By Atiya Weiss
It’s a natural goal of all societies for every generation to be healthier than the one before. Yet when it comes to maternal child health, our nation is failing. A mother in the United States today is more likely to die in childbirth than her mother. Our nation is the most dangerous country in the industrialized world to have a baby.
And, though New Jersey is one of the wealthiest and, overall, healthiest states, the situation here lags the national average.
In 2018, New Jersey was ranked 47th in the nation, or fourth highest, for maternal mortality overall, with Black women at least five times more likely to die from pregnancy-related complications than white women. Black babies are three times more likely than white babies to die before their first birthday. These disparities threaten all Black families, regardless of income, education, and other socioeconomic factors, a recent study found.
For decades, it seemed nothing could be done. Now we know better. There is greater recognition that we need a perinatal health care system built on trust, competence, belonging, and dignity for everyone, no matter their race, ethnicity, or class. That system must be free of the structural racism in policies and practices that can harm mothers and babies.
A first step to creating a more supportive and equitable system requires rethinking where we put our money. Four of every five maternal health dollars are spent on the brief window — usually 24 to 48 hours — of care around the time of birth. Just a small fraction supports prenatal and postpartum care, the times when opportunities are abundant for promoting well-being by addressing mental health and social needs that can threaten lives.
Some innovative pilot programs in New Jersey support women through pregnancy, delivery, and postpartum in ways shown to significantly improve mothers’ and babies’ health. We must expand these models of care.
One example is CenteringPregnancy, a relationship-based health care approach where eight to 10 pregnant women, all due around the same time, come together for their care. They take their own weight and blood pressure and record their own health data and have private time with their provider. Then the group, supported by nurses, midwives, and ob-gyns, gathers to discuss anything from nutrition and stress to labor and delivery to breastfeeding.
The Burke Foundation joined with the New Jersey Department of Health and other foundations to invest in a five-site CenteringPregnancy pilot in 2019. As of December 2022, birth data for 363 newborns show a 27 percent decrease in preterm births and a 20 percent reduction in low birth weight. We are scaling this relationship-based group healthcare model to 50 sites across New Jersey by 2026.
Another example of where more maternal care investment is needed: growing and strengthening the state’s corps of doulas. These non-clinical professionals — much more widely used in other countries — provide emotional, physical, social, and educational support during the prenatal, labor and delivery, and postpartum periods.
Burke funded the AMAR Community-based Doula Program in Trenton, which served over 150 families. Data from 2019-2022 documented a 79% reduction in preterm births; 49% decline in low-risk C-sections; and a 60% exclusive breastfeeding rate at three months. These results make a convincing case for expanding the use of doulas in New Jersey.
Relying more on midwifery is another necessity. Midwives are highly-trained clinicians and experts in the healthy processes of labor, childbirth, and breastfeeding, and midwifery has been shown to reduce unneeded medical interventions, increase rates of breastfeeding, and contribute to greater patient satisfaction. Burke is part of a coalition of advocates expanding and supporting midwifery practice in New Jersey.
To support this transformation of care, we must create a perinatal workforce that goes beyond ob-gyns — one that includes greater numbers of midwives, doulas, lactation consultants, home visiting nurses, and community health workers. We need pathways for more women of color to join this workforce, and we must improve compensation so we can turn these professions into sustainable careers.
Beyond improving health, these changes have strong economic benefits. We spend more on maternity and newborn healthcare than on any other area of health care. Reducing health conditions caused or worsened by pregnancy would reduce costs at the same time they give mothers and newborns their best chance to thrive.
The widespread support for the NurtureNJ campaign started by New Jersey First Lady Tammy Murphy shows there is a will to change the status quo. There’s a way, too. We need government and private insurers to think beyond hospitals when funding maternal-child health care.
We must diversify and expand the perinatal workforce and support innovative approaches. We can do more than just imagine a new system of care for mothers and babies. We can and must make New Jersey a state where no mother and no baby ever dies because they did not get the care they deserved.
Atiya Weiss is executive director of the Burke Foundation in Princeton, which is committed to early childhood policies and practices that promote healthy births and strong beginnings.
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