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Black Maternal and Neonatal Health Equity Can be Improved Through Strong Legislation.

To meaningfully address disparities in Black maternal and infant health, the health care system must be transformed to deliver patient-centered care that is equitable in nature and culturally relevant to the needs of Black mothers and infants. Innovations in Black maternal and neonatal health care requires centering Black Mothers lived experiences, acknowledging prematurity in the black population, and develop comprehensive policy solutions that are grounded in reproductive justice frameworks. And most critical, efforts should address systemic racism as the root cause of disparities in health outcomes, including the preterm labor rate for Black women, and the quality of care delivered to Black infants in the NICU.

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To assist policymakers in promoting maternal and neonatal health equity across the country, Once Upon A Preemie, Inc. has developed the following recommendations:

Priority #1: Federal funding should support policies that mandate implicit bias trainings to address discrimination in maternal and neonatal health care.

Black women and infants are more likely than white women to experience discrimination in the health care system which is shown to impact health outcomes. Despite the disproportionately high rate of Black patients in NICUs, providers are unprepared to deliver care that is culturally relevant. Implicit bias training is necessary because too many Black NICU families have reported experiencing discrimination in the NICU. xii Providers should be equipped with the relevant training to address implicit bias in practice through an expanded curriculum that unpacks discrimination in the health care system and at the bedside.

Priority #2: To improve maternal and neonatal health outcomes health care systems must collect accurate data.

Healthcare systems must consistently collect, analysis and report health outcomes by race, ethnicity, and language. A critical step in promoting health equity is the standardization of data collection, across the health care space for better analysis and reporting of quality metrics, including key demographics and patient experience. Further, robust data collection is needed to understand the full scope of the maternal and neonatal crises so that interventions may be better tailored.

Priority # 3: To improve the health of Black preemies we must increase and expand pathways to diversify the maternal and neonatal workforce

Research indicates that Black infants with complex health conditions fare better when they are treated by Black providers. Provisions to expand the perinatal workforce should also apply to the neonatal workforce. Diversification of the maternal and infant workforce will increase concordant care and improve health outcomes, improve Black patient experiences, increase trust between Black patients and providers, and increase the number of care providers who can offer culturally relevant care.


Priority #4: Black mothers and babies need access to high quality, culturally relevant and appropriate care, regardless of insurance status.

Access to high-quality health care is associated with better health outcomes. Clinical guidelines recommend that mothers have access to high quality health care that is ongoing and routine for at least one year postpartum, but without a federal mandate, too many Black mothers fall into coverage gaps.

Priority #5: To reduce disparities in maternal and infant health, the wellbeing of Black Mother’s and preemie babies must be centered in maternal health legislation.

The social risk factors that are associated with maternal mortality and morbidity are also associated with poor infant health outcomes including prematurity. Black women are more likely than white women to experience "weathering" from racism across the life course. To reduce disparities and improve maternal and infant health outcomes, legislation should develop a social safety net so that all families can thrive.

Priority #6: Expand access to Postpartum Doulas and Community Health Workers to support Black preemie families admitted to the NICU

Historically, Doulas have supported Black families by delivering culturally appropriate birthing, emotional, and practical support pre, during, and post-delivery. Research has shown that access to Doulas improves outcomes for successful births and healthy babies and has lowered the odds of Postpartum Depression and Postpartum Anxiety by about 58 percent. Furthermore, research indicates that support from Doulas can save Medicaid and private insurers $1,000 per birth. Therefore, given proven research, lived experiences, and recent federal priorities placed on increasing access to Doulas, no Black birthing woman in the US should be left behind. Expanding access to doula care and community health workers for Black preemie families is essential to ensuring the delivery of high-quality, culturally appropriate and family-centered care that Black birthing families require.

Priority #7: Provide mental health and social service support for Black Preemie Families.

Having a premature infant is a life changing and traumatic experience that for some women lasts a lifetime. Each minute a preemie spends in the NICU can seem like an eternity for parents. Many times, mental health disorders and depressive symptoms do not present themselves immediately upon a baby’s admission to the NICU. Additionally, many women’s need for mental, emotional, and social support goes underrecognized, or misdiagnosed. This difficult time is unfortunately exacerbated for Black families because of systemic, systematic and societal racism coupled with unconscious bias, and a lack of culturally appropriate mental health screening tools. As America Builds Back Better, we need to address this disparity to improve outcomes for families with premature infants.


A society’s wellbeing is measured by the ability of its population to thrive, yet far too many Black Mother’s and Black babies experience morbidity and mortality. Black Mother’s and Black newborns die at three times the rate of their white counterparts. This is the unfortunate reality of a society that devalues the lives of Black women. Health disparities can be addressed through policy levers. Without urgent action, Black mothers and babies will continue to experience poor health outcomes, high premature birth rates, and discrimination in the health care system.

Once Upon A Preemie, Inc. urges Congress to act now by enacting comprehensive policy solutions that center the needs of Black Mothers and Black Preemie Babies.

Help Us Ensure Racial and Health Equity for Black Preemie Families

We're committed to improving the health outcomes of Black Mothers and babies, unpacking disparities in NICU admissions, advancing equity in NICUs across the country, and educating NICU providers through anti- bias training. Once Upon A Preemie, Inc. advocates for the acknowledgement and integration of the needs of Black preemie parents in Congressional bills that support eliminating disparities for maternal and infant health.

Once Upon A Preemie, Inc. calls on policymakers to prioritize Black maternal and neonatal health through strong legislative action.

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