By Skye Crawford and Ashley Fredde
- The crisis is measurable. Black women in the U.S. are three times more likely to die from pregnancy-related causes than white women, and bias or discrimination was identified as a contributing factor in 70 percent of North Carolina maternal deaths, per the state’s own 2024 review committee.
- Solutions exist and have proven results, but keep stalling in legislative committees. Bills covering doula access, community support programs and programs to reduce infant mortality have been introduced repeatedly many never receive a hearing. The gap is largely a result of lack of political will and funding disagreements.
- Bipartisan concern hasn’t translated into bipartisan action. The story’s most notable tension is some Republican lawmakers champion these issues — yet the majority party controls the budget rooms where these programs live or die.
Three weeks after giving birth, Christine’s face and ankles became swollen at night. The 37-year-old Black woman from Robeson County became short of breath just walking to the kitchen, and lying flat made her feel like she couldn’t breathe. She had developed postpartum cardiomyopathy.
Jamila, a 27-year-old Black woman from a rural eastern North Carolina county, became dependent on pain-relieving pills after surviving a car accident. She wanted to stop before her second child was born, so she confided in her doctor. But she was not given a referral to an addiction specialist to help her safely manage her pregnancy.
Ayana, another Black woman in Charlotte, was near the end of her pregnancy when she told her doctor she wasn’t feeling well. It took three more visits — the last with a different provider — to discover that her organs were failing.
These anecdotes are representative of many cases that Dr. Michele Benoit-Wilson, a board-certified OB-GYN and founder of HerHealthMD, has seen during her 26 years in women’s reproductive care.
“[The] stories are fictional, but every detail is drawn from real data, real conditions and real failures of the system that was supposed to protect them,” Benoit-Wilson said. “Christine, Jamila, Ayana — three different women, three different counties, three different causes, but one number connects them.”
That connection brought lawmakers and advocates together last week to recognize Black Maternal Health Day and push for greater investment in addressing the issue.
In the U.S., Black women are three times more likely to die from pregnancy-related causes than their white counterparts. The leading cause of these deaths is mental health conditions, including overdose and suicide. Benoit-Wilson said substance use disorder causes more maternal fatalities than heart disease, hemorrhage and infection combined.
Moreover, The American Heart Association reports that Black women may be more than three times more likely to develop postpartum cardiomyopathy — a weakening of the heart muscle that leads to a decreased ability to pump blood — compared to their white counterparts.
According to Benoit-Wilson, Black women experience these complications at higher rates due to systemic barriers and unconscious racial prejudice.
“Bias and discrimination were found to be contributing factors in 70 percent of maternal deaths in the most recent report of the North Carolina Maternal Mortality Review Committee,” Benoit-Wilson said. The report was published in 2024.
“Whether the impact comes from a chronic stress that systematic racism imposes on Black women’s bodies over a lifetime, or from the interpersonal bias that can play out in a single clinical encounter — the evidence is clear. Implicit bias in health care leads to worse outcomes,” Benoit-Wilson said. “For Black women, it can mean the difference between life and death.”
North Carolina has struggled with maternal and infant health for years with little improvement; the state recently received a D+ in the 2025 report card from the March of the Dimes. North Carolina has the 11th highest infant mortality rate in the United States despite decades of effort directed toward improving it.
Multiple lawmakers have advanced a variety of maternal and infant health-related bills in recent legislative sessions; among them are two Durham Democrats, Sen. Natalie Murdock and Rep. Zack Hawkins, who spoke last week.
Hawkins said expanding access to doulas and ensuring that health care providers receive training to recognize and challenge unconscious bias are vital to improving Black maternal and infant health outcomes.
“The charge is on all of us until every mother has equal opportunity to survive pregnancy, deliver safely and return home to her family,” Hawkins said. “Our work is not done.”
Proposed solutions, proven outcomes
The General Assembly passed a bill in 2023 that allowed experienced certified nurse midwives to practice without physician supervision if they have completed at least 24 months and 4,000 hours of clinical practice, something the nurse midwives had been campaigning for for years. (The same bill also tightened North Carolina’s restrictions on abortion.) The change to rules governing midwifery was intended to expand access to maternity care in underserved areas.
The number of certified nurse midwives the year the legislation passed was 425, with 392 of those being in a collaborative practice. Since then, the number has grown to 501 — and just over half (257) are practicing independently, according to the Sheps Center for Health Services Research.
Now lawmakers are considering expanding access to doulas through Medicaid.
Doulas are trained support people who help a woman physically and emotionally before, during and after childbirth. Doula services — especially those provided to Black mothers by Black women — have been shown to combat the societal, racial and financial factors that can keep new mothers from being healthy and successful. A 2016 study conducted by researchers from the University of Minnesota School of Public Health found that women with a doula had a 22 percent lower risk of preterm birth.
The bill, Senate Bill 463 Medicaid Coverage for Doula Services, would require the North Carolina Department of Health and Human Services to seek federal approval to add doula services to the state’s Medicaid program. Other proposed bills and solutions include:
- Senate Bill 964 Expanded Access to Doulas and Midwives that would require NC Medicaid to cover doula services during pregnancy and the postpartum period and would provide recurring funding to support the doula workforce.
- Senate Bill 617 Accessing Certified Professional Midwives Act that would establish licensing and renewal requirements for midwives. It would also create a council of professional midwives appointed by the NC DHHS secretary responsible for overseeing certification processes. Sen. Jim Burgin (R-Angier) worked alongside Murdock to draft this bill.
- Senate Bill 1005 We Need More Midwives Act that would establish a midwifery education grant program for UNC System schools. The bill is supported by Sen. Ralph Hise (R-Spruce Pine) in collaboration with Sen. Sophia Chitlik (D-Durham).
- Senate Bill 907 The Ciji Graham Act that seeks to reduce racial disparities in maternal health outcomes by creating a high-risk pregnancy navigation program, a pregnancy consultation hotline and other resources. In 2024, Kentucky’s legislature expanded similar resources, including mental health consultations for pregnant individuals.
- Senate Bill 906 MOMnibus 3.5 seeks to address a variety of problems contributing to poor maternal and infant health outcomes by providing funding for community-based organizations, supporting lactation training programs at North Carolina’s historically Black colleges and universities, establishing implicit bias training for perinatal health care providers and more. At the end of April, Gov. Abigail Spanberger of Virginia signed that state’s “Momnibus,” a collection of similar bills aimed at addressing maternal health disparities. The state’s progress builds on initiatives from the previous year.
Lack of legislative will?
Some bills have gotten bipartisan support, but most proposals have been sent to committees where they never receive a hearing. Murdock has filed the MOMnibus bill in some variation four times since 2020, with some disagreements coming down to funding and reimbursement rates.
“We may disagree on that reimbursement rate, but we do have an agreement with a number of members that these are things that we know that work. It’s just a matter of having the political will to move them forward,” Murdock said.
Whether political will or partisan disagreement, the sticking point often appears to be differing funding priorities and weighing cuts to the Medicaid program, in particular this past year after the One Big Beautiful Bill Act reduced federal health care funding over the coming decade.
Among affected programs was the Perinatal Quality Collaborative of North Carolina, which coordinated hospital teams that work to improve care for mothers and newborns. The program began winding down operations last year after losing its roughly $905,000 annual budget tied to Medicaid funding.
The program operated in dozens of hospitals statewide since 2009. Republican lawmakers Rep. Grant Campbell (Kannapolis), a longtime OB-GYN, and Sen. Jim Burgin have been vocal proponents of restoring the program and its funding.
Campbell said that the initiative was “incredibly inexpensive” while improving outcomes.
Many of the other proposals before lawmakers would require new state spending, increased Medicaid reimbursement rates or long-term commitments to workforce development — priorities that will compete with other demands in the state budget when it is proposed. With Republican majorities in both chambers, budget discussions will mostly fall to Republican members.
“I get frustrated because both of those members [Burgin and Campbell] are in the majority party. They have the ability to fund that program if they wanted to, or to advocate for that in budget negotiations. I’m not in those rooms,” Rep. Julie von Haefen (D-Raleigh) responded when asked if there’s been any bipartisan discussion.
Looking ahead
Murdock said she has had “good conversations” with Republican lawmakers about including maternal health provisions in the state budget. She referenced last year’s discussions that led to making Medicaid coverage for 12 months postpartum a permanent feature of the program.
“With Virginia being the first state in the South to sign a comprehensive omnibus package, that is what we dream of, and we know that it is achievable,” Murdock said. “We know the support is there, and we just need the political will to get it across the finish line, and more allies and more support.”
Murdock said initiatives that extend postpartum Medicaid and improve access to care in rural areas help all mothers.
“I think what will likely happen is outcomes will improve with a more holistic approach, but I’m hopeful that in the future we’ll have more programs that are directly targeted to see what we’re getting wrong with our Black moms,” Murdock said.
Burgin said he is exploring additional avenues of care and funding sources.
“A Black infant has a three times higher probability of dying than a white or Hispanic infant, and that’s not acceptable. I’ve been meeting with all kinds of different groups about how we specifically look at that, and what we can do,” he told NC Health News.
Among those conversations are those with recipients of the Rural Transformation Fund, where Burgin said he emphasized a focus on pregnant mothers in rural areas. The Sheps Center estimates that between 12 and 18 rural hospitals have closed over the past decade. Other rural hospitals have eliminated their OB services and delivery, including Harnett County, which Bergin represents.
Burgin said he recently spoke with federal Medicaid officials and plans to visit Washington, D.C., in July to discuss solutions for addressing the disparity. The issue isn’t one he takes lightly or plans on letting fall by the wayside, he said.
“Before I leave the legislature, I want to cut that in half in the Black community, I think that’s a worthy goal,” he said. “We’ve been talking to pediatricians and OB-GYNs, and everybody that’ll talk to us about ‘what do we do’ and ‘how do we target this,’ so I think you’re going to see a lot of movement.”
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