The only place Sen. Kamala Harris (D-Calif.) has time to read anything that isn’t one of her briefing books is when she’s on a plane. In April 2018, Harris saw a harrowing story in The New York Times Magazine detailing the unique horrors of maternal mortality for black women.
“For black women in America,” the article reads, “an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death.”
“It was devastating,” recalled Harris to HuffPost this week. “When I was able to see to the numbers, it propelled me. It prompted me to do something.”
Women living in the U.S. have higher rates of maternal mortality than those in other high-income countries, due, in part, to the disproportionate rates of pregnancy-related deaths for black women. A recent CDC study found that black women are 3.3 times more likely to die from pregnancy-related complications than white women. This means that for every 100,000 live births, nearly 43 black women will die.
The disparity cuts across class and educational lines: Following the birth of her daughter, Serena Williams suffered a pulmonary embolism, among many other potentially fatal complications. A nurse brushed Williams off when she initially sought treatment. Beyoncé was on bed rest for six weeks due to preeclampsia — a sudden jump in blood pressure during the later stages of pregnancy, for which black women are disproportionately at risk — before having an emergency C-section.
Harris forwarded the Times article to her staffers and encouraged them to read it with the intent of figuring out what could be done legislatively. Nearly a year before, in the summer of 2017, Harris had read a Vox article about Stanford University’s California Maternal Quality Care Collaborative, an initiative that collects data on maternal health, identifies preventable complications and then figures out next steps. She sent her staff that one, too.
“Every day we wait, every day we don’t address it, is a day that a mother could possibly die.”
Her team got to work on what would evolve into the Maternal CARE Act, a bill comprising three key components that address the issue of black maternal mortality through a systemic lens. The legislation aims to make providers aware of any underlying racial biases they hold via implicit bias training, to commission a national study to develop ways to institute that training more broadly and to establish care programs that provide integrated services to pregnant women and new moms.
The bill, to be reintroduced in the coming weeks, is part of a current onslaught of legislation attempting to address the issue of black maternal mortality. Sen. Kirsten Gillibrand (D-N.Y.) reintroduced the MOMS Act, a complement to Harris’ bill, in January. In March, Illinois Democrats Rep. Robin Kelly and Sens. Dick Durbin and Tammy Duckworth reintroduced the MOMMA’s Act.
The following month, Reps. Lauren Underwood (D-Ill.), Ayanna Pressley (D-Mass.) and Alma Adams (D-N.C.) launched the Black Maternal Health Caucus in the U.S. House. Sen. Elizabeth Warren (D-Mass.) explained how she plans to tackle black maternal mortality as part of her 2020 presidential platform.
Pressley then introduced the MOMMIES Act in May, a companion bill to legislation Sen. Cory Booker (D-N.J.) initially introduced last year.
“I can’t sit by, knowing this is something that is happening, and not do something about it,” Harris said.
Harris didn’t simply send the articles out to her staff and sit back waiting on someone to hand her a finished piece of legislation.
“She made sure we all read it,” said Rohini Kosoglu, Harris’ Senate chief of staff. “‘This article came out, have people seen it?’ We sent it around, then she would follow up: ‘Have you guys read it?’ [and] have a conversation about it.”
The senator wasn’t checking in every day. But every few weeks, often when it was least expected, she would inquire as to the status of the bill. “She wanted to make sure that we’ve identified an issue — people are hurting who are vulnerable people — and that we are sticking to a decent timeline to get this all done and out,” said Kosoglu.
“Every day we wait, every day we don’t address it, is a day that a mother could possibly die,” Harris said. “Or just not receive the kind of health care that can lead to the best outcomes in terms of her health and the health of her baby. I take it very seriously.”
Harris has always been acutely aware of disparities in women’s health. Throughout her life, she listened to her mother, breast cancer researcher Shyamala Gopalan, discuss how health issues affecting women of color aren’t given the same level of attention.
“The fact of it is not shocking, but to see … the documentation of it and the unfairness of it — it’s just so wrong,” said Harris. “You don’t have to scratch the surface of this issue very deep to know it is literally all about racial bias.”
“You don’t have to scratch the surface of this issue very deep to know it is literally all about racial bias.”
Whenever a policy issue pertains to vulnerable populations — particularly women and children of color — Harris’ zeal becomes more apparent. In one instance, she went up to Sen. Tim Scott (R-S.C.) on the Senate floor to discuss black maternal mortality. Harris wants other lawmakers to be aware that socioeconomic status and educational attainment doesn’t prevent black mothers from dying.
“It’s literally all about race,” reiterates Harris while noting that Scott was “surprised and concerned.” (Scott’s office did not respond to HuffPost’s request for comment.)
“I think of that as being a part of my role and my responsibility as a leader,” she continued, “which is to help educate people about issues that they should know about and that if they knew about would prompt them to act.”
Jamila Taylor, a senior fellow and the director of Women’s Health and Rights at the Center for American Progress, reached out to Harris’ office to collaborate on the issue after the senator tweeted out a column Taylor had written about black maternal mortality for Mother’s Day. This sparked a series of meetings and conversations that took place throughout 2018 and 2019. Taylor, who helped write the legislation, continues to work with Harris and her office today.
“They were attentive. They were always seeking to learn more about the issue,” said Taylor of Harris’ staff. “They really wanted to get a grounding — and also wanted to make sure that she had a grounding — before they decided how they would enter into the space and what kind of legislation they would introduce.”
After months of research, the bill began to take shape. The first piece of the Maternal CARE Act focuses on establishing a $25 million grant program — $5 million each for fiscal years 2019 through 2023 — for medical, nursing and other health professional schools and training programs to institute implicit bias training.
The second part of the legislation provides $25 million in grants to up to 10 states so that they can establish pregnancy medical home programs that would deliver health care services to pregnant women and new mothers in hopes of reducing adverse outcomes. (Stanford’s CMQCC initiative would help inform the second piece of Harris’ bill, the Pregnancy Medical Home Demonstration Project, said Kosoglu. And working on that piece alone took about a year.)
The third calls on the pregnancy home medical programs to circulate their practices and commissions a National Academy of Medicine study that would provide recommendations for incorporating implicit bias recognition into clinical skills testing for all accredited medical schools.
Including bias training in the bill was of high personal importance to Harris. She had studied the issue and how it relates to policing during her tenure as California attorney general — under her directive, California police underwent implicit bias training following high-profile shootings of unarmed black people that, she says, reinforced her understanding that implicit bias has fatal consequences.
“When those women walk into a clinic or doctor’s office or a hospital, they are not taken as seriously as other women simply because they are black,” said Harris. “And that is about racial bias. It is about the bias that the person they are talking with brings to a decision about the legitimacy of their complaint or concern. So I wanted to address it at that root.”
When Harris’ team ran the idea of including implicit bias training by professors, medical professionals and experts, Kosoglu said they agreed it was necessary. “We were able to take that concept with her guidance on directing us how to do it, and have our experts say, ‘Yeah, we should be doing that here in this field,’” said Kosoglu.
It wasn’t easy to pin down those specifics. Staff still had to ensure that there’s accountability for the fact that black women are treated differently within the medical system.
The Center for American Progress’ Taylor hasn’t seen any recent drafts of the bill, but she has provided feedback on which components her team thinks should be strengthened. “All people who are interacting with women in the health care system … should be trained — not just the docs, not just the nurses,” she said.
“What are the other sort of training or educational entities for health care professionals and other support staff that could use training like this?” she continued. “And also not just implicit bias. It’s also explicit bias. So how do we get at some of those pieces and aspects of what is happening and how these things manifest in the health care system?”
Harris echoed this sentiment to HuffPost. “People should not consider it something that affects ‘them,’ as in the ‘other.’ The health status and the well-being of a black mother is an issue that should concern everyone — just like the maternal health of any woman should concern everyone.”