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Throughout the country, Minnesota is seen as a leader in health care with a rich history of innovation and off-the-charts rankings. Some of the leading clinics, technology manufacturers and insurance providers all call Minnesota home, and for good reason. But at the same time, the very health care systems in our state that promise care and comfort for families during one of the most significant health events in their lives — childbirth — fall short of meeting the needs of all birthers.

Despite increased attention on equity and DEI initiatives, there remains a stark disparity in maternal mortality rates between Black and white people. According to the Kaiser Family Foundation, Black women have a pregnancy-related mortality rate that is about three times higher than that of white women. In addition, a recent Minnesota Department of Health report indicated that, while the state's overall maternal mortality rate is much lower than the national average, there are also disparities. Black Minnesotans represent 13% of the birthing population, but made up 27% of pregnancy-associated deaths between 2017 and 2019. What is more unnerving is that this tragic reality cannot be attributed to biological differences but rather to the structural racism that pervades our society.

Factors such as lack of access to quality health care and culturally concordant care, racial bias and discrimination within health care settings, socioeconomic disparities, and environmental stressors all contribute to the elevated risk of maternal death among Black mothers and birthers.

According to a new poll commissioned by Blue Cross and Blue Shield of Minnesota, more than half of Black Minnesota mothers and birthing people feel that discrimination based on their race/ethnicity negatively impacts their health.

Respondents identified discrimination as a key impediment to health equity, with 59% indicating it adversely affects birther health. The survey exposes a challenging environment for Black women and birthing people, who must place significant trust in health care systems, yet have low confidence that their health care needs (particularly postpartum) are met.

The survey results also pointed to some potential solutions. About 52% of respondents said increasing the representation of Black health care professionals would have a strong impact in improving Black birther health.

Rooting our strategy and mission in advancing racial and health equity, Blue Cross is committed to working collectively to eliminate barriers to health and to proactively address large-scale systemic issues that drive racial and health inequities.

One key area of focus needs to include expanding access to quality and culturally informed health care for Black mothers and birthers, including prenatal and postpartum care, reproductive health services, and mental health support. Part of this work includes implementing anti-bias training for health care providers, helping to create a more diverse and inclusive health care workforce, and establishing protocols to ensure equitable treatment for all patients. It also includes educating new Black mothers and birthers throughout their journey so they have the necessary tools to advocate for themselves, which many of them inevitably end up having to do.

Another strategy is to make changes in policy. In August 2022, several members from various Black and Indigenous community organizations formed the Birth Justice Collaborative (BJC) as a way to inform and develop strategies that improve maternal health for American Indian and African American communities. Initiatives developed at the BJC have directly resulted in the Minnesota Department of Health vastly changing the way Blue Cross covers doula and midwife care for people on Medicaid, expanding coverage from eight to 17 visits. In the Black community, doulas have been the standard for the way important health knowledge gets passed down between generations. This knowledge and care are also known to play an invaluable role in healing, and to greatly improve maternal outcomes for Black women.

Community-based interventions are also crucial in this work. Communities have the answers, and it is incumbent on dominant systems and organizations to support and amplify the solutions that communities have identified and built. This includes supporting efforts focused on improving access to care, education, affordable housing, nutritious food and economic opportunities.

The Blue Cross and Blue Shield of Minnesota Foundation supports several organizations that focus on improving Black maternal health, including the African American Babies Coalition, which advocates for policies and programs that improve maternal and infant health outcomes within Black communities, addressing the root causes of maternal health inequities to ensure that Black birthers and babies receive the support they need to thrive. Another organization we support is the Roots Birth Center, which provides comprehensive maternity services and offers holistic care that respects the cultural traditions and preferences of clients to empower and reduce maternal health inequities.

By working together, Blue Cross and other health-driven organizations can set the standard where all birthers, regardless of race or socioeconomic status, can experience healthy pregnancies and childbirth. However, to be truly successful, we must expand the advocacy for Black mothers and birthers, and see greater efforts from many sectors, including policymakers, health care providers, community organizations, advocates and more. Ensuring safer, more personalized and more equitable maternity care for all birthers, babies and families should be paramount in a state so highly regarded for being one of the healthiest in the nation.

Bukata Hayes is the vice president of racial and health equity and chief equity officer for Blue Cross and Blue Shield of Minnesota.