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City council hearing on maternal health (photo: Emil Cohen / NYC Council)

At a hearing last week, New York City councilors discussed a package of legislation related to maternal health, mortality and morbidity and sought to address health inequalities as well as the Supreme Court’s decision to overturn Roe v. Wade’s constitutional abortion protections. The joint consultation held by the Council’s Health Committee and Hospital Committee dealt with 13 bills and resolutions.

This legislation includes a call for the state to require full insurance coverage for fertility treatments, increased access to maternal mortality and morbidity data, creation of a pilot program to provide doula and midwifery services to city residents, establishment of a sexual and reproductive health office within the Department of Health and Mental Hygiene (NYC DOHMH), and more.

Other resolutions called on the New York State Legislature and Gov. Kathy Hochul to make doula more accessible to people with Medicaid or people without health insurance, and called on President Joe Biden to sign the Black Maternal Health Momnibus Act of 2021, which seeks to close racial divides in mothers health.

In their introductory remarks, Queens Democrat Lynn Schulman, chair of the Health Committee, and Brooklyn Democrat Mercedes Narcisse, chair of the Hospital Committee, stressed that New York is a safe haven for abortion-seeking states where Roe has meant that abortion is banned as well as states that may soon pass laws to join this list.

In the wake of a leaked draft opinion in May and the court’s ruling in June, Democrats controlling the state of New York and city governments have enacted new legislative and budgetary measures to strengthen the state’s already strong abortion rights and reproductive health efforts. These efforts are under way at both levels of government.

“Our country has a long history of discrimination and structural inequality that is deeply rooted in the health care system,” Schulman said. “This decision will only exacerbate this, with post-pregnancy policies disproportionately affecting people of color, immigrants, LGBTQIA + individuals, young people and the poor.”

Both Schulman and Narcisse said the Supreme Court ruling would affect disproportionately colored people who have already experienced higher maternal mortality and morbidity rates than their white counterparts, a trend that was the original driver of much of the legislation examined at the hearing, and a topic that many of the new city council – the first with a female majority – and other newly elected officials, including Mayor Eric Adams and Brooklyn Borough President Antonio Reynoso, promised to take up the fight during last year’s campaigns.

According to Schulman, recent data obtained by the City Council shows that black mothers in New York City are eight to 12 times more likely to die from pregnancy-related complications than white mothers. The Centers for Disease Control and Prevention reported in April that black women are three times more likely to die from a pregnancy-related cause nationwide, meaning the crisis is far worse in New York City.

“The fact that black women and women giving birth do not receive the care and resources they need to survive during childbirth is unforgivable and morally reprehensible,” said Narcisse, who has been a nurse for more than 30 years.

After council members presented their bills, they had the opportunity to ask representatives of the city’s health department (DOHMH) about the city’s plans to improve access to abortion and combat maternal health inequality.

Michelle Morse, Chief Medical Officer of DOHMH, pointed out how the city has continued to address birth inequalities and the maternal health crisis – which she noted is driven by racism and bias in government, medicine, education, housing, economic policies and more – by developing programs and strategies using data focusing on pregnancy outcomes for black and Latino women.

Morse highlighted several urban services that have provided more equitable reproductive health care, such as the Nurse-Family Partnership, Newborn Home Visiting Program and By My Side Birth Support Program, and partnerships with hospitals and community-based groups, including Maternal Mortality and Review Committee, Maternity Hospital Quality Improvement Network, New York City Breastfeeding Hospital Collaborative, Birth Equity Working Group and more. She also praised the expansion of the Citywide Doula Initiative from Brooklyn to all neighborhoods in late March; the program sought to provide free access to doulas for 500 families by the end of June.

“We imagine a world where all New Yorkers have healthy, satisfying sexual and reproductive lives, where all children are born healthy, nurtured and loved, and where all births are safe – we are committed to making that vision a reality,” he said. Morse in her opening statement. “If we look at the legislation that is being heard today, the bills in this package cover a wide range of protections for pregnant women and those who may become pregnant.”

Morse said the city supports the intent of several city council bills, but noted how the department already provides similar services to some parts of the legislation that was introduced.

This included offering education on the city’s standards of respectful care at birth, proxy forms for health care and patients’ rights; increased access to maternal mortality and morbidity data; establishing a program in the department to train doulas and provide services; requires reports of polycystic ovary syndrome and endometriosis; establishment of an office for sexual and reproductive health (the current office is called the Bureau of Maternal, Infant and Reproductive Health); require family building services for city employees; and works with public information and outreach campaigns about risks of cesarean section.

It was clear during the consultation that the proposed bills would codify more current DOHMH programs and practices, an effort that could create new bureaucratic challenges for the department but also ensure the duration of these programs and practices and give the city council and the public more assurances, protections and clarity.

During the interrogation period, Schulman first asked how the city would be affected by the Court overthrowing Roe v. Wade. Laura Louison, assistant commissioner for the Bureau of Maternal, Infant and Reproductive Health at DOHMH, said the department has been preparing for the decision over the past two months and has been working to protect existing abortion access with community-based organizations and other government agencies. devices.

Louison added that the city is preparing for an influx of people seeking abortion who live in states where the procedure is restricted, and that the city has developed plans to provide accurate information about abortions to the public and providers, as well as support the expansion of services. in collaboration with clinicians.

Asked by Councilman Julie Menin, a Democrat from Manhattan, about how the Bureau of Maternal, Infant and Reproductive Health is specifically preparing for an increase in demand for abortion services, Louison said it is in the process of determining staffing and infrastructure needs to meet the expected increase in demand at the agency.

Louison did not have the exact number of referrals from the Bureau of Maternal, Infant and Reproductive Health to people seeking affordable abortion services, but said the agency is developing strategies to provide the public with more information on abortion access and partnerships with New York. State Department of Health to respond to states that may attempt to restrict travel to abortion services.

Councilor Marjorie Velázqez, a Bronx Democrat, followed up and expressed concern about “crisis pregnancy centers” trying to disguise themselves as abortion clinics. “It’s misleading practice and it harms our society, especially blacks and browns like mine,” Velázqez said.

Louison responded by saying that DOHMH will work with the Department of Consumer Affairs on a communications campaign and that the department has updated its website to include information on fake clinics and how to file a review. When asked about intimidation or harassment while providers and patients visit places with abortion services, Louison said the New York State Department of Health has increased funding for safety and the New York City Police Department will begin removing and prosecuting anti-abortion services. protesters if they break the law by preventing people from accessing abortion services.

“Abortion is legal in New York City, and it’s safe, and we’ve seen an increased presence of protesters at the health facilities that offer abortions in the five boroughs,” Louison said. “In order to maintain our commitment to safe and legal abortion, we need to ensure that patients are not harassed or intimidated when they enter the clinic, and that also applies to providers.”

Velázquez added that she is currently undergoing in vitro fertilization (IVF) and has experienced a lack of availability and communication with her provider. In apparent reference to the New York State Infertility Demonstration Program, she pressured the panel to review the program, saying she was concerned about other city employees who are also affected. “We have an opportunity here to say, ‘Let’s reconfigure this so that it can be accessible, because accessibility is part of the ability to deal with this situation and this health procedure,'” Velázquez said.

Councilwoman Rita Joseph, a Brooklyn Democrat, also asked about access to language services for new mothers. Machelle Allen, Senior Vice President and Chief Medical Officer at New York City Health + Hospitals, the public hospital system, said many different languages ​​are offered in the city’s facilities, which also have access to a language bar to call for interpreters. On inclusivity training, Allen said there has been anti-bias training throughout the system among senior executives and front-line staff, and the human resources department has adopted its own diversity and implicit bias training.

Following the administration’s testimony, councilors listened to public testimony from city officials and advocates of reproductive health, including Brooklyn Borough President Antonio Reynoso, Bronx Borough Vice President Janet Peguero on behalf of BP Vanessa Gibson, Greater New York Health Association Senior Vice President Lorraine Ryan, The Motherhood of New York Founding Director Paige Bellenbaum, Midwife Patricia Loftman on behalf of the New York Midwives and Sickle Cell Thalassemi Patient Network President Teresa Ginger Davis. Many spoke about their own experiences with the maternal health crisis and emphasized their support for the bills put forward.

“New York is in a historic moment with a female leadership team in the Bronx Borough Hall, New York City Council and at the state level,” Peguero said. “Now, more than ever, with the ruling of Roe v. Wade, we need stronger legislation at the local level to support women and lead this progressive national effort to ensure that standards of respectful care at birth become universal. . “

During his testimony, Ryan from the Greater New York Health Association noted how the racial differences seen in pregnancy outcomes, as well as for prenatal and postpartum colored women, have persisted in recent years, despite supportive state and city programming. health departments, the American College of Obstetricians, Gynecologists and the Greater New York Health Association and other organizations. She pointed to the challenges that hospitals continue to face, especially with inconsistent Medicaid pricing and the inability to properly expand services across the system.

“We know that hospital care before pregnancy, prenatal, postpartum, is not enough,” Ryan said. “That’s what we do for patients in society in terms of housing, education, transport and employment. The four walls of a hospital environment alone cannot guarantee the best results.”

Reynoso, who has said his first priority as city president is to improve the health of black mothers and reduce racial differences in maternity care, testified that his Brooklyn Borough Hall has invested $ 15 million and other resources in the district’s public hospitals to secure black and Latino women. receive adequate care. He expressed concern about how midwives are treated compared to doctors and others in the NYC Health + Hospitals system, and mentioned how patients have waited more than four hours to see a midwife, doctor or other care provider.

“We hope to make Brooklyn the safest place for all women to have babies within four years, and hopefully within eight years, Brooklyn is the safest place in the country for women to have babies,” said Reynoso, who took office in January. “Infrastructure is part of a bigger problem when it comes to maternal mortality.”

Bellenbaum of The Motherhood Center in New York highlighted that one in five new and expectant mothers experience perinatal mood and anxiety disorders (PMAD), and their risk and severity have been driven by racism and low economic status beyond neurochemical causes. She said she was lucky enough to speak to the city council after nearly losing her life 16 years ago to a PMAD. “Shame on us as a city for neglecting the mental health needs of expectant mothers and expectant parents,” Bellenbaum said.

City Council President Adrienne Adams, who was not present during the hearing, issued a statement thanking Schulman and Narcisse for holding the discussion. She said the overthrow of Roe v. Wade is representative of gender-based violence and will affect blacks, people of color, low-income and marginalized communities disproportionately.

“To put it bluntly, this Supreme Court ruling will cause women and women in labor to die,” Adams said. “I look forward to working with these committees and the administration to do what we can to pass this important legislation and make New York City a safe place for all women and women giving birth.”

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