Health care providers, community advocates and others gathered at St. Anselm College Saturday to discuss how to improve maternal health in New Hampshire – and address glaring racial disparities seen in pregnancy-related deaths nationwide.
The Maternal Health Conference was organized by Black Lives Matter New Hampshire, part of a larger effort the organization is launching to tackle the issue.
“Our goal is really to just bring awareness and do more education around what's happening with Black maternal health,” said Tanisha Johnson, the organization’s co-founder. “So our goal is to bring in programming, support groups, do more baby showers, baby resources, collaborate with other organizations that are doing this work as well.”
The U.S. has a much higher rate of maternal mortality than other high-income countries, and the risks are especially acute for Black women. Black women were more than three times as likely to die from pregnancy-related causes as their white counterparts in 2023, according to the Centers for Disease Control and Prevention.
“We as a country are failing all birthing people,” but Black women bear the disproportionate burden, said Ndidiamaka Amutah-Onukagha, a professor of Black maternal health at Tufts University School of Medicine and the conference’s keynote speaker.
Amutah-Onukagha said lack of access to quality care, geographic gaps, rates of chronic disease, poor clinical support and structural racism can all contribute to those disparities.
'The lack of birthing hospitals and birthing centers in New Hampshire is a challenge.'Tanisha Johnson, Black Lives Matter New Hampshire co-founder
Saturday’s conference aimed to raise awareness about these disparities – including among health care providers – while also providing a space for healing, said Camilla Thompson, BLM New Hampshire’s maternal health coordinator.
“A lot of people don't talk about their birth trauma, and I think there's a lot of it, especially Black women in this space, where it's not always thought about or addressed,” she said. “So I hope that this is just a safe space for everyone.”
Johnson said one of the challenges here is that “we do not have enough BIPOC doctors in New Hampshire who can really address the needs of Black women in maternal health.”
“We don't have enough resources,” Johnson said. “The lack of birthing hospitals and birthing centers in New Hampshire is a challenge.”
Amutah-Onukagha pointed to one recent policy change in New Hampshire that could improve maternal health: extending Medicaid coverage to 12 months postpartum. She said more could be done to make sure culturally competent care is available and to support doulas — non-clinical support professionals, whose presence has been associated with better outcomes.
The closures of many hospital labor and delivery units in the past two decades have also limited access to care for pregnant people in many areas of New Hampshire, she said.
Between 2018 and 2022, there were 21 deaths in New Hampshire that were deemed pregnancy-related, according to New Hampshire’s Maternal Mortality Review Committee. That panel is charged with reviewing the circumstances of such deaths, though it uses a somewhat different definition from the CDC.
Mental health conditions were the leading contributor of the deaths identified in New Hampshire, with more than half caused by drug overdoses or suicide. The rest involved heart conditions or other medical issues. Ninety percent of the deaths involved non-Hispanic white people, according to the committee’s report, which did not list race or ethnicity for the other deaths. Around half had a high school education or less.
Mental health also an area of focus
Other talks throughout the conference covered mental health access, the role of fathers, and postpartum care, among other topics.
Daisy Goodman, a certified nurse midwife who also teaches obstetrics and gynecology at the Geisel School of Medicine at Dartmouth, led a discussion on postpartum care with Dr. Trinidad Tellez, a family physician and Democratic state representative from Manchester. Tellez also previously led New Hampshire’s Office of Health Equity.
Goodman and Tellez were part of a team that conducted research on how to better help people experiencing postpartum depression and improve systems of care in rural areas.
As part of that research, they surveyed people on their emotional experiences throughout and after their pregnancies. They found that, across the board, many may start their pregnancy journeys feeling excited, but many found their mental health worsened after receiving care that wasn’t supportive to their experiences in and out of the hospital.
“All of our birthing communities in the state should think about what is needed, especially postpartum, so we can prevent people from really experiencing the worst of the maternal mental health crisis that we’re having,” Goodman said.
'All of our birthing communities in the state should think about what is needed, especially postpartum, so we can prevent people from really experiencing the worst of the maternal mental health crisis that we’re having.'Daisy Goodman, a certified nurse midwife
About 12% of New Hampshire parents reported experiencing postpartum depression, according to a national 2022 pregnancy risk assessment monitoring system (PRAMS) Goodman cited during her presentation. But, she noted, Black women often don’t get the support they need in that area.
“From the perspective of racial disparity, the access to care and who gets prescribed medications and who has a follow-up visit heavily shows that Black women get about half as much care for postpartum depression as white women,” Goodman said. “Which is terrible because mental health conditions are now a leading cause of maternal mortality in this country.”
From their research, Goodman and Tellez heard a range of stories from Granite Staters who felt let down by their maternal care providers. Some felt a sense of powerlessness in their own deliveries. One respondent said they felt humiliated when a provider laughed at their desire to have a natural birth. Another was concerned about the amount of blood being drawn for tests and feared for their safety.
These instances eroded patients’ trust, Goodman shared, and made it harder for them to reach out for mental health support after their children were born.
The event also featured discussions on how to better support Latino parents in New Hampshire. Wanda Castillo, with the Manchester Health Department, said there’s a lack of prenatal care resources and parenting classes for this population. She also noted that many families are also dealing with added pressures, including concerns around immigration enforcement, differences in cultural norms around infant care and more. She also noted that there are many people who are uninsured or underinsured.
“So that puts more pressure because they cannot access the services that they need,” Castillo said.
