Truly, I do like Elizabeth Warren as a Democratic candidate for president in 2020. She’s said a number of things that jive with the direction I’d like to see this country move. However, upon reading this article from CNN this morning, I find that she’s made a statement that sounds really great on paper about reducing maternal mortality among black women. However, when you look at the high level, talking points plan, it falls very short of the mark and smacks of a lack of in depth understanding of the issue of why black mothers die at a rate of four times higher than the rate of their white counterparts.

Her approach, according the article is to reward hospitals financially for reducing rates of black maternal mortality while reducing funding and financially penalizing hospitals that don’t reduce rates of black maternal mortality.

This sounds an awful lot like “No Child Left Behind” where failing schools are penalized financially and the best schools are rewarded. This cycle perpetuates the poor schools by not granting them the resources needed to do better. It’s no different with her hospital plan.

Penalizing hospitals will mean they may close their maternity units, thus reducing access to care. Most maternity units cost hospitals money, they aren’t money makers. Many rural hospitals have closed or consolidated their maternity units to urban centers, leaving women with drive times of an hour or more for prenatal care, let alone for birth. Better access to care is imperative.

This country is also short about 100,000 obstetricians. We would do well to have thousands more midwives in this country too, to provide care. Midwives are lower cost and have a different model of care for their patients with better outcomes. More providers isn’t enough of a solution. We need to work with the providers we have currently too.

Warren is correct in that we need better education for all medical providers on the issues of race and medical care. However, this is much deeper than cultural competency. Competency is what Warren showed us – she understands there is an issue and it needs to be fixed. Cultural humility is what is truly needed to cover the complexity of human identity and experience. It includes life long learning, mitigating the power imbalances between patient and provider and the institution needs to change. (credit to Melanie Tervalon and Jann Murray-Garcia) For more information please do watch their video on the topic.

This issue of systemic racism starts well before black women are pregnant and in need of prenatal care and care during childbirth. Our medical system has erroneous beliefs about black women’s bodies that go back generations. Please do read “Medical Bondage: Race, Gender, and the Origins of American Gynecology” by Deirdre Cooper Owens if you’d like an in depth, academic history of why and how these beliefs came about and the impact they have currently on black women’s healthcare.

Warren’s response is a gross oversimplification of a problem of endemic racism and weathering in the black community. This penalizing of hospitals won’t solve it. Quite frankly its a panacea. It sounds great, but won’t make the change she’s seeking.

Warren needs to look to the places like the CMQCC and other similar state programs to see what’s working and what’s not. The March for Moms and their team of experts, who have a much deeper understanding of the issues than I do, should be consulted as well. She needs a panel of people who are experts in their fields to consult with and who will initiate evidence based plans to combat maternal mortality specifically among black women.

This issue isn’t as simple as “we’ll charge them money for not making improvements.” See how well that works for the EPA and big polluters. It’s cheaper to pay the fine than to make the change. Making real change, with a multi-factor, nuanced issue like this isn’t easy or straightforward. It will take time, expertise, education and a whole lot of people to admit they have racial biases and are willing to make the change needed.

Warren’s acknowledgement of the issue of black maternal mortality is a good start. However, humility is knowing what you don’t know and where and from whom to seek help. Warren needs help to make real change. I hope she asks for it from the right people.

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