Improving Birth Equity in California


Woman & Child

Why This Work Matters

In California, as in much of the US, Black mothers/birthing people experience the highest rates of maternal morbidity (serious complications) and mortality (death) of any racial/ethnic group. Despite impressive reductions in maternal mortality for all racial/ethnic groups in California, Black mothers/birthing people* are still three to four times as likely to die (PDF) from pregnancy/birth-related causes and twice as likely to suffer a maternal morbidity (such as hemorrhage and infection) than those in all other racial/ethnic groups. These statistics are especially concerning given that maternal morbidity and mortality metrics are widely considered to be some of the most fundamental barometers of public health.

Importantly, these variations cannot be explained away by factors such as age, income, educational level, and health insurance status. Evidence points to implicit bias and racism, not race, as key causes of disparities in maternity care and maternal outcomes for Black mothers/birthing people. For example, a Black mother/birthing person with a college education is still twice as likely to die than a white counterpart with a high school education. Implicit biases and racism are known to exist both at the level of the health care system and at the individual provider level.

As found in the 2018 Listening to Mothers in California survey (PDF), our health care system does not listen to mothers in general; and Black women/birthing people in particular are among the least listened to, costing them their health and, in some cases, their lives.

Our Approach

Through its investments in birth equity, CHCF aims to improve maternity care and maternal outcomes by, with, and for Black mothers/birthing people in California. We have chosen to focus on mothers/birthing people because they are often an overlooked population, forgotten once the baby is born, that is critical to our families and to our society as a whole.

In approaching this work that aims to address longstanding inequities, we know the road will be challenging and that CHCF, as a funder, will not always get it right the first time. We are committed to listening, to approaching the work with cultural humility (PDF), and to partnering with those most impacted by the inequities to find spreadable, scalable approaches for improvement in the health care system in California.

A summary of CHCF’s current portfolio of birth equity projects can be found below.

Project Highlights

Transparency/Monitoring/Data

  • A research team at UCSF is developing patient-reported experience measures to solicit feedback (via a survey) specifically from Black mothers/birthing people about their hospital care experiences, with the goal of informing quality-improvement efforts in the hospital. (In process)
  • The CHCF Almanac report Maternity Care in California describes the state of maternity care in California, including available statewide data that highlights disparities in maternity care and maternal outcomes. (November 2019)
  • The Listening to Mothers in California survey (cofunded with the Yellow Chair Foundation), fielded in English and Spanish by the National Partnership for Women & Families, highlights the attitudes and experiences of mothers around maternity care. Black mothers/birthing people were oversampled and an issue brief (PDF) about their experiences is available, along with many other resources. (September 2018)
  • The California Maternal Quality Care Collaborative (CMQCC) has developed a birth equity dashboard in its maternal data center that contains data from hospitals representing 95% of the births in the state. Currently, these data are available to CMQCC’s hospital members for quality-improvement purposes. (August 2019)

Delivery System Interventions

  • The National Health Law Program is conducting focus groups to better understand on-the-ground issues impacting doulas who provide care in California (e.g., scope of practice, training/certification, reimbursement). It is also developing fact sheets for policymakers to help inform the discussion about Medi-Cal coverage for doulas. (In process)

Lived Experience and Community Voice

Learn More

For information, please contact Stephanie Teleki.

*We use the term “birthing people” to recognize that not all people who become pregnant and give birth identify as a woman or a mother.