Policy Is the Missing Prescription: Advancing Black Maternal Health Through Systems Change
By Dr. Sherri Johnson, DNP, MPA, RN, FADLN, FAAN
Founder, The Institute for Health and Social Equity, Inc.
Black maternal mortality is not just a public health crisis—it is a policy failure with generational consequences.
As the United States continues to report some of the highest maternal mortality rates among industrialized nations—Black women and birthing people continue to bear the brunt, dying at 2–3x the rate of their white counterparts, regardless of income or education. These inequities are driven not just by what happens in the clinic or delivery room, but by the policies—or lack thereof—that shape access, quality, and accountability across our health system.
At the Institute for Health and Social Equity, we believe policy is one of the most powerful tools we have to close the maternal health equity gap. But policy must be informed by practice, led by community, and backed by the political will to act.
🩺 The Policy Gaps Behind the Crisis
Despite growing awareness, there remain significant structural gaps that worsen outcomes for Black mothers and birthing people:
- Inconsistent Medicaid Coverage
Many postpartum individuals lose coverage 60 days after birth. Expanding postpartum Medicaid to 12 months nationally is a basic step toward preventing avoidable deaths. - Underfunding of Title V and Title X
These federal programs provide critical maternal and reproductive health services—but have faced chronic underinvestment. - Lack of Data Transparency and Accountability
Without disaggregated data by race and geography, it is impossible to track the full scale of maternal health inequities—or hold systems accountable. - Limited Access to Culturally Aligned Care
The absence of Black midwives, doulas, and nurse-led maternal health models in many communities contributes to the erosion of trust and worse outcomes.
Policy Levers That Can Save Lives
Here are key legislative and policy mechanisms that must be prioritized:
A comprehensive package of 13 bills that addresses social determinants of health, funding for community-based organizations, investments in the perinatal workforce, and maternal mental health. If passed, this legislation would represent the most robust federal response to date.
While many states have opted in temporarily, federal action is needed to make 12-month postpartum coverage mandatory nationwide, not optional.
- Investment in the Perinatal Workforce
Funding programs that diversify and expand the perinatal workforce—including Black midwives, community health workers, and nurse-led birth centers—is key to equity and sustainability.
Expanding funding and updating Title V Maternal and Child Health Services Block Grants will allow states to better address maternal mortality and inequities on a local level.
- State-Level Policy Reform
From Medicaid reimbursement to licensure for doulas and midwives, state policy plays a direct role in access to care and patient outcomes. Local advocacy is just as critical as federal reform.
From Awareness to Accountability
Awareness is no longer enough. It’s time for the nursing profession, public health advocates, and equity-focused institutions to push for policy accountability:
- Track where your state stands on postpartum Medicaid and maternal health bills.
- Demand transparency on maternal mortality review board data.
- Partner with legislators who understand nursing and community health.
- Engage youth and early-career professionals in advocacy education.
The Institute’s Policy Pillars for Maternal Health Equity
At The Institute for Health and Social Equity, we anchor our work around three key principles:
- Proximity: Policy must be informed by the people most impacted. We elevate community voice and frontline expertise.
- Interdependence: Maternal health cannot be separated from housing, food security, workforce access, and environmental justice.
- Justice: We advocate for equity not as charity, but as repair—a commitment to addressing historic and ongoing harm.
Join Us in Shaping What Comes Next
We invite policymakers, nurses, educators, funders, and advocates to join us in reimagining a maternal health system where no one’s life is endangered by the color of their skin or their zip code.
The Institute stands ready to partner, convene, and lead.
If you’re interested in co-sponsoring a roundtable, commissioning a white paper, or supporting a community policy fellowship focused on Black maternal health—contact us at info@institute4equity.org
Because every life lost is one too many. And policy is the missing prescription.
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Written by Sherri Johnson, DNP, MPA, RN, FADLN, FAAN – Founder
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