay brother to Sharpay who is a main character in the film. Ryan is seen in many clips spying or sabotaging people in the film to get what he or his sister want. This clearly demonstrates the LGBTQIA+ community in film stereotypes and puts the gay character in the villain position. Ryan’s character being gay is also executed in a very social norm way with the higher voice, liking pink, and hanging out with the girls and doing “girl” activities like theater.

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Ryan's Best Moments | High School Musical

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https://www.cinemablend.com/streaming-news/bridgerton-julia-quinn-explains-important-difference-between-race-blind-color-conscious-casting-netflix-diverse-ensemble#

Jones, A. (2025, February 5). Bridgerton’s Author Explains Important Difference Between “Race-Blind Casting” And “Color-Conscious Casting” While… CINEMABLEND. Retrieved March 10, 2025, from https://www.cinemablend.com/streaming-news/bridgerton-julia-quinn-explains-important-difference-between-race-blind-color-conscious-casting-netflix-diverse-ensemble#

When the series first aired there was a lot of controversy regarding the racial aspects of the casting and the directors came out and said that their casting was not a random choice but was very well thought out. Race-blind casting is when the race of the actor is not taken into account in any manner. This has been seen in many new renditions of films in which race is interchanged between the original and the remake. This is done to create a more diverse cast and to only take into account the actors skills to prevent discrimination in media.

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https://youtu.be/fqWuCsHKZU0?si=2C4h447oeAT0z_pm

Sky Walk. (2020, March 17). Megan Fox Iconic Car Scene - Transformers: (2007) HD [Video]. YouTube. https://www.youtube.com/watch?v=fqWuCsHKZU0

This clip of Megan Fox clearly depicts the male gaze in media and is known to be an iconic clip in which young males remember from the Transformers movie. The character is shown in very low rise bottoms and a cropped shirt to show her midriff. She is then seen to be helped because of her looks and is perceived as oblivious. After the car stops working she goes to work on it and the camera pans up her body as she is leaning over the car and she is even talking about how she pretends to not know about cars because her previous boyfriends didn’t like that she knew more about cars than them. The male gaze sexualized her knowledge about cars and objectified her.

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Megan Fox Iconic Car Scene - Transformers: (2007) HD

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T, T. (2014, October 21). Character Roles. Pinterest. https://pin.it/1gxdbIHMW

This graphic shows the percentage of actors that have speaking roles in media. There is a definite difference between male and female roles that are getting to have a voice in media. This representation is not fair to females as their voice is equally as important to male voices. For children who grow up watching this and seeing these people as role models this leads to an unrealistic ideal that females shouldn’t get the same amount of attention in media as males. Regarding gender representation if there are already more males represented in media than females and more males get speaking roles then females are more outnumbered.

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https://www.colorado.edu/cmci/news/2024/08/06/journalism-trump-nabj-racism-chuang

In ‘other’ news: Can coverage be balanced when it comes to race, gender? (2024, August 6). College of Media, Communication and Information. Retrieved March 10, 2025, from https://www.colorado.edu/cmci/news/2024/08/06/journalism-trump-nabj-racism-chuang

The opportunity for women and specifically women of different races to get to attend political events are lower than those of the typical white male. This decreases the representation of all point of views and does not show all ideas on the topic regarding different genders and races. This leads to information that may not be of interest to those of the “norm” to not get reported on and that leads to uninformed voters. The importance of diversity in politics to ensure that minorities are heard includes these two social aspects as well as many others.

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College of Media, Communication and Information

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In ‘other’ news: Can coverage be balanced when it comes to race, gender?

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By Joe ArneyWhen early reports of Donald Trump’s behavior at the National Association of Black Journalists convention started to trickle in, Angie Chuang’s

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Man explaining baseball. (2020). Know Your Meme. https://knowyourmeme.com/memes/bro-explaining

This image demonstrates the communication social norms for communication between females and males. The male has his hand on her neck showing power and dominance over her and he appears to be talking down to her in an authoritative manner. The female is looking straight ahead with compliance and her face does not show any emotion in a polite manner or out of fear. The communication norms in this scene set the standard for what society expects the genders to act during this act.

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https://youtu.be/tV8FKrM44to?feature=shared

Mattia Sasso. (2021, August 29). But you don’t look gay (original tik tok) [Video]. YouTube. https://www.youtube.com/watch?v=tV8FKrM44to

This sound that is shown in this TikTok was trending for awhile in order to make fun of people for saying that a person’s outward appearance doesn’t match their identity. The original video says that the person doesn’t look gay outwardly so then the person changes their voice and the verbiage to match the societal norm. This trend was very impactful with sexuality norms as well as racial, career, and religious norms. This trend challenged the stereotypes that were placed on those of a minority who did not fit the “norm” that people would expect.

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But you don’t look gay (original tik tok)

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https://www.advocate.com/politics/michigan-lgbtq-hate-crime-law

Adamczeski, R. (2025, January 27). Michigan adds LGBTQ+ identities to hate crime law. Advocate.com. https://www.advocate.com/politics/michigan-lgbtq-hate-crime-law

This article goes through the newly added categories to the hate crime law in Michigan. They added sexual orientation and gender identity because it is becoming a growing issue for people to have hate crimes happen to them because of these identifiers. There are so many new and different aspects of Sexual Orientation that people don’t understand and that has lead to violence with those that do not agree or understand these aspects. People who go against the social norm of Heteronormativity and believe that gender is on a spectrum and not just defined by two genders are those who are experiencing these hate crimes.

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Michigan's hate crime law has been updated to include sexual orientation and gender identity after Democratic Gov. Gretchen Whitmer signed several bills into law last week.

House Bills 5400 and 5401 amend the definition and sentencing guidelines of the state's 1988 "ethnic intimidation" statute to include sexual orientation, gender identity or expression, disability, and age, designating them as protected groups against hate crimes if they are found to be a motivating factor for violent behavior.

State Attorney General Dana Nessel, who is an out lesbian, said in a statement that "it's incumbent upon those of us with the authority to unilaterally denounce such sentiments; otherwise, there's no stopping this behavior."

"Over the past decade, we have seen not just an uptick in hate crimes, but a normalization of racist, antisemitic and bigoted language, symbolism and actions - including a close adviser to the President giving the Nazi salute during an inaugural rally just this week," Nessel said. "I applaud the Governor for signing these long overdue changes to the state's statutes."

The bill amending the hate crime statute's definition was first introduced by Democratic state Rep. Noah Arbit in 2023, but failed to pass after conservatives falsely claimed that the law made it a felony to misgender someone. Arbit noted in a conversation with at the time that the bill did not contain the word "misgender" in its entire text, calling the claims "far-right fiction."

Related: Michigan bans 'gay and trans panic' defense as Gov. Gretchen Whitmer signs historic bill (exclusive)

Arbit said in a statement that he is "enormously proud that ... after two years of battling disinformation, bigotry, lies, and apathy, my Michigan Hate Crime Act was signed into law by Governor Whitmer."

"As a Jew at a time of rampant antisemitism, as a gay man at a time of fragile rights, and as representative for my diverse community, this issue is a matter of deep conviction to me," Arbit said. "Today's signing of the Michigan Hate Crime Act marks a historic, long-overdue victory in Michigan's decades-long battle against hate crimes, and I could not be prouder to see this gold standard legislation become law."

The hate crime bills will take effect on April 2. The Advocate has reached out to Gov. Whitmer's office for comment.

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Michigan adds sexual orientation and gender identity to hate crime law despite 'far-right fiction'

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House Bills 5400 and 5401 amended the definition and sentencing guidelines of the state's 1988 "ethnic intimidation" statute for the first time in over 36 years.

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https://www.wwno.org/2024-11-06/california-and-colorado-protect-same-sex-marriage-hawaii-results-still-to-come

Kcrw, D. C. (2024, November 6). California and Colorado protect same-sex marriage. Hawaii results still to come. WWNO. https://www.wwno.org/2024-11-06/california-and-colorado-protect-same-sex-marriage-hawaii-results-still-to-come

The laws surrounding same sex marriage contribute to the sexual self-schemas on the macro level. These can influence the decisions and feelings of people regarding their sexuality. The protection of these laws are essential for those in or potentially going to be in same-sex marriages and the acceptance that those are valid marriages by the courts can influence the future of same-sex marriage. If these laws take away same-sex marriage it will put a restriction on a variety of people and if their marriage is seen as an “actual” marriage by the legal system.

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California and Colorado protect same-sex marriage. Hawaii results still to come

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Published November 6, 2024 at 12:44 AM CST

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https://www.bbc.com/news/articles/cn8l614431zo

Meredith, R. (2024, November 7). “Easier to reveal sexuality than faith,” Education Committee told. Retrieved March 10, 2025, from https://www.bbc.com/news/articles/cn8l614431zo

This article on the acceptance of religion versus sexuality compares how comfortable the incoming generation feels to reveal these characteristics of their life. The shocking discovery that people are found to find it more accepting for them to reveal their sexuality rather than that they are religious is a very different outcome than most would imagine. The duality of these factors are seen to be both ones that are highly judged but to the new generation the sexuality is more expected compared to in the older generation it would be more accepted and even praised to be religious. These are two social factors that are intertwined highly because of religious views on sexuality and what sexuality the religion deems acceptable.

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‘Easier to reveal sexuality than faith,’ Education Committee told

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Assembly members are told some NI pupils feel it is easier to come out as LGBT than as Christians.

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OliviaRodrigoVEVO. (2023, September 8). Olivia Rodrigo - all-american bitch (Official Lyric Video) [Video]. YouTube. https://www.youtube.com/watch?v=n2BnbpjpRdo

The writing in this song conveys the idea of general social norms in that women have to be something but also have to be the contradicting characteristic. One line that really expresses this to me is “And I am built like a mother and a total machine.” This is stating that a woman must look feminine and loving but also never get tired and never stop working. This leans into the “performative” aspect of what society believes femininity should be, looking fit/skinny, alright with offensive jokes, and be optimistic in every situation. Throughout the song Olivia expresses her rage over these norms and how people tell her she is supposed to act that she is almost making fun of the norms.

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Olivia Rodrigo - all-american bitch (Official Lyric Video)

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https://youtu.be/gO2kA01jqIg?si=W1WBhj6ZdsBjVQkp

GoodRx. (2024, September 2). How gender affirmation surgery Improves Mental Health: Emily’s story | GoodRX [Video]. YouTube. https://www.youtube.com/watch?v=gO2kA01jqIg

During lecture and the outline we learned about gender assignment, gender identity, and gender expression. This video dives deeper into the aspects that are affected with being Transgender. When someone identifies as being transgender they have options for gender affirming surgery which can help that individual align their bodies with how they feel. This surgery can have more impacts than just on their physical bodies and can really help those individuals feel more welcomed by communities and feel more comfortable with themselves.

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How Gender Affirmation Surgery Improves Mental Health: Emily’s Story | GoodRx

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https://www.jacksonlewis.com/insights/dismantling-gender-walls-construction-industry

Dismantling gender walls in the construction industry - Jackson Lewis. (2023, September 28). Jackson Lewis. Retrieved March 10, 2025, from https://www.jacksonlewis.com/insights/dismantling-gender-walls-construction-industry

Research conducted on gender in the construction field finds that there is a definite divide between female and male presence. The construction field is tainted with this toxic masculinity in that it’s a man’s job because you have to be strong and tough and there is no way that a woman could enter this field. This caused women to feel out-numbered and less likely to want to choose this career path. This ideal is now being challenged as some more women begin to enter the construction career.

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Dismantling Gender Walls in the Construction Industry - Jackson Lewis

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According to the national construction industry trade association Associated Builders and Contractors, construction labor demands are high. The construction business pays well and offers great opportunities for progression. The traditionally male-dominated industry has struggled, however, to convince women to join its workforce.

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https://www.tiktok.com/t/ZP82h5Ust/

TikToK - Spencer Barbosa. (n.d.). Retrieved March 10, 2025, from https://www.tiktok.com/t/ZP82h5Ust/

This video depicts a creator violating social norms on the female body and expressing that there is not one body that is a “healthy” body. The norm that for a woman a healthy body should be lean and be very skinny is not realistic and is also a sexist norm as men who have a lot of muscle and are bulky are seen as “healthy” and fit. The reality of this normal is the female and male bodies are designed differently for different purposes. They are not meant to look the same so a “healthy” female body will not look the same as a “healthy” male body because there are different functions of each genders body parts for example; birth.

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471.1K likes, 4957 comments. “everyone’s “healthy body” looks different 🫡 stop deciding mine isn’t healthy because it isn’t your size!!!!! Inspo @Katie Roe”

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@spencer.barbosa
everyone’s “healthy body” looks different 🫡 stop deciding mine isn’t healthy because it isn’t your size!!!!! Inspo @Katie Roe #girls #relatable #bodyimage
♬ my lips like sugarrrrrrr - keize

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This article depicts the discrepancies in medical care for women giving birth and for those of different races. The care for women and maternal health is concerning considering the developments that have been continually made in health care. It is ever more concerning how different the mortality rate is for women of color compared to white/Caucasian women. These results of gender and racial differences in care show that sexism and racism can go hand-in-hand as social factors.

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Summary

Stark racial disparities in maternal and infant health in the U.S. have persisted for decades despite continued advancements in medical care. The disparate impact of the COVID-19 pandemic for people of color has brought a new focus to health disparities, including the longstanding inequities in maternal and infant health. Additionally, with Roe v. Wade now overturned, increased barriers to abortion for people of color may widen the already existing large disparities in maternal and infant health. Recently, there has been increased attention and focus on improving maternal and infant health and reducing disparities in these areas, including a range of efforts at the federal level. This brief provides an overview of racial disparities for selected measures of maternal and infant health, discusses the factors that drive these disparities, and provides an overview of recent efforts to address them. It finds:

Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to White women. Pregnancy-related mortality rates among Black and AIAN women are over three and two times higher, respectively, compared to the rate for White women (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to White women. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women.

Maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors and structural and systemic racism and discrimination are primary drivers for maternal and infant health. Notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities.

The increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity the health care workforce, and enhance data collection and reporting. However, addressing social and economic factors that contribute to poorer health outcomes and disparities will also be important. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination within the health care system as part of efforts to improve health and advance equity.

Introduction

The COVID-19 pandemic has exacerbated longstanding disparities in health and health care for people of color, including stark disparities in maternal and infant health. Despite continued advancements in medical care, rates of maternal mortality and morbidity and pre-term birth have been rising in the U.S. Maternal and infant mortality rates in the U.S. are far higher than those in similarly large and wealthy countries, and people of color are at increased risk for poor maternal and infant health outcomes compared to their White peers. Amid the COVID-19 pandemic, maternal deaths have continued to rise and racial disparities have further widened. Moreover, with the overturning of Roe v. Wade, increased barriers to abortion for people of color may widen the already existing large disparities in maternal and infant health. Together these factors have contributed to growing attention and efforts to improve overall maternal and infant health and reduce disparities in these areas.

This issue brief provides analysis of racial and ethnic disparities across selected measures of maternal and infant health, discusses the factors that drive these disparities, and provides an overview of recent efforts to address them. It is based on KFF analysis of publicly available data from CDC WONDER online database, the National Center for Health Statistics (NCHS) National Vital Statistics Reports, CDC Pregnancy Mortality Surveillance System, and a report from the US Government Accountability Office (GAO). While this brief focuses on racial/ethnic disparities in maternal and infant health, wide disparities also exist across other dimensions; for example, there is significant variation in some of these measures across states and disparities within rural communities.

Status of Racial Disparities in Maternal and Infant Health

Pregnancy-Related Mortality Rates

Black and AIAN women have pregnancy-related mortality rates that are about three and two times higher, respectively, compared to the rate for White women (41.4 and 26.5 vs. 13.7 per 100,000 live births) (Figure 1). These disparities increase by maternal age. For example, the pregnancy-related mortality rate for Black women between ages 30 to 34 widens to over four times higher than the rate for White women (48.6 vs. 11.3 per 100,000), while the rate for AIAN women in the same age group is nearly four times as high as the rate for White women (41.2 per 100,000). Moreover, they persist across education levels. Notably, the pregnancy-related mortality rate for Black women who completed college education or higher is 5.2 times higher than the rate for White women with the same educational attainment and 1.6 times higher than the rate for White women with less than a high school diploma. There are small differences in the rate pregnancy-related death between Asian and Pacific Islander and White women (14.1 vs. 13.7 per 100,000), and the rate for Hispanic women is lower compared to that of White women (11.2 vs. 13.7 per 100,000). These findings may mask underlying differences in subgroups of these populations. Other research also shows that Black women are at significantly higher risk for severe maternal morbidity, such as preeclampsia, which is significantly more common than maternal death. Further, Black women have higher rates of admission to the intensive care unit during delivery compared to White women, which is considered a marker for severe maternal morbidity.

Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women. According to recent GAO analysis that examined maternal deaths during pregnancy or within 42 days of pregnancy, Black women had the highest maternal mortality rates across racial and ethnic groups during the pandemic in 2020 and 2021 and also experienced the largest increase when compared to the year before the pandemic in 2019 (Figure 2). The maternal mortality rate for Hispanic women was less than the rate for White women prior to the pandemic but increased significantly and was similar to the rate for White women in 2020 and 2021. Data show that most of the increase in maternal deaths in 2020 and all of the increase in 2021 can be attributed to COVID-19 related deaths, which were higher among Black and Hispanic women (13.2 and 8.9 per 100,000, respectively) compared to White women (4.5 per 100,000).

Birth Risks and Outcomes

Black, AIAN, and NHOPI women are more likely than White women to have certain birth risk factors that contribute to infant mortality and can have long-term consequences for the physical and cognitive health of children. Preterm birth (birth before 37 weeks gestation) and low birthweight (defined as a baby born less than 5.5 pounds) are some of the leading causes for infant mortality. Receiving pregnancy-related care late in a pregnancy (defined as starting in the third trimester) or not receiving any pregnancy-related care at all can also increase risk of pregnancy complications. Black, AIAN, and NHOPI women have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women (Figure 3). Notably, NHOPI women are four times more likely than White women to begin receiving prenatal care in the third trimester or to receive no prenatal care at all (19% vs. 5%). Black women also are nearly twice as likely compared to White women to have a birth with late or no prenatal care compared to White women (9% vs. 5%).

Factors Driving Disparities in Maternal and Infant Health

The factors driving disparities in maternal and infant health are complex and multifactorial. They include differences in health insurance coverage and access to care. However, broader social and economic factors and structural and systemic racism and discrimination, also play a major role (Figure 6). In maternal and infant health specifically, the intersection of race, gender, poverty, and other social factors shapes individuals' experiences and outcomes. Recently there has been broader recognition of the principles of reproductive justice, which emphasize the role that the social determinants of health and other factors play in reproductive health for communities of color. Notably, Hispanic women and infants fare similarly to their White counterparts on many measures of maternal and infant health despite experiencing increased access barriers and social and economic challenges typically associated with poorer health outcomes. Research suggests that this finding, sometimes referred to as the Hispanic or Latino health paradox, in part, stems from variation in outcomes among subgroups of Hispanic people by origin, nativity, and race, with better outcomes for some groups, particularly recent immigrants to the U.S. However, the findings still are not fully understood.

Research also highlights the role of racism and discrimination plays in driving racial disparities in maternal and infant health. Research has documented that social and economic factors, racism, and chronic stress contribute to poor maternal and infant health outcomes, including higher rates of perinatal depression and preterm birth among African American women and higher rates of mortality among Black infants. In recent years, research and news reports have raised attention to the effects of provider discrimination during pregnancy and delivery. News reporting and maternal mortality case reviews have called attention to a number of maternal deaths and near misses among women of color where providers did not or were slow to listen to patients. In one study, Indigenous, Hispanic, and Black women reported significantly higher rates of mistreatment (such as shouting and scolding, ignoring or refusing requests for help) during the course of their pregnancy. Even controlling for insurance status, income, age, and severity of conditions, people of color are less likely to receive routine medical procedures and experience a lower quality of care. One recent study of hospital births in Florida found that there were significant improvements in mortality for Black newborns who were cared for by Black physicians, pointing to the importance of culturally concordant or competent care. A KFF/The Undefeated survey found that most Black adults believe the health care system treats people unfairly based on their race, and one in five Black and Hispanic adults report they were personally treated unfairly because of their race or ethnicity while getting health care in the past year, with a higher share of Black mothers reporting unfair treatment. Black adults also were more likely than White adults to report feeling a provider didn't believe they were telling the truth and being refused a test, treatment, or pain medication they thought they needed.

Current Efforts to Address Maternal and Infant Health Disparities

Increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving maternal health and infant health outcomes and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity the health care workforce, and enhance data collection and reporting.

In June 2022, the Biden Administration released the Blueprint for Addressing the Maternal Health Crisis. The Blueprint outlines priorities and actions across federal agencies to improve access to coverage and care, expand and enhance data collection and research, grow, and diversify the perinatal workforce, strengthen social and economic support, and increase trainings and incentives to support women being active participants in their care before, during and after pregnancy. Several of these proposals are included in the MOMNIBUS, a federal legislative package sponsored by the Congressional Black Maternal Health Caucus. Federal agencies also have announced plans and actions to support the Blueprint, including the Centers for Medicare & Medicaid Services (CMS), which released a maternity care action plan in July 2022; the Health Resources and Services Administration (HRSA), which has committed $350 million to states to strengthen maternal and child health, and the Office of the Assistant Secretary for Health (OASH), which invested $8.5 million in initiatives designed to reduce pregnancy-related deaths and complications that disproportionately impact people of color and those living in rural areas.

Recent federal legislation has expanded access to and helped stabilize Medicaid coverage during the postpartum period. Medicaid covers almost half of births nationally. However, historically, many pregnant women lost coverage at the end of a 60-day postpartum coverage period because eligibility levels are lower for parents than pregnant women in many states, particularly those that have not implemented the Affordable Care Act (ACA) Medicaid expansion. The American Rescue Plan Act (ARPA) of 2021 provided states a new option for five years, beginning April 1, 2022, to extend postpartum coverage to a full year. As of October 27, 2022, 27 states, including DC, had implemented a 12-month postpartum coverage extension, and an additional seven states were planning to implement the extension. KFF analysis suggests that the coverage extension could prevent hundreds of thousands of enrollees from losing coverage in the months after delivery. In addition, at the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 PHE ends in exchange for enhanced federal funding. This provision has prevented coverage gaps or losses that otherwise might have occurred during the postpartum period due to changes in eligibility and/or administrative challenges associated with maintaining coverage. However, coverage losses may occur after states resume redeterminations of eligibility when the PHE ends. Additional actions may also help to reduce disparities, including adoption of the ACA Medicaid expansion in the 12 remaining states that have not yet expanded, as nearly six in ten adults in the coverage gap in these states are adults of color. Further, Medicaid expansion promotes continuity of coverage in the prenatal and postpartum periods. The Biden Administration Blueprint encourages states to take-up the ARPA postpartum coverage option and urges Congress to close the Medicaid coverage gap and require all states to provide 12 months postpartum Medicaid and CHIP coverage.

Implementation of evidence-based best practices may help to improve maternal and infant health outcomes. As part of its maternity care action plan, CMS has outlined a proposal for a "Birthing-Friendly" hospital designation that would provide public information on hospitals that have implemented best practices in areas of health care quality, safety, and equity for pregnant and postpartum patients. Moreover, in 2022, CMS has launched a new effort within its maternal and infant health initiative to reduce low-risk Cesarean births to improve infant and maternal health. This program is centered around a learning collaborative that outlines approaches Medicaid and CHIP agencies can put in place to reduce low-risk cesarean deliveries and works directly with states to implement evidence-based best practices in their state.

Recent actions have enhanced access to data on maternal and infant health outcomes and disparities. For example, the Centers for Disease Control and Prevention (CDC) conducts national pregnancy-related mortality surveillance and regularly releases findings as a source of information around the risk factors and causes of pregnancy-related deaths. The CDC also developed Levels of Care Assessment Tool (LOCATe) to assist states by standardizing their assessments of levels of maternal and neonatal care and promotes the Hear Her campaign to raise awareness of urgent maternal warning signs during and after pregnancy. In addition, the CDC supports state efforts to prevent maternal deaths through several efforts including the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) program and perinatal quality collaboratives (PQCs), which aide in increasing understanding of the drivers of pregnancy related mortality and identify health care processes that contribute to improved outcomes for mothers and infants to reduce racial disparities and geographic disparities. Maternal mortality review committees in several states are comprised of clinicians, community members, researchers, and other experts to review all deaths within one year of pregnancy, and identify causes, drivers, and opportunities for quality improvement. Data collection by these committees has been particularly important in understanding that a large share of deaths are preventable as well as identifying the significant portion of deaths that occur after delivery and encouraging efforts to strengthen care in the postpartum period. Moreover, there are several research and data collection initiatives directed by CDC to monitor sudden unexpected infant deaths, reduce infant mortality and build epidemiological support at the state and local level to improve maternal and child health programs.

A variety of efforts are underway to increase workforce diversity and expand access to doula and other services to improve maternal and infant health outcomes and reduce disparities. Studies have shown that a more diverse healthcare workforce and the use of doulas may improve birth outcomes. The percent of maternal health physicians and registered nurses that are Hispanic or Black is lower than their share of the female population of childbearing age. The Biden Administration's Blueprint includes efforts by HRSA to develop a maternal care pipeline to provide scholarships to students from underrepresented communities in health professions and nursing schools to grow and diversify the maternal care workforce. The use of doula services is another approach to increase diversity and expand the maternal health workforce. Doulas are trained non-clinicians who assist a pregnant person before, during and/or after childbirth by providing physical assistance, labor coaching, emotional support, and postpartum care. Pregnant women who receive doula support have been found to have shorter labors and lower C-sections rates, fewer birth complications, are more likely to initiate breastfeeding, and their infants are less likely to have low birth weights. The Biden Administration's Blueprint includes a FY2023 budget request for $20 million to grow and diversify the doula workforce. Additionally, in recent years there has been growing interest in expanding coverage of doula services through Medicaid. Federal legislation has been introduced to expand coverage of doula services through Medicaid, and some states are taking steps to include coverage through their state programs. State efforts to date have had mixed success, in part because of challenges with certification requirements and low reimbursement levels. In 2022, there were at least 17 states considering, planning, or implementing coverage of doula services through Medicaid reimbursements. Some states are also implementing or expanding coverage for other services focused on improving maternal and infant health including home visiting programs to teach positive parenting and other skills; postpartum services provided by lactation counselor and consultants, public health nurses, and medical caseworkers; as well as targeted case management and other programs to meet needs of pregnant and postpartum individuals with substance use disorders.

States, providers and health systems, foundations, and communities also are engaged in a broad range of efforts to advance maternal and child health and reduce disparities. Several states have developed plans and initiatives to address disparities in maternal and infant outcomes. For example, New Jersey launched the Nurture NJ Strategic Plan to outline challenges, action areas, and recommendation to achieve equity for all women with a focus on dismantling structural racism and addressing social determinants of health. In addition, many state Medicaid programs have implemented policies, programs, and initiatives to improve maternity care and outcomes and , including expanding eligibility for people during and after pregnancy, conducting outreach and education to enrollees and providers, expanding coverage for benefits such as doula care, home visits, and substance use disorder and mental health treatment, and using new payment, delivery, and performance measurement approaches. Also, five states reported including Performance Improvement Projects (PIPS) for their Medicaid services that focused specifically on reducing disparities related to maternal and child health in Fiscal Year 2022, including Illinois, Michigan, Minnesota, Nevada, and Texas. California is in the process of implementing provisions from legislation passed in recent years requiring implicit bias training for all perinatal health workers, as well as elements of the California MOMNIBUS, which directs the state to invest in improved data analysis, streamlining administrative procedures within the welfare program for pregnant people, and broadening the midwifery workforce. Northwell Health, the largest healthcare provider in New York, recently launched a Center for Maternal Health to address pregnancy related health risks facing Black women by seeking to address issues within healthcare and in the community that arise before, during, and after pregnancy. The Changing Woman Initiative is a Native American midwifery organization in New Mexico providing culturally centered care to address maternal health disparities, high rates of gestational diabetes, and low birth weight deliveries among Indigenous women.

At the same time many efforts are focused on improving maternal and infant health and reducing disparities, the recent overturning of Roe v. Wade may contribute to widening disparitie s in maternal and infant health, People of color are likely to be disproportionately affected by state actions to fully prohibit or implement extensive restrictions on abortions as they are more likely to seek abortions and more likely to face structural barriers that will make it more difficult to travel out of state for an abortion, including more limited access to health care and fewer financial and transportation resources. Increased barriers to abortion for people of color may widen the already existing large disparities in maternal and infant health, have negative economic consequences for families, and increase risk of criminalization for pregnant people of color.

Looking Ahead

Overall, these data show that racial disparities in maternal and infant health persist. Improving maternal and infant health is key for preventing unnecessary illness and death and advancing overall population health. Healthy People 2030, which provides 10-year national health objectives, identifies the prevention of pregnancy complications and maternal deaths and improvement of women's health before, during, and after pregnancy as a public health goal. The COVID-19 pandemic further highlights the urgency and importance of addressing disparities in health more broadly and increased attention to disparities in maternal and infant health specifically. Moreover, the overturning of Roe v. Wade may contribute to worsening disparities in maternal and infant health, further amplifying the importance of attention to these areas.

The increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity the health care workforce, and enhance data collection and reporting. However, addressing social and economic factors that contribute to poorer health outcomes and disparities will also be important. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination within and beyond the health care system as part of efforts to improve health and advance equity.

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Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them | KFF

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This is an update to our analysis of racial disparities in maternal and infant health and an overview of current efforts to address them.