Jenny Bautista-Ravreby, diversity, equity and inclusion manager
Blue Cross & Blue Shield of Rhode Island

Growing up I always knew I wanted to be a mom, but I, like many others at a young age, was blissfully unaware of the intricate nuances involved in having a baby. In early conversations with the women in my Dominican family, no one spoke of things like infertility or post-partum depression -- they were considered taboo topics, despite being experienced by numerous women. As I got older and started thinking more seriously about having my own family, I looked more deeply into the birth stories of women of color like myself, and I was inspired by their strength, but at the same time disheartened by their experiences of low quality maternal care and feeling powerless in their road to motherhood. I started getting nervous about what all these things meant for me personally. As a young woman of color, what would my experience be like if and when I have children?

Data from the Rhode Island Department of Health (RIDOH) Center for Health Data and Analysis Maternal and Child Health Database, as reported by Rhode Island Kids Count, shows that between 2015 and 2019:

• 23.5% of black women received delayed or no prenatal care, compared to 13.1% of white women.
• 11.5% of black women had preterm births, compared to 8.2% of white women.
• 11.7% of black women gave birth to low-birthweight infants, compared to 6.6% of white women.
• The rate of infant mortality among black women was 12 per 1,000 live births; for white women, it was 3.5 per 1,000 live births.

In the last few years, initiatives and rallies have popped up across Rhode Island as attention for maternal health disparities climbed to a national crisis. In 20 de junio20, the staff at Women & Infants Hospital, with the support of hospital administration, held a silent protest seeking a renewed focus on correcting racial maternal health disparities. In 20 de agosto20, Rhode Island became the 33^rd state to join the Alliance for Innovation on Maternal Health with the goal to implement a series of actionable steps to improve care for mothers and infants with a special focus on those of color.

The fight for maternal health equity continues with a new Rhode Island law that makes doula services eligible for reimbursement through private insurance plans and Medicaid. Doulas are trained healthcare professionals who provide women with continuous physical, emotional, and informational support during pregnancy, childbirth and throughout the post-partum year. This legislation provides more women with access to doulas as a means to help address health disparities faced by communities of color.

Studies show that doulas help reduce the rate of C-sections, which occur at higher rates among Black women. Doulas also increase successful breastfeeding, which improves the health of new moms and babies and is less common among Black or low-income women. A recent case study of Mamatoto Village, a nonprofit organization in Washington D.C. whose mission is to support mothers of color, also found that when low-income and minority women were provided family-centered care from a midwife, doula and lactation specialist, they had zero infant and maternal deaths, and 89% were able to initiate breastfeeding, as reported by Center for American Progress.

Blue Cross & Blue Shield of Rhode Island stands in support of the new doula coverage law and recognizes that doulas can improve health outcomes and the likelihood of a positive childbirth experience and reduce risk of complications for women of color.

Through its new maternal-health-focused work group, BCBSRI is exploring where we might be able to take action related to culturally appropriate interventions for mothers and newborns, improving the safety of childbirth for women of color and providing support for women experiencing post-partum depression. The Blue Cross Blue Shield Association's recent Health of America Report on Racial Disparities in Maternal Health provides the backdrop for which the work group will look to localize initiatives aimed at improving outcomes for pregnant Rhode Islanders of color.

During our annual Diversity Week at BCBSRI, we recently welcomed Ade Osinubi, a documentary filmmaker, photographer and 3^rd year medical student at Brown University to host a screening of her documentary "Black Motherhood Through the Lens". I moderated a conversation with Ade and two mothers who were featured in the film, Jai-me and Shannon. This was such an insightful and powerful conversation on what the experience has been for black mothers right here in Rhode Island. While the disparities for pregnant women of color are real and sobering, I still look forward with hope. And I'm heartened by BCBSRI's commitment to being a part of the larger work being done in the state in addressing racial health disparities within maternal health.

Putting a spotlight on these issues and acknowledging and understanding what we're up against is half the battle. I have faith that we can work together with community and national partners to effect real change for women like myself who want to experience the joy of motherhood without having to worry about the care we and our babies will receive. Faith that we can help create a healthcare system that helps us to succeed and also to have more agency over our bodies and our experiences in the road to motherhood. For more information on how Rhode Island is working to improve maternal and birth outcomes across the state, including actions taken through the Alliance for Innovation on Maternal Health and participating hospitals, visit the Perinatal Neonatal Quality Collaborative of Rhode Island's website: www.pnqcri.org/.