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California can afford to protect the lives of black mothers. Will Legislature act?

Video: Woman credits Black Infant Health program for healthier pregnancy

Karmerica Wiseman, 20, is 5 months pregnant with her second child and credits the Black Infant Health program for a healthier pregnancy this time around. Video by SILVIA FLORES
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Karmerica Wiseman, 20, is 5 months pregnant with her second child and credits the Black Infant Health program for a healthier pregnancy this time around. Video by SILVIA FLORES

Are black women’s lives worth $348,000?

This is the current debate in the California Assembly Appropriations Committee as they decide whether to support Senate Bill 464, the California Dignity in Pregnancy and Childbirth Act

SB 464 aims to reduce adverse maternal health outcomes in California by mandating implicit bias training for perinatal health care workers and requiring rigorous tracking of pregnancy-related deaths and complications.

The California Department of Finance opposes this bill, deeming it too costly and saying it should be considered as an addition to next year’s budget instead. As medical students, we strongly disagree.


It is well established that giving birth in America is more dangerous than in any other developed nation. Each year, childbirth results in death for more than 700 women and life-altering injuries for nearly 50,000. These severe complications include hysterectomies, hemorrhage, stroke and life-threatening infections. Nationally, black women have a much higher risk of experiencing these adverse pregnancy-related outcomes compared to non-black women.

While California has taken great strides to reduce the number of pregnancy-related deaths, significant disparities persist. Despite accounting for only 5 percent of all pregnancies in California, black women account for nearly 21 percent of pregnancy-related deaths. This means that every year, nearly four times as many black newborns grow up without their mothers compared to white newborns. Black women are also three to four times more likely to develop severe complications from pregnancy than the state’s average.

Data and high-profile cases such as Serena Williams’ confirm that this disparity in maternal outcomes is not explained by income, education, access to prenatal care, individual behaviors or overall health. It is better explained by racism and racial bias. In fact, a national 2019 study found that black women were about 8 percent more likely as white women to experience mistreatment and twice as likely to have calls for help ignored during childbirth. As John Oliver recently claimed on the subject in Last Week Tonight that “we are disbelieving black women to death.”

But why? Surveys and studies indicate that white medical students and residents believed biological myths about racial differences, including that black patients have less-sensitive nerve endings and that their blood coagulates more quickly than white patients. Even in our own experiences as California medical students, we’ve come across racial stereotypes in study materials.

If California is to succeed in reducing racial disparities in pregnancy-related outcomes, perinatal health care workers must undergo evidence-based implicit bias training. We expect Starbucks and Sephora employees to recognize and address their biases. Shouldn’t we expect the same for health care professionals?

SB 464 takes several important steps towards addressing these alarming maternal health inequities. Requiring implicit bias training for perinatal health care providers will give health care workers the tools to recognize and reduce racial biases in care. Mandating public sharing of maternal morbidity and mortality data, stratified by race, will prompt hospitals to act with greater transparency and accountability. Finally, requiring hospitals to provide information on how to file reports of discrimination will empower patients to report unequal treatment.

Despite passing unanimously on the floor of the California Senate and in the Assembly Committee on Health, the Assembly Appropriations Committee has allowed SB 464 to stall. The Department of Finance opposes this bill primarily because it will cost $348,000 per year – as well as a one-time cost of $167,788 – requiring extra funds that had not been accounted for in the state’s 2019-2020 budget. This represents a mere 0.0003% of the General Fund, which totaled $138.7 billion in 2018-2019. If SB 464 fails to make it out of the committee by the end of the month, it will not become law.

We know that the lives of black mothers in our state are worth more than $348,000. We cannot afford to wait for a new legislative cycle when new mothers in our state are at risk.

As future medical providers and concerned Californians, we believe SB 464 is an important step towards securing the fundamental right all of pregnant people to receive unbiased and equitable health care. California has an opportunity to build a community in which all pregnant people can expect to be treated with dignity and to return home safely with a new addition to their family. We hope the California State Legislature shares this vision, and pushes to pass SB 464 before it is too late. The lives of California’s mothers are at stake.

Jazzmin Williams is a Second Year Medical Student at UCSF School of Medicine in the Program in Medical Education for the Urban Underserved, and a member of White Coats for Black Lives. Christina Schmidt is a Second Year Medical Student at UCSF School of Medicine, where she co-founded the UCSF Sexual and Reproductive Health Collaborative.

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