Below is our Policy Strategist Sabrina Harris' proponent testimony on House Bill 142. This was delivered to the House Families, Aging, and Human Services Committee on October 28, 2021.
Dear Chair Manchester, Vice Chair Cutrona, Ranking Member Liston, and members of the House Families, Aging, and Human Services Committee:
My name is Sabrina Harris, and I am a Policy Strategist at the ACLU of Ohio. Thank you for allowing me to submit written testimony in support of HB 142.
The ACLU of Ohio eagerly supports legislation that expands reproductive access, and that is exactly what HB 142 would do. This crucial legislation addresses Ohio’s high maternal and infant mortality rates, especially among Black Ohioans. HB 142 would standardize training and certification requirements, establish a four-year pilot program allowing doula care to be covered by Medicaid, and provide for a pilot project in the Department of Rehabilitation and Corrections for expectant parents.
Across the nation and here in Ohio, infant and maternal mortality rates constitute a public health crisis. We know this crisis has a disproportionate impact due to the structural and engrained racial bias that exists within healthcare systems. Black women are dying a rate that is 2.5 times higher than white women. In Ohio, Black women account for 34% of all pregnancy-related deaths, while only accounting for 17% of all pregnancies.* In 2019, the Black infant mortality rate (14.3 deaths per 1,000 live births) was nearly three times higher than the white infant mortality rate (5.1).** For comparison, only five states have a higher Black infant mortality rate than Ohio.***
Doula care is recognized as one of the most promising approaches to combating disparities in maternal health; yet, it remains out of reach for many, especially those that could benefit most. Doulas are not typically part of the traditional maternity healthcare team; therefore, it is unlikely for private or public medical insurance to cover their services. High out-of-pocket costs create financial barriers to birthing people trying to access individualized care.
HB 142 helps to mitigate these barriers by creating a pilot program which allows doula care to be covered by Medicaid. Increased access to doula services will lead to healthier and safer families across the state. People that receive doula care have been found to have improved health outcomes for both themselves and their infants, including higher breastfeeding initiation rates, fewer low-birth weight babies, and lower rates of cesarean sections.**** Doulas are birth workers who provide health education, advocacy, and physical, emotional, and nonmedical support for pregnant and postpartum persons before, during, and after childbirth. They serve as primary advocates for pregnant and postpartum people by helping them navigate complex medical systems. Doulas can also help reduce the impacts of racial bias in health care on pregnant and postpartum people of color by providing culturally responsive, patient-focused care and advocacy.
We are fortunate in Ohio to have a number of organizations – Restoring Our Own Through Transformation (ROOTT), Birthing Beautiful Communities, and Cradle Cincinnati – doing this important work, specifically within Black communities. HB 142 would uplift these essential programs. If passed, this legislation would empower birthing people, reduce rates of racial disparities in maternal and infant mortality, and ultimately save lives.
Changing the barriers that exist within our healthcare systems will not happen overnight. Expanding access to doula care, HB 142 is a necessary step forward in addressing systemic racial bias. All pregnant and postpartum Ohioans deserve equitable access to the full spectrum doula care. The ACLU of Ohio thanks former Representative Crawley and Representative Brinkman for their leadership and urges the committee to support this important piece of legislation.
* A Report on Pregnancy-Associated Deaths in Ohio 2008-2016. The Ohio Department of Health, 2019.
** 2019 Infant Mortality Annual Report. The Ohio Department of Health, 2020.
*** Taking action: Eliminating racial disparities in infant mortality. Health Policy Institute of Ohio, 2021.
**** The National Health Law Program's Doula Medicaid Project.