Healthbeat

It’s a dangerous time for mothers and babies in the U.S.

2026-05-13T11:00:00+00:00

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Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

It was Mother’s Day in the United States on Sunday. In addition to being an important day of celebration, it can also be a solemn occasion, because of the fatal health risks associated with pregnancy and the newborn period. This week I’m highlighting recent stories about emerging risks to mothers and babies in the United States, including restricted access to essential medications, misinformation, and violence.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a global nonprofit focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

Supreme Court will consider restricting access to medication-assisted abortion

Abortion is an essential medical procedure. Roughly 1 in 4 American women will have one in their lifetime, and, over the past two decades, it has become safer, more effective, and more accessible, largely because of the two-drug regimen of mifepristone and misoprostol.

Today, medication abortion accounts for nearly two-thirds of all abortions in the United States, and about a quarter are provided through telemedicine. A systematic review of 99 studies concluded that the two-drug regimen is safe and effective. At least three studies in the United States have additionally demonstrated it is safe and effective to screen patients by telehealth and provide medications by mail, supporting the findings of a systematic review that included studies from around the world.

Access to abortion medications is now at risk in a case before the Supreme Court. On May 1, the Fifth Circuit Court of Appeals sided with Louisiana in Louisiana vs. FDA, temporarily reinstating a Food and Drug Administration requirement that mifepristone be dispensed in person, a rule the FDA lifted in 2023 after reviewing more than two decades of safety data. Justice Samuel Alito issued a one-week administrative stay on May 4, and the full court will decide soon whether to keep mailed mifepristone available while the case proceeds.

NYC looks to bolster home nursing service to fight health disparities in pregnancy

Louisiana’s argument is, frankly, absurd. Louisiana claims standing because it spent $92,000 in Medicaid funds treating two patients who experienced complications from mifepristone obtained out of state. As the drug manufacturers Danco and GenBioPro argued in their emergency appeal, this theory of injury, if accepted, would let any state challenge any federal policy that ends in a doctor visit the state pays for.

Two years ago, the Supreme Court unanimously rejected a similar challenge from anti-abortion physicians on standing grounds. But I and many others are worried that the conservative super-majority will use this case to further restrict abortion access.

If the court rolls back the 2023 rule, telehealth providers could shift to providing a one-drug regimen with misoprostol, which is less likely to be restricted because it has medical indications beyond abortion. While a single-drug protocol works, it is less effective and causes more pain, bleeding, and gastrointestinal side effects. Quite simply, overturning the FDA’s rule would harm women.

Homicide and suicide are now leading causes of death for pregnant women

One of the most harmful fallacies in the push to restrict abortion access is that abortion is dangerous and that pregnancy is safe. In fact, pregnancy places a woman at high risk of serious illness and death. A new study in the New England Journal of Medicine reveals that there are two less well-recognized reasons why American mothers are dying during pregnancy: overdoses and violence.

Columbia University researchers analyzed every death among pregnant and postpartum women in the United States between 2018 and 2023. Of 7,901 deaths, the single leading cause was unintentional drug overdose (1,152 deaths). Violence, including homicide and suicide combined, was second, at 866 deaths.

Homicide rates were highest among non-Hispanic Black women aged 15 to 24, at 14.3 deaths per 100,000 live births, which was more than four times the rate for white and Hispanic women in the same age group. Firearms were used in 77% of homicides and 39% of suicides.

Taken together, overdose and violence accounted for more than a quarter of all maternal deaths and nearly equaled the combined toll for the four causes of death that we generally believe to be the most important in pregnant and post-partum women: cardiovascular disease, infection, hypertension, and hemorrhage.

Babies are dying because parents are refusing vitamin K

We are now seeing that American babies are also at risk of dying soon after birth, and the primary reason is misinformation.

Newborns are born with very low levels of vitamin K, which the body needs to produce clotting factors. Without enough vitamin K, infants can bleed into their gut, lungs, or, most catastrophically, their brain. Before universal newborn vitamin K injections began in 1961, up to 1 in 60 babies developed bleeding from vitamin K deficiency in the first week of life. A single intramuscular injection at birth, given within hours of delivery, has nearly eliminated the condition.

‘We Can Do Better’: Q&A with childbirth safety expert on ways to stop preventable maternal deaths

Increasingly, parents are rejecting this life-saving injection. The proportion of U.S. newborns not receiving vitamin K rose from 2.92% in 2017 to 5.18% in 2024 — a 77% increase. Babies who do not receive the shot are 81 times more likely to develop late vitamin K deficiency bleeding, and the Centers for Disease Control and Prevention estimates that 1 in every 5 babies who develop the condition will die.

I encourage you to read a detailed article that tells the stories behind these deaths. Reporters reviewed autopsies from babies across the country whose deaths were attributed, in whole or in part, to vitamin K deficiency bleeding. Hospitals are reporting refusal rates that have doubled or tripled since the pandemic. At Idaho’s St. Luke’s system, the refusal rate climbed from 3.8% in 2020 to 9.8% in 2025; one hospital reached 20%.

What is driving parents to refuse vitamin K? Quite simply, it’s misinformation. Parents are telling pediatricians they fear toxins, distrust pharmaceuticals, think the injection will lead to leukemia (it does not), and prefer “natural” approaches. While these same parents refuse vaccinations for children and themselves, I have not been able to understand why they refuse a vitamin.

Many adults who oppose vaccinations consume vitamins and supplements regularly themselves, believing it will enhance their health, but, oddly, they are the same people denying a life-saving vitamin for their newborns.

Celebrating Mother’s Day

Mother’s Day should be a celebration. For me, the best way to celebrate mothers in America is to ensure they and their future babies have access to the medications, care, and accurate information they need to live healthy lives.

- Jay

Dr. Jay K. Varma, who is recognized globally for his leadership in the prevention and control of infectious disease, writes about public health for Healthbeat. He has guided epidemic responses, developed policies, and implemented programs that have saved lives across Asia, Africa, and the United States. He is based in New York. Contact Jay at jvarma@healthbeat.org.

NY health update: Declining MMR vaccinations, high Black maternal death rates, fish safety, and spring health alerts

2026-04-24T15:55:34+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Before I jump into this week’s newsletter, I have to give a shoutout to my mom, who just ran the Boston Marathon. Watching her train so hard, get up at the crack of dawn, and then run 26.2 miles with 30,000 other runners was incredible. I’m so proud of her.

And congratulations to everyone else who left it all on the course last weekend. The videos of runners helping other runners over the finish line, people giving everything they had, and the volunteers, medics, and coordinators making sure everyone stayed safe and cared for — wow. Man, I love runners.

Okay, back to this week’s New York Dose. I’m covering new data on childhood MMR vaccination, what New York is doing to reduce Black maternal mortality, an environmental win for people fishing the Lower Hudson, and a few spring health updates, including what I’m doing to get ready for warm weather.

NYC childhood MMR coverage is down

New York has long had some of the highest vaccination rates in the country. But even here, cracks in that strong foundation are starting to show. In New York City, new data suggest routine childhood vaccination is being delayed. In March, the city reported that about one in three 2-year-olds had not received all doses of the seven recommended vaccines, prompting officials to launch a new campaign in response.

This is the kind of shift that can seem small on paper, but it’s exactly how vulnerability builds quietly over time.

One of the clearest warning signs is measles, mumps, rubella coverage. In 2024, 93% of New York City children ages 24 to 35 months had received at least one MMR dose by their second birthday. In 2025, that dropped to 89%.

Percent of New York City children ages 24-35 months who received at least one measles, mumps, rubella vaccine by their second birthday.

That matters, especially right now. As of this month, New York state has confirmed eight measles cases this year. Nationally, we’ve seen how quickly measles can spread in communities with lower vaccination rates (YLE national has covered that here). And in 2019, New York City experienced a major outbreak, with 649 cases in a largely unvaccinated community in Williamsburg.

Even small percentage-point drops matter. In a city as large as New York, they translate to thousands more children vulnerable to measles if the virus is introduced.

This is one of those issues that can feel abstract until it isn’t. Delayed vaccination leaves young children vulnerable during the exact years when some vaccine-preventable diseases can hit hardest. Measles is extraordinarily contagious, and community protection depends on keeping coverage high.

Black mothers in New York state die from pregnancy-related causes at 4x the rate of white mothers

Black Maternal Health Week (April 11–17) just wrapped up across the state, and unfortunately the numbers underlying it are striking. The week exists in part to address some of the most persistent and devastating disparities in American medicine: Black women are substantially more likely to die from pregnancy than mothers of other races. State data estimate that Black women died of pregnancy-associated causes about four times more often than white women in New York. In New York City, it’s about five times higher.

That gap is shocking, and frankly, unacceptable. But New York is taking steps to reduce Black maternal mortality by putting several policies in place to help.

Here are some programs in New York aimed at reducing maternal deaths:

Postpartum coverage now lasts a full year. New York Medicaid and Child Health Plus extended postpartum coverage from 60 days to 12 months, helping more families stay connected to care during a period when serious complications can still happen.
Doula care is covered by Medicaid. New York Medicaid covers doula services during pregnancy and up to 12 months postpartum, including prenatal visits, labor and delivery support, and postpartum care. Eligible New Yorkers can find participating doulas in the Medicaid program here.
New York became the first state in the country to offer paid prenatal leave. Since Jan. 1, 2025, New York has required private-sector employers to provide pregnant workers with 20 additional hours of paid prenatal leave for pregnancy-related medical care. This is the first law of its kind in the country, and it is separate from other leave options.

The paid prenatal leave policy is especially important. It gives workers paid time off for things like OB visits, testing, monitoring, and other pregnancy-related appointments. And that matters, because barriers to prenatal care are often not about willingness, but can be about whether someone can afford to miss work. It may mean choosing between a clinic visit and food for dinner, a co-pay and prenatal vitamins, an ultrasound, and keeping the air conditioning on. Policies that reduce the financial cost of getting care are one of the clearest ways to reduce barriers to care.

What you can do to access benefits:

If you’re pregnant or recently postpartum and on Medicaid, confirm that your coverage extends for a full year after pregnancy.
If you want labor or postpartum support, check whether you’re eligible for a state-covered doula through New York’s Medicaid doula directory.
And if you work in the private sector, ask your HR department about your paid prenatal leave rights.

For the first time in 50 years, you can eat striped bass you catch from the lower Hudson River

New York state recently updated its fish consumption advice and says you can now eat some fish from the Lower Hudson River for the first time in 50 years. The updated advisory reflects decades of cleanup on the Hudson to lower polychlorinated biphenyls (PCBs — a toxic synthetic chemical) contamination enough to meet health guidelines.

The biggest update is for striped bass: Pregnant women and children under 15 can now eat one meal per month, and the general population can eat up to four meals per month from the Lower Hudson. But some fish, including carp and small-mouth bass, are still off-limits because of PCBs, so it’s still important to check the specific guidance before eating what’s caught.

For example, there are new advisories on forever chemicals known as PFOS, which apply to Lake Ontario, Lake Erie, Lake George, Lake Champlain’s Cumberland Bay, Seneca Lake, and others. So, if you fish or your family fishes, check the local updated guidance before eating your catch.

New York fish advisory regions.

This change is a good reminder that public health wins can be slow, and often unglamorous (no offense to the fish). But the fact that we have cleaner water, better environmental regulation, and long-term monitoring for these chemicals — and can see our progress firsthand — is worth celebrating.

Pollen and tick updates

Some quick notes on spring health.

Tree pollen is ramping up, with some parts of the state now experiencing high levels. For those with asthma or more intense allergies, it’s a good idea to speak with a health care practitioner about controlling symptoms before pollen makes it worse.

Reducing pollen exposure comes down to a couple key behaviors:

Avoid pollen outside. Check local pollen counts (like on pollen.com) and limit outdoor activity during early morning and on high-wind, dry days. The best time to go outside is after it rains, which helps clear pollen from the air.
Avoid pollen inside. Remove shoes before entering your home, wipe down pets, change after being outside, shower especially before bed to rinse off pollen, keep windows and doors closed, and run a HEPA filter.

For a deeper dive, check out my recent post on pollen.

We’re also in the thick of tick season. From now until about October, ticks will be active across New York, including in New York City. If you’re heading to parks, wooded areas, or anywhere with brush and tall grass, use repellent, and do tick checks on yourself, kids, and pets.

Emergency department visits for tick bites in the Northeast so far this year (green) compared to last year.

Last quick segment. I know the weather has been all over the place, from gorgeous 88-degree afternoons, back to the icy rain we have this week, but I wanted to get a couple things on your radar as we get closer to more warm days.

First, the program that provides free air conditioners is now accepting applications across New York state. This is important because extreme heat is New York’s most deadly weather.

To see if you qualify to get a free air conditioner through the Essential Plan Cooling Program, check out the qualifying conditions and application here.

Second, now is a good time to check the expiration date of your sunscreen. The active ingredients that block UV rays in sunscreen degrade over time, reducing effectiveness, increasing sunburn risk, and potentially causing skin irritation or rashes. It’s a good idea to make sure what you have on hand isn’t expired, and replace it if needed.

Bottom line

You’re all caught up on New York public health news. Have a great weekend, and I’ll see you next week!

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health advocate. She specializes in infectious diseases, outbreak response, and emerging health threats. She has led multiple outbreak investigations at the California Department of Public Health and served as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Donnelly is also an epidemiologist at Biobot Analytics, where she works at the forefront of wastewater-based disease surveillance.

‘Mama Stories’ turns maternal health research into live performance in Atlanta

2026-04-01T18:49:52+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

A new way to communicate about maternal mortality – through actors and poetry – is coming to Atlanta.

“Mama Stories” will be performed April 12 at Spelman College. The collaboration between maternal health researcher Natalie Hernandez-Green and Nashville artist Cynthia Harris aims to find new ways to talk about public health, especially among those who are most affected.

The performance presents the stories of women of color who nearly died in childbirth. The academic-theater collaboration began when Hernandez-Green and her team at Morehouse School of Medicine’s Center for Maternal Health Equity interviewed 87 women, mostly Black and many from Georgia, to better understand their experiences. The goal was to put women’s voices at the center of what Hernandez-Green sees as often “sensationalized” public discussion of maternal mortality.

Georgia, like many other Southern states, has high rates of maternal mortality and morbidity, and it’s even higher for Black mothers than the general population. The mortality rate for women in Georgia is 30 per 100,000 live births but that increases to 55 for Black women, according to America’s Health Rankings.

Black and Hispanic women also have higher rates of severe maternal morbidity (like cardiac conditions and eclampsia) than white women and are less likely to get adequate prenatal care than white women in Georgia.

The study found that women didn’t feel heard by their health care providers and were often unaware of or confused by what was happening to them in the midst of a medical crisis, Hernandez-Green and researcher Kaitlyn Hernandez-Spalding said.

Actors depict the stories of women who nearly died in childbirth in the choreopoem "Mama Stories" by Cynthia Harris.

Relatively high levels of education or income didn’t prevent women of color from having those experiences. Their trauma resulted in short- and long-term effects, with some reporting panic attacks or not wanting to have more children.

Hernandez-Green wanted to make sure that these women’s stories would reach beyond the often inaccessible pages of academic journals – so she reached out to Harris, a playwright and public health researcher at Meharry Medical College in Nashville. Harris wrote a “choreopoem” about these women’s experiences, using their firsthand accounts. The goal was to educate and heal through an emotional and personal medium, rather than dry public health data.

“Our stories are medicine that we can see and understand,” Harris said.

Harris watched each interview, which ranged from an hour to two in length, to better understand the women’s perspectives. Her “verbatim theater process” preserved the women’s stories, including their gestures, expressive language, and facial expressions.

The “purpose is to be plain speaking, to tell the truth, to be as simple as possible, and to reflect not just words but to capture experience, tone, and meaning,” Harris said.

Each performance is followed by a salon where audience members, no matter their background, can reflect and share in a safe space, Harris said.

“Mama Stories” has been performed in Nashville. Harris and Hernandez-Green said women of color who have experienced the stress and trauma of birth – or those close to them – are one audience they want to attend at Spelman.

Each woman who provided an interview for Hernandez-Green’s initial study has been invited to attend the Atlanta performance. The team wants people from the community to attend as well.

“We want them to be more knowledgeable so they can better support mothers of color during pregnancy, delivery, and the postpartum period,” Harris said. “A more educated community is always going to be beneficial for a mom.”

Actors portray the stories of Black women who nearly died in pregnancy in "Mama Stories," which will be performed in Atlanta on April 12.

There are many other audiences, as well. That includes those training in medicine and as nurse-midwives, Hernandez-Green said. The team is starting a pilot project to use that training with medical students at Morehouse School of Medicine. That training is also being used by Blue Cross Blue Shield of Illinois

Asked whether the play might be depressing or traumatic for those who have experienced similar birth challenges, Harris said she makes sure to “double down on hope,” weaving bright spots into the story and finding ways for people to connect, such as in the post-performance conversation.

Hernandez-Green agreed, saying that some of the women interviewed in the original research reported feeling relief from being able to share their difficult stories and she sees the play and associated research as healing and dignifying.

“These women survived, and they were alive to tell their stories, and through their stories, they’re helping us create interventions that will make sure that another woman doesn’t have to go through what they have to go through,” she said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Mamdani’s first major health project uses child welfare agency funds to bolster home nurses for expecting parents

2026-03-06T17:50:12+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The first major public health project announced under New York City Mayor Zohran Mamdani is a $20 million effort that includes strengthening a program that sends nurses into the homes of mothers struggling to make ends meet.

The money would be transferred to the Department of Health and Mental Hygiene from the city’s Administration for Children’s Services under the preliminary 2027 budget to fund more home visits in the Nurse-Family Partnership, which pairs registered nurses with expecting parents who receive Medicaid or WIC.

In the home, the nurses take into consideration the surrounding environment while working one-on-one with clients to develop strong parenting skills in the areas of diet and nutrition, with the aim of supporting a healthy pregnancy and a healthy baby.

“This program is putting families first and those that are in need the most,” Deputy Mayor Helen Arteaga Landaverde said Feb. 27 in announcing the funding at a community health center in East Harlem. She oversees ACS and the health department. “We will use this program to help increase higher rates of breastfeeding, childhood immunization, and, more importantly, making sure that our families keep growing nice and healthy.”

The announcement comes at a critical time. Health officials over the years have wrestled with trying to stem the city’s high maternal mortality rates, especially among Black women, which are some of the highest in the United States. New York City sees about two dozen deaths tied to pregnancy or childbirth each year. Three in four Black maternal deaths are ruled preventable by the health department’s Maternal Mortality Review Committee. For white women, it’s about half.

Mamdani mentioned the disparity last week at a private reception honoring Black History Month. Under the gigantic blue whale model suspended at the American Museum of Natural History, the mayor noted that Black mothers suffer mortality rates much higher than white mothers. Mamdani’s predecessor, Eric Adams, had also raised concerns over high maternal mortality rates, launching a citywide doula program.

City officials see bolstering the NFP program as a potential remedy.

Shutdown deal brought a reprieve for WIC. But NY braces for ripple effect of other looming aid cuts.

Officials from ACS, the city’s child welfare agency, the health department, and a local nonprofit focusing on childhood mental health services met in late January at the ACS office in Manhattan to present the Strong Foundations initiative to expand the NFP service. They had been researching the program since early 2024 and developing a proposal through last May, according to literature circulated at the presentation.

At last week’s announcement, the city’s new health commissioner, Dr. Alister Martin, introduced his mother, a registered nurse seated in the front row, as an example of how an NFP nurse builds connections.

“She was a year-round Santa Claus, delivering things to each family she met with,” Martin said. “But it went beyond the gifts. She delivered connection. She delivered health education. She delivered compassion.”

NFP has helped 25,000 expecting parents in NYC

The $20 million initiative will help expand NFP eligibility over a three-year period by allowing clients who already have a child to register instead of limiting it to first-time parents. They will also be able to enroll later in pregnancy, after 28 weeks. The program aims to double the number of families it serves to 3,000, according to documents from the presentation.

The program will also provide training for early childhood mental health professionals by creating a three-year fellowship program that develops a “pipeline of clinicians with perinatal and early childhood experience,” according to a press release.

NFP has supported more than 25,000 expecting parents in New York City since the program was adopted in Jamaica, Queens, in 2003, officials said. The original Nurse-Family Partnership was created by David Olds, a professor of pediatrics at the University of Colorado, in the 1970s and was later expanded as a nationwide program, hailed for curbing high maternal and child mortality rates.

Sascha James-Conterelli is a “full supporter” of the NFP program and has spent considerable time collaborating with NFP nurses since she came across the program in 2007 while working as a perinatal director at a hospital on Long Island. A member of the New York State Maternal Mortality Review Board, she said she was struck by how NYP nurses provide a true public service, because they understand the nuances and health needs of the community.

Preventing maternal deaths: 5 From the Field Q&A with childbirth safety expert Dr. Elliott Main

“They’re not blindly going in and giving some prescriptive type of advice, like, ‘oh, eat healthy or eat better,’” said James-Conterelli, director of the nurse-midwifery program at New York University, where she’s also a clinical associate professor. “They already have nurses that reside in the area and know what foods are available to them, where their markets are, what religious practices are common in the area.”

In 2023, the Montefiore Health System in the Bronx threatened to cut its $800,000 NFP program until the New York State Nurses Association compelled the health system to salvage it during negotiations related to a nurses strike, said Vanessa Weldon, a NYSNA member and Montefiore RN.

The funds transfer, included in the fiscal 2027 preliminary budget, comes as the city faces a potential budget shortfall of $5.4 billion. The preliminary budget will go to the City Council this spring for public hearings, followed by rounds of revisions and negotiations. The finalized budget is due at the end of June, to take effect July 1.

Luisa Linares, deputy commissioner of the Family Services Division at ACS, told Healthbeat the $20 million had been budgeted for an infant program that ended last year, so the funds were available. The agency’s research suggested there was no need for “traditional procurement,” she said.

“When we knew that that program was going to end, we began doing research to think about what do we do with the funding?” she said.

Community trust essential to NFP’s success

Some advocates raised concerns about any ACS connection to NFP, saying parents could be deterred from signing up if they fear a nurse’s visit could lead to their children being taken away.

“What they’re doing is buying a doorway for reports,” said Joyce McMillan, founder and executive director of Just Making A Change for Families, a local nonprofit known as JMACforFamilies that works to improve the foster care system by keeping families together. “If people are coming in [homes] — because this is for mental health help — they’re going to talk about the things [the parents] struggle with, and then those struggles are going to be turned into cases against the family, separating more kids from their home.”

Mimi Bhatt, a midwife and assistant professor at NYU Rory Meyers College of Nursing, said the faith built between the nurse and a client is critical for the success of the NFP program.

“The ethos of NFP is trust. The nurse develops such a trusting relationship with this family over time and is able to really realize the opportunities for a family and realize their health goals,” she said. “If you say to people that ACS is involved in this expansion, to me, that implicitly communicates that ACS now has a greater hand in people’s homes. And that is a problem.”

An ACS spokesperson said in a statement to Healthbeat that ACS “will not play a direct role in NFP.” The spokesperson added that “by expanding eligibility, NYC is providing more support to families upfront BEFORE child protection intervention is needed.”

“The goal of this partnership is to move resources from ACS to DOHMH to specifically expand DOHMH’s ability to provide services to people in need, without ACS being involved with families — thereby addressing the deterrent that some in the community are concerned about.”

A health department spokesperson wrote separately that the NFP program is a preventive measure:

“ACS does not have a role in the administration of Nurse Family Partnership or the Perinatal Early Childhood Mental Health Clinic Network. This is an upstream approach to prevent ACS involvement and support New Yorkers by connecting at-risk families to long-term support from home visiting nurses and mental health resources.”

ACS has drawn criticism over the years, with Black families accusing the child welfare agency of bias against them. Caseworkers have been accused of showing up unannounced, rummaging through personal belongings and looking for signs of bad parenting, confusing symptoms of poverty for signs of neglect and then seeking to separate families. A year ago, a state appellate court ruled that the ACS practice of requiring child welfare investigations of parents who are victims of domestic violence is illegal.

“If the true goal is to help the citizens of New York, especially the Black citizens and Black mothers in order to reduce the rates of maternal mortality and severe maternal morbidity in our city, and we’re intentional about that, then this should thrive,” said James-Conterelli of NYU. “If there’s a hidden alternative agenda that is not being publicized, then our rates are just going to stay the same, or get worse.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Preventing maternal deaths: 5 From the Field Q&A with childbirth safety expert Dr. Elliott Main

2026-02-24T10:00:00+00:00

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Maternal deaths and serious childbirth complications in the United States are often preventable.

Dr. Elliott Main, a professor of obstetrics and gynecology at Stanford University and a founder of the California Maternal Quality Care Collaborative, has spent decades studying why mothers die or nearly die from pregnancy and childbirth — and what can be done to protect them.

Main helped pioneer the creation of what have become national “patient safety bundles” and toolkits to help hospitals and health care providers standardize their use of evidence-based best practices for identifying complications early and providing effective treatments.

In recent years, about 650 to 1,200 women across the United States have died annually from causes related to pregnancy, according to federal data. Thousands more have been at risk of dying because of severe complications, including from hemorrhaging, cardiac and blood pressure issues, and infections.

The rate of maternal deaths is far higher for Black mothers (43.3 deaths per 100,000 live births) than it is for white (13.8 deaths), Hispanic (11.1), and Asian (12.8) mothers, according to provisional data from the Centers for Disease Control and Prevention for the 12-month period ending in September.

In the context of all of the births that occur each year, maternal deaths and severe complications are relatively rare. But each statistic is a person’s life and case reviews have found that 80% of deaths could have been prevented.

“We do need to do better, and we can do better,” Main told Healthbeat as he recently provided insights on five questions about making pregnancy and childbirth safer.

This 5 From the Field interview has been edited for clarity and length.

Are we where we need to be on maternal safety?

There is lots of room for improvement.

One of the biggest struggles we see is with disparities among different races. It’s not just Black mothers. It’s other mothers, too, that may not speak English well, or who are in some ways different from their care providers.

How do you create trust between the physician and the nurses with the patients if they are from very different backgrounds? That’s a challenge. You’re in labor and things change rapidly and you’re making life and death decisions. The best physicians have developed skills to sit down and ask what the patient’s goals are, what she’s fearful of and work out ways of working together. Trust is a common issue that we’re failing at in some circumstances.

Another significant issue is support, particularly in transitions of care. One of the biggest areas of weakness in the medical system is when you transition from the hospital to home.

Why do some hospitals struggle more than others when it comes to preventing maternal deaths and serious complications?

Obstetrics is way undervalued in the current medical reimbursement system. That means there’s not much incentive to make investments in obstetric care, and that’s particularly an issue in hospitals that are less well-funded, rural hospitals, inner city hospitals. And in certain parts of the country that are poorly funded to begin with, in particular the South, that has terrible outcomes for maternity care.

Looking at public health data from my state, that has over 200 hospitals, and in other states, there is great variation that we see among hospitals. All the measures show extreme variation. And that shouldn’t really be.

How connecting with nature helps Black women have healthier pregnancies

In medicine we have a long tradition, unfortunately, of blaming the patient. And that’s really clear in this setting. When you control for patient conditions, the degree of hypertension or diabetes or advanced maternal age or obesity, there is still huge variation.

What I’ve seen over the years is that hospitals – if they are doing poorly on the national measure, they will first blame the patient, then blame how the data is collected, then blame the measure itself. But they should be spending the time figuring out how they can learn from others and improve their care.

You need to have leadership, both at the physician and nursing levels, for there to be meaningful change. It’s hard to change practice behaviors or the culture of a unit unless you have strong leaders involved.

Why are so many maternal deaths and severe complications preventable?

There are two driving forces. One is that, in general, maternity goes well in at least 95% to 97% of the cases. Everyone gets kind of lulled by the expectation of normality. So we tend to overlook deviations from that. You don’t want to over-call things because most of the time it goes fine.

The second issue is that many of the symptoms of significant complications are actually easily confused with the symptoms of normal pregnancy.

One of the biggest killers in the postpartum period is cardiac disease. The symptoms of heart failure are tiredness, shortness of breath, and having a hard time sleeping. And you know, most postpartum women are tired – but what degree of tiredness is abnormal?

Many postpartum women are much more focused on the care of their infant than themselves. So, things get delayed. Doctors tend to not respond to phone calls about such generalized symptoms. And so it spirals until it’s too late.

Where has standardizing maternity care made the biggest difference?

We have done better in the U.S. for hemorrhage, so it’s no longer the leading cause of death here as it is worldwide. But it is still the biggest cause of major complications for morbidity.

Essentially about 3% to 5% of women will have a significant amount of extra bleeding at birth. And that was the first thing we tackled, and we realized that every doctor had a different way of approaching it. No one had a standardized approach, or even a standardized definition of how much bleeding was too much.

So that was the genesis of a safety bundle, of having all the tools you need in a hemorrhage cart or kit that could be immediately brought into a room. You had a standardized procedure that you could teach and practice, you do drills and then assess afterwards. And then having a

standardized way of collecting the blood, so you could see exactly where you were in the process. It’s so easy to say she’s bleeding a little, but not that much, and lose count.

Those kinds of standardized approaches actually made a really big difference. And they have become now a national safety bundle, supported by bodies like the American College of OB/GYN and even the Joint Commission. CMS is now wanting every hospital in their Medicaid reporting system to document they have included it. And the WHO is supporting the bundle approach worldwide.

What still needs to be done?

We have to keep the momentum up for supporting change in the medical system. One of the things we’ve helped support is the development of perinatal quality collaboratives in every state in the country. Those can be based in or partnered with public health departments.

We now have bundles and toolkits for hemorrhage, hypertension and sepsis, cardiac disease, and mental health. But the trick is always about implementation. That’s always the hard part – how you implement that in every hospital, in every practice in your state.

That’s where you want a collaborative that includes medical leadership, organizations like the American College of OB/GYN and the maternal fetal medicine society, the nursing societies… all the providers, the payers, Medicaid and the insurance companies, and community organizations.

Data is the critical piece. This is where public health organizations can play an important role. Everybody wants to think that they’re doing well, and everyone is surprised when the data doesn’t show that. The data really does drive change.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

‘I never thought I deserved something so valuable’: How health kits are empowering birth care in New York and abroad

2026-01-21T14:58:37+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 18 at Powerhouse Arena bookstore in Brooklyn. Watch the full show here. Sign up to receive Healthbeat’s free New York newsletter here.

I’m going to share with you two “aha” moments – both revolving around the lifesaving toolkits that we at Saving Mothers distribute to pregnant women. It’s a story that highlights both the shared experiences of giving birth, no matter where on Earth you live, but also the wide discrepancies in available birth care.

I’ll start here at home in New York City, where Saving Mothers has been giving out “mPOWHER” kits.

These are maternal health kits that contain resources that women need to take charge of their maternal health care and understand their health risks in pregnancy. They also contain cards that are meant to help them talk to their doctors and nurses in the hospitals and clinics so they can make sure that they are seen and heard.

We know that racial disparity in maternal health is very high here in New York City. So these kits are specifically aimed toward addressing racism and disparity, making sure women can advocate for themselves, get their needs met, and frame their questions in a way that they can get quick answers and thorough answers.

The kits have these resources, including a blood-pressure cuff, a Fitbit, some venodyne stockings to address blood clots. They target the top causes of maternal death here in New York City, that’s where we focused the kit.

These kits cost about $125 because they include a lot of nice resources, like the Fitbit, the blood-pressure cuff, a beautiful diaper bag for the mother, and some other giveaways. They are nice kits that we put together, that we do by hand, that we have our teams pack.

The goal of the kit was to improve maternal health and improve their odds in pregnancy. We give it out to the women, and we asked for feedback. And one mom I remember, and this was an “aha” moment for me: She opened the kit, she looked at all the resources, and we asked her about her feedback, like, how did she think that the kit was helpful? And she said, “When I opened this kit, I just started crying, because no one has ever given me anything so beautiful and so valuable. And I never thought that I deserve something so valuable.”

That was her feedback. It was an “aha” moment for me as a doctor, as an OB-GYN, because I’m thinking she’s going to give me feedback about how she used the blood-pressure cuff, or how she used the resources. But she was so touched by the fact that someone packed this kit for her and that it had valuable contents – it had a Fitbit, it had things that she knew had some value – and she just loved it so much.

From Kenya to New York: How a global nonprofit is addressing local maternal health needs

She said, “I brought my mPOWHER kit everywhere. I brought it to every appointment. I did everything that was in it. I felt so lucky to have such a valuable kit.” I thought that was really, really interesting and really telling about how mothers, especially underserved mothers, those who live in shelters, or in areas of the city where they don’t have a lot of access, how much they truly do value this. She could see that we put a lot of thought and effort into it, too. We put little handwritten notes in it, like “You can do this.” We have a lot of inspirational messaging that we include.

Through the feedback that the mothers in New York have given us, we’ve also added a mental health component to the kit. Now the kit has a journal, and that journal has inspirational words and stories for mothers along the lines of “You are valuable. You are important. You are amazing. You can complete this pregnancy, have a baby.” We have inspirational words to get them through pregnancy and postpartum, as well.

That one helped us understand the mental health piece, which I think is something that needs more attention. Now our $125 kit includes that. It includes a mental health card and a wellness card and a journal, and it actually incorporates a lot of the feedback that we got from our mothers and the focus groups.

I’ve learned other things from those focus groups, too, like that blood-pressure cuff that we give women – the woman doesn’t just use it for herself in pregnancy. It’s actually become a family unifying thing. They do everyone’s blood pressure, the in-laws come over, the parents come over. Everyone’s getting their blood pressure checked now, and a lot of these families are larger. That’s also a really great downstream effect of habit, giving people resources and making sure they know how to use them.

These are low-cost, high-impact kits, the “mPOWHER” kits that we’ve used in New York. But we have another kit, probably our longest-standing kit that we created when we started Saving Mothers in 2009 – the clean, safe birth kit.

In Africa, women must bring own birthing supplies to hospital

What I have learned about birth in many of our countries that we’ve served in many parts of Africa, specifically many of the hospitals there, is that mothers, when they want to deliver, they cannot come into the hospital, even a major hospital in a big city, like in rural West Pokot, Kenya, without bringing their own birth supplies.

A laboring woman will come to the hospital, and she will be turned away for delivery because she doesn’t have her clean birth supplies, like cord clamps, scissors to cut the umbilical cord, gloves for the doctor or nurse, a clean surface, soap – some of these basic tools that women and their families in very poor, very underserved regions of the world, have to go and find and purchase and come back with.

I didn’t realize when we first created the clean birth kit that the hospitals also needed the resources, that women were actually being asked to bring their own clean birth kit. That was an “aha” moment.

The clean birth kit was meant for the over 80% of women that deliver babies at home in most regions of the world. In most of the world, there aren’t a lot of trained OB-GYNs. There are whole countries that have a handful of trained OB-GYNs. Back when we were working in Liberia years ago, 2009, 2010, there were like three. The vast majority of women around the world are being delivered by birth attendants or midwives with varying levels of training. Some places they have some training; other places, not as much.

They’re called anything from traditional birth attendants to midwives. But they lack training, and obviously they’re not surgically trained – any of them – to be able to deal with urgent, emergent and C-section type delivery. So these clean birth kits were meant to be a resource for women at home, so that we could promote sanitary birth, so we could lower the risk of infection to the newborn. So that the mother had a provider that was using gloves. So that there was a clean surface. So that the attendant washes their hands, at least with Purell, even if there was no running water.

Our safe birth kit cost $15, and we’ve sent tens of thousands of these kits around the world since we started. They go everywhere, from clinics, directly to community health workers and birth attendants, especially in the areas where we train them, like Guatemala and Kenya. Then we empower them with the kits, as well. It’s been really amazing to see how much these kits are needed everywhere.

The $15 includes shipping. We bundle that into the cost because we want them to be accessible and low cost. Our big goal is always to make all of our things low cost. It’s about creating things and streamlining programming so that the highest number of women have access, so the cost is always important.

People need our kits everywhere. They need them, based on the culture, the circumstance, the issues that bring the highest risk of maternal death. Those causes are different in different communities. But the need is the same: for all women, everywhere, to have a safe, clean birth.

Dr. Taraneh Shirazian is the founder and president of Saving Mothers, a 501(c)3 non-profit organization founded in 2009. Saving Mothers is dedicated to eradicating preventable maternal deaths and birth-related complications in the developing world. She is also a practicing gynecologic surgeon and associate professor at NYU Langone Medical Center and director of NYU Langone’s Center for Fibroid Care.

Her story was told at Healthbeat’s event by Re Perry, program coordinator for Saving Mothers who earned her MPH at NYU.

Universal child care, NYC nurses’ strike, ACA subsidies, and the flu

2026-01-16T18:46:54+00:00

There’s a lot happening in New York health right now — from universal child care plans and the New York City nurses’ strike to rising health care premiums and continued flu. Let’s jump right in.

Hochul and Mamdani announce a plan for universal child care in New York

Last week, Mayor Zohran Mamdani and Gov. Kathy Hochul announced a joint plan to bring truly universal child care to New York City and extend it across the state.

Why this matters

Access to high-quality child care has been shown to benefit children’s and parents’ health and well-being:

High-quality early care and education programs are associated with positive developmental outcomes for children, including early learning, cognitive and language development, stronger school readiness, and emotional skills.
Child care has been associated with improved maternal mental health, including protection against symptoms of depression, by reducing stress and caregiving burden on parents.
Expanded access has also been shown to increase maternal employment and economic stability — important components of health equity. One assessment found that mothers’ labor force participation in New York City increased by 7.5% after universal pre-K for 4-year-olds was implemented.

It’s important to note that the quality of the care is what’s most important, not necessarily where the care takes place. High-quality care and education can take place at child care centers or inside the home, and with community-based caretakers or family members.

What’s the plan?

The joint plan to expand child care in New York City and the rest of the state is mostly driven by funding additional child care facilities and increasing staffing levels.

In New York City, the additional funding would help make 3k (child care for 3-year-olds) access truly universal. Right now, many families qualify for 3k but don’t have spots available in their neighborhoods, requiring them to commute unfeasible distances or find/pay for other child care. The funding would increase facilities and staffing in New York City.

The proposal would also launch a new “2-Care” program in the city, providing free child care for 2,000 2-year-olds in high-need areas beginning this year. The program would then be expanded citywide over four years, with the state fully funding it for the first two.

The state’s goals are to expand child care to all 4-year-olds (also called pre-k) statewide by fall 2028, and help counties build pilot programs to offer affordable child care. Hochul said the broader statewide plan would increase affordable child care to nearly 100,000 additional children through a mix of universal pre-K expansion, new community-based care programs, and broader eligibility for child care subsidies.

The plan also includes:

Increasing state funding for pre-k seats to at least $10,000 per child
Expanding child care subsidies, with most eligible families paying no more than $15 per week
Raising income eligibility to about $114,000 for a family of four

How will it be funded?

The governor has committed a $1.7 billion investment to expand child care across the state. If the legislature approves the budget, total child care and pre-k funding will be $4.5 billion for fiscal year 2027. The current proposal uses funds that already exist and would not currently require increased taxes. However, a plan for long-term funding of the expansion has not been proposed.

What happens next?

To accomplish the goals of universal child care in New York, there are a couple of big milestones ahead:

The state legislature still needs to approve Hochul’s funding requests, although the strategy of using existing state funds rather than raising taxes makes it more likely to go through.
The child care workforce will then need rapid growth, including hiring and training teachers, and improving the infrastructure of the current fragmented system of schools, day care centers, and private home caregivers.
The plan will also need long-term funding. If the program is successful, will taxpayers and lawmakers be willing to sustain its funding? Additionally, how will changes in federal funding affect New York programs? ($10 billion in federal funding for child care subsidies is currently frozen, including in New York, and being debated in the courts.)

Making child care truly universal in New York has great potential to improve the health of children and parents. I’ll be watching its progress closely and reporting back.

~140,000 New Yorkers now face higher health care costs

Remember the 43-day government shutdown in the fall? (Feels like years ago already, I know …) One of the issues at the center of the debate was whether to extend health insurance subsidies under the Affordable Care Act. While the government eventually reopened, Congress never reached an agreement, so the enhanced subsidies expired on Dec. 31.

Now, 140,000 New Yorkers, and millions of Americans across the country, are seeing their health insurance costs substantially increase.

I did a deep dive on ACA subsidies in November, but here’s a quick refresher:

Under the ACA, coverage in New York is tiered based on income, anchored to the Federal Poverty Level. Before 2021, anyone making just $1 over 400% of the FPL — roughly $60,000 for an individual or $124,000 for a family of four — got zero financial help through the ACA. This was called the “subsidy cliff.” It disproportionately affected those who don’t get insurance from an employer and don’t qualify for Medicaid or Medicare. This includes many self-employed or freelance workers, small business owners, farmers, and early retirees, among others.

In 2021, the pandemic relief package removed the subsidy cliff, allowing anyone to get financial help if their premiums were greater than 8.5% of their income. But when the ACA subsidies expired at the end of last year, the cliff came back.

Hochul’s office estimates the average health care cost for a New York couple who previously qualified for ACA subsidies is now up 38%, meaning an additional $238 per month. That’s nearly $3,000 more per year for couples. It also varies across New York; Mohawk Valley has seen the steepest increase at 49%.

(Data from Gov. Kathy Hochul’s office.)

Despite the increases, there are some signals that Congress may be moving toward getting these subsidies back up. Earlier this month, the House passed a bill to reinstate and extend the ACA subsidies another three years; this moved to the Senate for consideration, where negotiations are ongoing. (A similar bill was voted down just last month.)

If you have questions about your New York coverage options, premiums, or eligibility, call 1-855-355-5777 or visit nystateofhealth.ny.gov. The deadline to enroll in a Qualified Health Plan (i.e., if you aren’t eligible for Medicaid, Medicare, the Essential Plan, or Child Health Plus) is Jan. 31.

I’ll also keep watching this and share updates as they come.

NYC nurses strike: What’s happening and what it means for you

This week, nearly 15,000 nurses across some of New York City’s major hospitals — Montefiore Medical Center, Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, and NewYork-Presbyterian — went on strike. This is the largest health care strike in New York City’s history.

Why are they striking?

The union is calling for:

Legally enforceable nurse-to-patient staffing ratios, so that nurses aren’t overwhelmed with too many patients, increasing safe patient care.
Higher wages to keep pace with inflation and retain staff amid worsening nursing shortages.
Increased hospital security to reduce workplace violence, which has risen in New York City health care settings.

The hospitals have pushed back on the demands, stating they would cost billions of dollars over the next three years and that they can’t afford the increases in light of health care funding cuts from the One Big Beautiful Bill Act. They also say these funding issues will be exacerbated as more New Yorkers lose health insurance, resulting in more uncompensated medical care.

What this means for patients

The New York State Nurses Association is encouraging patients to continue seeking care at the hospitals. In preparation, hospitals have brought in travel nurses and temporary staff, and Hochul issued an executive order to temporarily suspend certain licensing and practice restrictions so that clinicians who are licensed and in good standing elsewhere can work in New York without penalties, allowing hospitals more flexibility to keep adequate staffing. Still, hospitals may resort to transferring patients to other hospitals if capacity is strained.

How long will it last?

The last major New York City nurse strike in 2022 lasted three days. This one is much larger with the potential to cause more disruption to hospital systems — the longer it continues, the more pressure hospitals may face to delay non-emergency procedures and divert incoming patients.

Why it matters

Staffing ratios are a public safety and health equity issue. Studies show that safe nurse staffing is linked to lower patient mortality, shorter hospital stays, and better health outcomes. A 2002 JAMA study showed that:

Hospitals that staff 1:8 nurse-to-patient ratios experience five additional deaths per 1,000 patients than a 1:4 nurse-to-patient ratio.
The odds of patient death increase by 7% for each additional patient the nurse must take on at one time.

Ensuring nurses have the time and bandwidth to adequately care for their patients is vital.

I’ll keep you updated if anything changes.

Infectious disease ‘weather report’

Flu: It looks like flu may have peaked in New York, but levels remain very high across the state and New York City. Even with recent declines over the past two weeks, we’re still at levels close to the peak of the 2023-24 season. In short: Flu is still widespread in New York.

Flu cases in New York City.

I wouldn’t be surprised if we saw flu pick up again — that happens in some seasons. Because flu will still circulate into February and March, it’s not too late to get your flu shot.

RSV: Remains high but may have plateaued. (I know I said that last week, but the data is holding.) The good news is that RSV this season is lower than in the past two years.

RSV cases in New York City.

Covid: In good news, Covid is still low across the state. State case data show that it may have peaked, and at a lower level than the late-summer surge we saw earlier this year.

Covid cases in New York this season and last season.

Bottom line

There’s a lot going on in the New York health policy world, with many evolving situations that I’ll keep a close eye on.

From an infectious disease standpoint, flu is still the biggest concern right now. Staying cautious, especially in crowded indoor settings, is still a smart move, particularly for those at higher risk (older adults, people who are immunocompromised, pregnant, etc.).

Love,

Your NY Epi

Shutdown deal brought a reprieve for WIC. But NY braces for ripple effect of other looming aid cuts.

2026-01-12T10:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The WIC program, which has provided healthy food, health care referrals, and breastfeeding support for women, infants, and young children for more than 50 years – historically receiving strong bipartisan support – came out of the fall federal government shutdown intact for another year. But New York City public health experts fear that President Donald Trump’s looming transformation of public assistance will have ripple effects that will still hamper WIC access.

“We are headed toward a very uncertain future,” said Jack Newton, who directs the Public Benefits Unit in the Bronx office of Legal Services New York, helping people obtain and retain public benefits. “The next two years will be a sea change among low-income New Yorkers, who will find a dramatic change for nutrition assistance and health care.”

The U.S. Department of Agriculture reported that about 6.7 million people received monthly WIC benefits, including about 41% of all infants nationwide. That same year, 233,703 New Yorkers relied on WIC each month – over half of the state’s total beneficiaries, according to the New York State Comptroller.

On a typical day at a WIC agency in New York City, parents and their children come in for a health check, breastfeeding advice, or a nutrition consultation. They come to get referrals to prenatal or pediatric health care. They might also refill their eWIC benefit cards they can use to purchase healthy food and baby formula for a few months. Often they get help enrolling in other public assistance programs, such as the Supplemental Nutrition Assistance Program (formerly known as food stamps), the Head Start early education program, Healthy Start, or Medicaid.

Since the Covid-19 pandemic, WIC services have increasingly moved to remote access, allowing families to avoid taking time off work or organizing child care to keep their required appointments. Yet, throughout the country, and across New York City, local clinic offices, rooted in their communities, remain a key feature of the program.

When the federal government shut down on Oct. 1, unable to pass a budget for fiscal year 2026, WIC recipients and providers worried about how long the local agencies could remain open, and what changes might occur in the short term. Concern ran parallel to fears about SNAP benefits, which were disrupted in early November, delayed and debated in court, and finally distributed to New Yorkers on Nov. 9.

Cuts to food benefits stand in the way of RFK Jr.’s goals for a healthier national diet

Each new day of the shutdown brought new, often conflicting information. Several states, including New York, jumped in to cover a looming funding lapse with their own budgets. The USDA moved money around to cover WIC benefits. The White House injected emergency funds. Most WIC clinic managers in New York proceeded with a precarious “business as usual,” taking one day at a time and keeping a low profile.

As New York state’s largest WIC Vendor Management Program and WIC provider, Public Health Solutions, however, quickly took a vocal stance. On Oct. 8, leaders of the non-profit organization gathered for a press conference at their WIC office in the Bronx with Democratic U.S. Rep. Ritchie Torres. Speakers highlighted the urgency of the situation – and the consequences of a sudden lapse in or loss of WIC benefits for the 35,000 low-income women, infants, and children that PHS annually serves through their WIC program.

A chart presented at a news conference on Oct. 8, 2025, in the Bronx shows the impact of the WIC program.

For the Bronx, Torres said, WIC is essential.

“My congressional district is the largest recipient of WIC of any congressional district in New York state,” Torres said. On that day, he was speaking “not only as a United States congressman, but as the product of a strong single mother, who raised my twin brother and me on the strength of the WIC program.”

PHS was responding to the immediate crisis. But concern about the future of WIC had begun before the shutdown, and remains top of mind for many recipients and advocates, despite the funding deal’s reprieve.

The recurring, principal concern is that social benefits are not designed as isolated forms of support – they work together. Changes to one part of the system, the non-profit National WIC Association explains, will not be contained. Changes in other programs to eligibility criteria, new work requirements, enrollment procedures, cost-shifting onto the states, and, now, a potential expansion of the nation’s “public charge” determination means fewer people might access WIC.

Many recipients of public assistance have been anticipating those ripple effects, Newton said. Participants who visited Legal Services New York in mid-October were seeking clarity. Their shutdown anxiety, he said, was “greatly compounded” by the One Big Beautiful Bill Act and its looming cuts to SNAP and Medicaid, new eligibility and work requirements, and the long-term consequences of shifting the costs of the programs to states.

On the one hand, Newton said, it is the combination of different public benefits – SNAP plus WIC, for example – that helps low-income families access adequate nutrition.

“When you’re pregnant or have young children, your need for nutrition increases - so the already inadequate SNAP benefits plus WIC gets you closer to a place where you can provide adequate nutrition and healthy nutrition,” he said.

How connecting with nature helps Black women have healthier pregnancies

On the other hand, WIC is “extraordinary” among benefits, Newton explained, because it does not have immigration requirements like SNAP and Medicaid.

“For some families, that is the only benefit they have,” Newton said of WIC. But to get even just that, a pregnant or new parent would have to feel inclined, safe, and comfortable enrolling in the program. For public health experts, the “chilling effect” of the federal government’s immigration-related actions, and the sense of chaos and uncertainty many experience, is a considerable source of concern.

To the alarm of many, days after the shutdown came to an end, the government re-introduced possible changes to the public charge rule, which, if passed, could discourage people from enrolling in public assistance.

Here’s what else to know about WIC.

What is WIC?

“WIC is best thought of as a public health program,” Nell Menefee-Libey, senior public policy manager for the National WIC Association, told Healthbeat in a recent interview. “The goal of WIC is to support and improve pregnancy and birth outcomes, child development outcomes, with a very specific nutritionally tailored food package, with nutrition education, and breastfeeding support.”

Launched as a pilot program in 1972 to address a growing concern over malnutrition and poor health outcomes of mothers and children across the nation, WIC offers eligible families through pregnancy and early childhood direct nutritional assistance (vouchers and cash benefits) and other support.

It is managed at the state level, often through contracted local independent agencies – primarily public hospitals, community health centers, or non-profits. Embedding the program within institutions providing health care services typically helps promote WIC’s mission to improve health outcomes.

WIC’s purchasing guidelines are strict. The benefits can only be used for specific foods, in specific quantities, based on the recipient’s specific circumstances (fully breastfeeding, partially breastfeeding, or not). Covered items include dairy, cereal, canned fish, whole wheat bread, dry or canned legumes, baby food, peanut butter, and fruits and vegetables, through the popular Cash Value Benefits.

Eligibility is determined by income, nutritional risk, and/or enrollment in other public benefit programs, also known as “adjunctive eligibility.” The income limit is set at or below 185% of the U.S. Poverty Income Guidelines. In 2025, according to the U.S. Department of Health and Human Services, that represented $59,477.50 a year, for a family of four.

What has been the impact of the WIC program?

Over the past five decades, studies have shown WIC to be effective in improving diet quality (including consumption of important nutrients such as iron, protein, and vitamins); increasing access to early prenatal health care, as well as post-partum and pediatric health care, and reducing adverse maternal and birth outcomes, such as premature births, low and very low birth weight, or fetal and infant mortality.

“The consequences of a child not getting enough nutrition are multifaceted,” Dr. Adam Aponte, pediatrician and CEO of the East Harlem Council for Human Services, said in a recent interview. “It affects brain growth, it affects all sorts of organ systems within the body. If [children] do not have proper nutrition during those early years, that can have consequences for the remainder of their life.”

Aponte highlighted the considerable energy needs for growth of the baby in utero, those of the child in its first two years of life, and the changes to nutritional demands that occur in a pregnant person’s body. WIC, he said, directly helps ensure children and their mothers have access to good quality, nutritious foods and get connected with other forms of support and health care.

For over 40 years, Aponte said, EHCHS ran its own WIC program. Since the organization has a Federally Qualified Health Center component – the Boriken Neighborhood Health Center, which provides pediatric and OB-GYN care – managing a WIC program was “very convenient.” It embodied the embedded, streamlined, and comprehensive continuity of care that makes many WIC programs unique.

But the agency ceased operating its WIC program in 2022, Aponte said, due to a post-Covid provider consolidation effort across the city, and the increase in online and remote services. Other WIC providers serve the area, including the NYC Health + Hospital in Harlem and the Institute for Family Health.

How will cuts to SNAP and Medicaid affect WIC?

The funding deal struck to end the government shutdown includes the full year of appropriations for the USDA, where WIC’s budget resides, Menefee-Libey explained. So its funding is assured through October 2026.

The funding deal gave WIC two other wins, the NWA noted. Reductions to the program’s fruit and vegetable benefits, which had been proposed over the summer in Trump’s and in the House Agriculture Committee’s budgets, were dropped. And the federal government refilled WIC’s emergency contingency fund, which played a key role in holding the program over during the shutdown.

But other cuts to the ecosystem of public benefits are expected this year, and that could affect WIC access.

“Programs like WIC, Medicaid, and SNAP all work together to help to improve public health outcomes,” Menefee-Libey said. “Upheaval or uncertainty in any of these programs doesn’t stay isolated; it will have ripple effects.”

For many of the families Newton’s office helps access, retain, or increase public benefits, losing one, or both, he says, would have “very adverse consequences.”

The consequences are practical: They are about how much food a family will be able to have on the table if they have to manage without SNAP, or what health care will look like for them if they lose Medicaid.

But beside the immediate implications of losing other benefits for a family supported by WIC lies an important bureaucratic “domino effect.”

“If someone is participating in Medicaid and SNAP,” Menefee-Libey explained, “they are presumed to be eligible for WIC – their certification process is streamlined.” That process is called “adjunctive eligibility.” The point of this is to increase the reach of the public benefit programs, and simplify the bureaucratic process.

But the looming changes throw a wrench in the machine. If people lose access to one kind of public benefit, and then become pregnant and want to enroll in WIC, they would, at the very least, need to complete additional administrative steps. But, in the worst case, Menefee-Libey said, they could “lose their eligibility entirely.”

That concern is particularly relevant in the states like New York that expanded Medicaid under the 2014 Affordable Care Act, Menefee-Libey said. The ACA gave states the option to extend Medicaid coverage to address the “coverage gap” that left adults with incomes too high to qualify for traditional Medicaid, but too low to afford for private health insurance – and who often had no access to employment health benefits – with virtually no options.

Now, people who stand to lose access to Medicaid may lose WIC, too.

What would Trump’s proposed ‘public charge’ rule mean for WIC?

On Nov. 19, the federal government reopened the “public charge” rule dossier, as Trump had done in his first term.

The rule refers to a test under federal law that allows immigration officials to deny applications for lawful permanent residence, or a green card, and certain visas if they determine that the applicant could become a “public charge.” The current policy for the test does not consider participation in health care programs like Medicaid, nutrition programs, or housing programs, and focuses instead on cash assistance and long-term institutionalized care. It was established in 2022 and remains in effect.

Ripple effects of ICE raids create health challenges for New York City

But the Trump administration is seeking to considerably broaden the test. Effectively, the new proposed rule does not provide explicit guidance as to which benefits would or would not be considered.

WIC providers have said that such an expanded rule could further discourage immigrant and mixed-status families from seeking enrollment in WIC and other benefits.

“The fear is that many immigrant and mixed-status families will withdraw from public benefit programs entirely, including from WIC,” Menefee-Libey said. “We know that will have tremendous implications for public health impact generally – worse health and pregnancy outcomes, and real uncertainty and fear during a challenging period” of pregnancy and early parenting.

Multiple studies have documented the relationship between punitive immigration policies and decreased health care utilization among immigrants (known as the “chilling effect”).

Answering the public comment period for the rule, which is open through Jan. 26, many public health organizations and individuals have voiced opposition. The Protecting Immigrant Families Coalition issued a response, signed by 725 national, state, and local organizations, including PHS, the NWA, New York’s Legal Aid Society, and the Committee for Hispanic Children and Families.

“Unknown rules lead to chaos and bias,” the coalition wrote Dec. 19. “This proposal would remove essential guardrails that protect millions of immigrant families, in favor of an unknown immigration policy that invites arbitrary decisions and political bias. It will deter millions of U.S. citizens in immigrant families, as well as lawfully present immigrants, from seeking care and aid for which they qualify under law. It will undermine the nation’s health and weaken our country’s economy, while making every social problem we face worse.”

Julie Flandreau is a freelance reporter in New York.

Homeward bound: How MedShare is bringing global mission back to Atlanta

2025-12-19T21:30:01+00:00

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MedShare is a global health nonprofit founded in Atlanta in 1998. It sends medical supplies that are frequently discarded in the United States to clinics around the world for free. More recently, it has added domestic work to its portfolio, providing unique insights into the needs of American safety-net clinics that serve the most vulnerable.

Since its founding, the nonprofit has grown to work in 120 countries, including disaster zones, like Jamaica after Hurricane Melissa, and war-torn Ukraine. It ships items as small as sutures and syringes, to those as large as X-ray machines, transformers, and even, once, a morgue, around the world.

Now the organization is looking homeward, bringing its “circular approach” to medical supplies to American clinics that serve people in need, including in its home state of Georgia.

While the organization had periodically helped out in domestic crises like wildfires in California, CEO and Executive Director Stacey Koehnke told Healthbeat, Covid brought home the similarities between MedShare’s work abroad and domestic needs, since it had personal protective equipment to supply during the pandemic.

Since Covid, MedShare has adopted an intentional approach to working with clinics domestically. There are many similarities, she said.

Like the clinics it supports internationally, safety-net clinics in the United States serve vulnerable populations.

That domestic work has become a priority for MedShare over the past 18 months, Koehnke said, with 10% of its resources distributed domestically, with an eye toward further growth.

“Where our biggest impact is in access domestically for those communities who may be under- or uninsured,” she said, pointing to the examples of rural areas that lack hospitals, Native American reservations, and neighborhoods with many immigrants as other sites of health care need. MedShare has provided supplies to clinics in about 35 states, including at least 27 clinics in Georgia, in urban and rural areas.

Creative partnerships with medical supply companies help MedShare meet clinics’ needs at home or abroad. The goal is to provide needed supplies while preventing waste.

Take, for example, a recent effort to send ultrasound machines to low-cost clinics across the country. MedShare obtained machines from medtech firm BD. The equipment was new, but BD had taken the machines off the market in favor of updated models. MedShare sent the outdated but functional ultrasound machines to 30 states, Koehnke said. MedShare also provided training to technicians at those clinics in troubleshooting and using the equipment.

Patients can save money and time if they can get ultrasounds in clinics, rather than an outside provider, Koehnke said. That could help with maternal health and other issues, she said. MedShare also provides clinics with blood pressure monitors, both for patients with hypertension and for pregnant women who need to keep an eye out for pre-eclampsia.

Three of the clinics that got the ultrasound machines are in Georgia. Bethesda Community Clinic, based in Ball Ground in Cherokee County, will use one on a women’s health van to be deployed in the spring. The ultrasound machine will be used for basic prenatal care like confirming pregnancies and identifying complications early.

“Having this capability on our mobile unit allows us to bring essential diagnostic services directly to underserved patients who otherwise lack access to these resources,” said executive director Melissa Belfield. The free machine is helping the clinic expand its services without incurring costs that would take away from direct patient services.

The Macon Volunteer Clinic also got an ultrasound machine through the program, and the clinic’s nurse practitioner has attended a virtual training. The clinic plans to use it for placing IUDs and determining blood flow in cases of deep vein thrombosis, spokesperson Julia Norman said.

MedShare has in recent years focused on ensuring that the medical equipment it sends to clinics at home or abroad gets used over the long term by including training.

The domestic ultrasound donation program led MedShare to develop a remote training program since it couldn’t send team members to each of the American clinics that got the devices. It also sends its workers abroad to help clinic workers learn to use and maintain equipment.

“If there’s no one there who knows how to do basic troubleshooting and basic repairs, it becomes a wasteland of beautiful equipment that’s unusable,” Koehnke said.

Maternal care is a top concern, but it looks different in different places

Domestic work gives MedShare employees a close-up view of the challenges American safety-net clinics face.

One clinic that was using disposable tools was able to save money after MedShare provided it with an autoclave. The goal is to increase the resources that go to direct patient care instead of supplies, Koehnke said.

Decreasing federal and state funding is one concern, Koehnke said. The reduction of services or closure of community hospitals also puts added pressure on the clinics. She said many hospitals first eliminate maternity care due to liability risk, pushing the clinics to pick up the slack.

“We are seeing added requests, added needs for equipment that we originally didn’t know that we would need to provide,” she said. “We get requests for ultrasound all the time now. We don’t have as many ultrasounds to give as we’d love to.”

Maternal care is a concern domestically and globally, Koehnke said, but it looks different depending on the setting.

“We’re still working kind of within that (U.S.) system, so people are used to certain levels of care. There’s certain expectations from the different clinics and hospitals, and even the patients that we’re working with, which may have a different sensibility internationally,” she said.

For example, clinics abroad often want clean birthing kits, which help people deliver babies at home in sterile conditions. But that’s not the case in the United States. “That is not something we’d be able to provide domestically, even for mothers who may not have a hospital nearby.”

Koehnke said the needs are similar – pregnant women need to be prepared for safe births – but in the United States, the focus is more on preventing complications, such as through providing blood pressure monitors and pulse oximeters, the clip-on fingertip devices that measure heart rates and how well oxygen is moving through the body.

“It’s a different way to provide care, but the fact is that there are still underserved communities with families and children who need access to health care, and our role is to help ensure that those who can provide that direct care are given the tools and support to do that,” Koehnke said.

How MedShare works: It’s like Amazon – but free

Equipment comes to MedShare in a variety of ways, Koehnke said. Along with donations of equipment that is no longer for sale or has been refurbished, hospitals often have a large amount of everyday supplies like syringes that would otherwise go to waste.

She gave the example of a case of individually packaged syringes that a hospital or home health care facility would otherwise dispose of once it was opened, even though the remaining syringes were safe to use.

“We’re able to repackage those and get them actually out to someone who can still use them. So there is also a very much an underlying environmental element to the work that we do,” Koehnke said.

Nurses are often key catalysts for the donations, she said: “They’re thinking, ‘Wow, I really don’t want to throw this out. How can I get this to someone?’” Supply chain administrators at hospitals are also key conduits.

Once the supplies reach MedShare, it operates like most online shopping. Clinics register with MedShare and, once approved, they use an online portal to look for supplies. All supplies are free, and clinics outside Georgia pay only shipping costs, while Georgia clinics do not pay for shipping.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

How adding doors to toilets became a lifeline for women’s health in the Balkans

2025-12-08T16:03:15+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 3 at Manuel’s Tavern in Atlanta. Watch the full show here. Sign up to receive Healthbeat’s free Atlanta newsletter here.

My story is about health care deserts in the heart of the Balkans. It involves periods, toilets, and a mobile clinic.

Health care desert number one: menstruation.

It was 2019, and I was serving as the British Ambassador to North Macedonia. The country’s Institute of Public Health had released a survey that showed over 90% of girls in rural areas in North Macedonia miss school during their period due to poor menstrual hygiene facilities at schools.

Girls were missing school not just because they couldn’t afford sanitary products, but also because the school toilets didn’t have doors. Doors! It was frankly eye opening to see that in a European country.

After this survey was released, we, the United Kingdom, partnered with a regional government to fix a small number of toilets and fund free menstrual products in school bathrooms. We talked to some journalists about the project, and that helped get information out about the problem and the impact on education.

It was a small campaign. It was not expensive to the UK. But the ripple effect was amazing. Here’s what happened next:

The World Bank supported a project to refurbish toilets across primary schools.
The central government offered free menstrual products for high school girls.
The government dropped the value-added tax from period products nationwide.

Rachel Galloway is the British Consul General to the Southeast United States.

Because of all of these steps, girls in rural areas were able to go to school when they had their periods. That moment — watching a policy shift born from a box of pads and a few well-placed headlines — it was stunning. And it made me think, what else can the UK do here?

Which brings me to health care desert number two: mammograms and pap smears.

The UK funded a mobile gynecology unit — an ambulance retrofitted to deliver exams in rural villages. It was a lifeline, especially during 2020 pandemic lockdowns, when women were trapped at home, often in unsafe situations.

The unit reached Roma communities and others who had never seen a doctor. It was a fantastic program. I was really proud of it. But something gnawed at me.

There were no records. No continuity. The nurses remembered faces, the doctors remembered stories, but the system remembered nothing. It was health care by memory, not by data. And in a pandemic, memory isn’t enough.

Local health care workers spoke about the challenge of serving a community without having background knowledge of who people were, what they needed, and even what they understood.

Both of these examples highlight the problem of health care deserts, which are a global problem. And as our mobile clinic demonstrates, it’s not just about providing direct access, but also about the need for better tools. Maybe this is where artificial intelligence could be useful.

An AI future does seem a little scary at times. But when it comes to health care, AI could change lives for the better. It is an area that the UK and the United States are collaborating on through our new technology partnership.

Imagine mobile units equipped not just with medical tools, but with smart systems that build records, track needs, and flag risks. Imagine AI helping us understand those farflung communities in rural locations. It could go a long way in predicting future outbreaks, tailoring care, and building trust.

It won’t replace the nurse who remembers every patient’s story. But it could mean that the next time we roll into a village, we’re not starting from scratch. We’re building on knowledge, not just goodwill.

And maybe we’ll remember that sometimes diplomacy starts with a door on a toilet — and ends with a country changing its laws.

Rachel Galloway is the British Consul General to the Southeast United States. She arrived in July 2022 having previously served as the UK’s Ambassador to the Republic of North Macedonia where she played a pivotal role in strengthening diplomatic relations in the region, including the country’s accession to NATO. Her career spans various positions, from working in Brussels at the EU, to leading a team working on Darfur policy, to a posting in Helmand Province in Afghanistan to a stint at the British Embassy in Washington.

Breastfeeding by candlelight: My ‘aha’ moment for improving maternal and child health in emergencies

2025-11-17T19:22:08+00:00

While this story could be named “Why I almost named my son after a hurricane,” instead it tells the story of what inspired me to spend my public health career addressing vulnerabilities in maternal and child health.

On Sept. 16, 2004, two days after delivering my first child, I was discharged from an Atlanta area hospital into the aftermath of Hurricane Ivan. In my post-partum haze, I had no idea what havoc this storm was about to unleash in our lives. At that time, Hurricane Ivan was one of the largest, most devastating hurricanes to hit Georgia, producing tornados, flooding, and power outages throughout the state.

What should have been a 20-minute drive home, took 2 1/2 hours. At one point, we had to pull off the highway so I could feed my son in the car. When we finally arrived at our house, we learned that we had no power and no air conditioning, which even in early fall in Atlanta can create relentless humidity.

This next part may be TMI, but it is important to share that my infant weighed 10 pounds, 14 ounces. Yes, I gave birth to an almost 11-pound baby! What this meant was that he was hungry ALL THE TIME. As the downpour continued, amidst the darkness and heat, we hurried to get settled. For the first hour or so, I tried to breastfeed my new son by candlelight, but through tears, sweat and frustration, I just could not function. I needed my husband’s help to get out of the house and to a hotel, where safety and electricity comforted us through our first night out of the hospital.

This “aha” moment of breastfeeding by candlelight turned into a career inspired to address disparities in maternal and child health.

Unfortunately, being a new mother going through the nightmare of a natural disaster is not a unique or unusual experience, but it is in fact, a dangerous one.

History has shown that pregnant and postpartum women are particularly vulnerable during emergencies. They have functional needs that require additional social and health care-related support, including prenatal and postpartum care and lactation support. Evidence has demonstrated that emergencies can cause heightened stress among this population, often leading to adverse maternal and health outcomes including miscarriage, premature delivery, low birthweight, and mental health challenges.

These were experiences of many women who were pregnant or delivered during several national disasters, including Hurricane Katrina in Louisiana, Hurricane Harvey in Texas, and most recently Hurricane Helene in North Carolina.

Sarah Blake with her newborn son after Hurricane Ivan in 2004.

There are other types of emergencies that mothers experience that are both harmful and preventable. For instance, extreme heat during pregnancy has been shown to increase women’s risk for severe maternal morbidity and adverse infant health outcomes. The Covid-19 pandemic shed light on the importance of maternal immunization to protect women from complications of infectious disease during and after pregnancy. Even human-caused disasters (such as those caused by bioterrorism) have shown to have long-lasting effects on mothers and their infants.

Through my work, I partner with public health agencies and community organizations to create strategies that improve maternal and child health public health emergency preparedness planning and response. Just recently, I worked with my collaborators from the Morehouse School of Medicine’s Center for Maternal Health Equity and Healthy Mothers, Healthy Babies Coalition of Georgia to complete Project Prepare, a Centers for Disease Control and Prevention-funded study of preparedness and readiness for emergency planning among pregnant and postpartum women in Georgia.

Our findings revealed that mothers in Georgia are often disconnected from their health care providers for essential information and support before, during, and after emergencies. They also lack essential financial and social services during emergencies that are needed to ensure healthy outcomes. These findings are important, especially in Georgia, where women experience among the highest rates of maternal mortality.

As both a women’s health advocate and health services researcher, it is my mission to address the vulnerabilities that women experience, particularly during the perinatal period. It is both my purpose and a call to action that I take on willingly and, in these challenging times, with unwavering resolve.

I dedicate this story to my firstborn son, Will – or Ivan as he is fondly sometimes called.

Dr. Sarah Blake, PhD, is an associate professor at Emory University’s Rollins School of Public Health and serves as director of Emory’s Maternal and Child Health Center of Excellence. A health services researcher, she applies a health equity lens to address women’s health care.

Is Covid during pregnancy linked to autism? What a new study shows, and what it doesn’t

2025-11-05T15:42:36+00:00

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A large study from Massachusetts has found that babies whose mothers had Covid-19 while pregnant were slightly more likely to have a range of neurodevelopmental diagnoses by age 3. Most of these children had speech or motor delays, and the link was strongest in boys and when the mother was infected late in pregnancy.

The increase in risk was small for any one child, but because millions of women were pregnant during the pandemic, even a small increase matters. The study doesn’t prove that Covid infection during pregnancy causes autism or other brain conditions in the fetus, but it suggests that infections and inflammation during pregnancy can affect how a baby’s brain grows, something scientists have seen before with other illnesses. It’s a reason to help pregnant women avoid Covid and to keep a close eye on children who were exposed in the womb.

What the study found

Researchers at Massachusetts General Hospital examined medical records from more than 18,000 mothers and their children born from March 2020 through May 2021, before vaccines were widely available to pregnant women. Because everyone giving birth during that period was tested for Covid, the team could clearly see which pregnancies were exposed to the virus causing it.

About 5% of those mothers had Covid while pregnant. Their children were modestly more likely to be diagnosed with a neurodevelopmental condition by age 3 than those whose mothers weren’t infected, even after accounting for differences in maternal age, race, insurance status, and preterm birth.

The link appeared strongest among boys and when infection occurred in their mother’s third trimester. Still, most children in both groups showed typical development.

‘Sick to my stomach’: Trump distorts facts on autism, Tylenol, and vaccines, scientists say

“This was a very clean group to follow,” said Andrea Edlow, a maternal-fetal medicine specialist at Mass General and one of the study’s authors. “Because of universal testing early in the pandemic, we knew who had Covid and who didn’t.”

Independent authorities say Covid, which causes a powerful immune response in some people, fits the biological pattern seen with other infections in pregnancy. Alan Brown, a professor of psychiatry and epidemiology at Columbia University who studies maternal infection and brain development and was not involved in this research, explained, “Covid would be a very strong candidate for it to happen because the amount of inflammation is very extreme.”

How might infection affect brain development?

Scientists are still piecing together how various infections during pregnancy can affect fetal development. Severe illness can cause inflammation that disrupts brain growth or can trigger preterm birth, which carries its own risks.

“There’s a long history of evidence showing that maternal infection can slightly raise the risk for many neurodevelopmental disorders,” said Roy Perlis, vice chair for research in psychiatry at Massachusetts General Hospital and co-author of the new study.

Edlow’s lab is investigating how infection and inflammation may interfere with brain development. In a healthy brain, immune cells help shape developing neural circuits by trimming away extra or unnecessary connections, a process known as “synaptic pruning,” which sculpts the brain’s wiring. When a mother’s immune system is activated by infection, inflammatory molecules can reach the fetal brain and alter the pruning process.

Animal studies support Edlow’s hypothesis. When scientists trigger inflammation in pregnant mice, their offspring often show changes in how brain cells grow and connect, changes that can alter learning and behavior.

Why late pregnancy and why boys?

In Edlow and Perlis’ study, the link between Covid and developmental delays was strongest when infection occurred late in pregnancy, during the third trimester. That’s also when the fetal brain is growing most rapidly, forming and refining millions of neural connections.

“When we think of organ development, we think earlier in pregnancy, but the brain is an exception in this regard, where there’s a massive amount of brain development in the third trimester. And that continues after birth,” Perlis said. “It is entirely plausible that the third trimester is a period of vulnerability specifically for brain development.”

At least 3 babies have died of congenital syphilis in NY this year amid rise in cases

But not all researchers agree that the third trimester is uniquely vulnerable. Brian Lee, a professor of epidemiology at Drexel University, cautioned that because most mothers in the study were tested at delivery, there were simply more late-pregnancy infections to analyze. “That gives the study more power to find a difference in the third trimester,” he said. “It doesn’t prove earlier infections aren’t important.”

The study also found stronger effects in boys. That pattern is familiar: Boys are generally more likely than girls to have speech or motor delays and to be diagnosed with autism. Researchers suspect that male fetuses may be more susceptible to stress and inflammation, though the biology isn’t fully understood.

What the study can and can’t show

Edlow and Perlis are careful to say the study shows an association, not proof that Covid infection in pregnancy causes developmental problems. Many other factors could explain the correlation.

Mothers who get sick with Covid may have other health issues, such as obesity, diabetes, or mental health conditions, that increase the risk of developmental delays in children. “Persons with mental disorders are much more likely to get Covid. Women with mental disorders are much more likely to have kids with neurodevelopmental problems,” Lee said. “Mothers with worse physical health are also at higher risk of having children with neurodevelopmental problems.”

Lee’s research has shown that even infections before or after pregnancy can be linked to autism, suggesting that shared genetics or environment, rather than the infection itself, could be at play. That’s why experts say much larger, longer studies are needed to understand the extent of any risk from the infection.

Edlow, Perlis, and their team plan to follow the children in their study as they grow older to see whether early differences persist or fade. They’re also studying how inflammation during pregnancy affects the placenta and fetal brain, and how to counteract these effects.

What about vaccination?

Because this study followed pregnancies from early in the pandemic, it doesn’t answer whether vaccination changes the risk. But other research offers reassurance.

A large national study in Scotland found no difference in early developmental outcomes between children whose mothers were vaccinated and those who weren’t. Another study in the United States found the same: no link between prenatal Covid vaccination and developmental delays through 18 months. Both align with decades of data showing that vaccination during pregnancy is safe for both the mother and the baby.

“Vaccination is a short spike … your immune system revs up, then it goes back to normal,” Edlow said. “Covid [infection] is much more prolonged, unpredictable, and people can get … a dysregulated immune phenomenon that really doesn’t exist in vaccine responses.”

What this means for parents and clinicians

Since late 2020, there’s been widespread confusion and misinformation about the safety of Covid vaccination during pregnancy. Some women have hesitated to get vaccinated out of fear it might harm their baby. But the evidence since then has been clear: Covid vaccines are safe in pregnancy. The American College of Obstetricians and Gynecologists strongly recommends Covid vaccination to protect both mother and child.

Experts say the broader lesson is that pregnancy is a period of vulnerability, and prevention matters, not only for Covid, but other infections as well.

Janet Currie, a professor of economics at Yale University, said these risks remain “underappreciated,” despite decades of evidence. “Even though the flu vaccine is recommended for pregnant women, very few pregnant women get it,” she said. “Physicians seem to be reluctant to vaccinate pregnant women.”

As Gil Mor, scientific director of the C.S. Mott Center for Human Growth and Development at Wayne State University in Detroit, put it, “Protecting the mother is protecting the long-term health of the offspring. … The best intervention is vaccination.”

A century-old echo

The idea that what happens in the womb can shape life after birth took root with studies of famine, like the Dutch “Hunger Winter” in the final months of World War II. In 1944 and 1945, as German forces blockaded the western Netherlands, rations fell to just a few hundred calories a day. Thousands died of starvation, and women pregnant during that period gave birth to babies who later faced higher risks of heart disease, diabetes, and schizophrenia. The episode became a cornerstone of the “fetal origins” idea, that deprivation or stress in pregnancy can have lifelong effects.

The 1918 flu pandemic broadened that idea to infection. Babies exposed to influenza in utero later showed small but lasting differences in education and earnings, a sign that illness during pregnancy could affect brain development.

Researchers in Taiwan, Sweden, Switzerland, Brazil, and Japan found similar consequences. Some argued that those findings reflected the disruptions of World War I, not the flu itself. But later studies, including those from the United Kingdom and Finland, have strengthened the case for a biological effect, reinforcing that the infection itself, not wartime upheaval, was the key driver.

“It isn’t simply influenza that can alter fetal neurodevelopment,” Kristina Adams Waldorf, a professor of obstetrics and gynecology at the University of Washington, explained. “Many types of infections … in the mother can be transmitted as a signal to the fetus, which can alter its brain development.”

A century later, the same question has returned with Covid: Could infection during pregnancy subtly shape how children grow and learn? The new Massachusetts General Hospital study offers an early look at an answer.

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

‘Sick to my stomach’: Trump distorts facts on autism, Tylenol, and vaccines, scientists say

2025-09-23T13:22:27+00:00

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Ann Bauer, a researcher who studies Tylenol and autism, felt queasy with anxiety in the weeks leading up to the White House’s much-anticipated autism announcement.

In August, Bauer and her colleagues published an analysis of 46 previous studies on Tylenol, autism, and attention-deficit/hyperactivity disorder. Many found no link between the drug and the conditions, while some suggested Tylenol might occasionally exacerbate other potential causes of autism, such as genetics.

Bauer, an epidemiologist at the University of Massachusetts-Lowell, and her team called for more judicious use of the drug until the science is settled.

On Monday, President Donald Trump stood beside Health and Human Services Secretary Robert F. Kennedy Jr. for what he called a “historic” announcement on autism. “If you’re pregnant, don’t take Tylenol, and don’t give it to the baby after the baby is born,” Trump said. “There are certain groups of people that don’t take vaccines and don’t take any pills that have no autism,” he added, without providing evidence. “They pump so much stuff into those beautiful little babies, it’s a disgrace.”

A fact sheet released alongside the White House briefing cited Bauer’s analysis. But she was alarmed by Trump’s comments. If prenatal Tylenol has any association, which it may not, it would help account for only a fraction of cases, she said. Further, research has not deeply examined Tylenol risks in young children, and many rigorous studies refute a link between vaccines and autism.

Bauer worries such statements will cut both ways: People may put themselves at risk to avoid vaccines and Tylenol, the only safe painkiller for use during pregnancy. And she frets that scientists might outright reject her team’s measured concerns about Tylenol in a backlash against misleading remarks from Trump and other members of his “Make America Healthy Again” movement.

“I’m really concerned about how this message is going to play out,” she said. “It’s a sound-bite universe, and everyone wants a simple solution.”

Autism experts at the Centers for Disease Control and Prevention were neither consulted for the White House’s long-awaited autism announcement nor asked to review a draft of the findings and recommendations, CDC scientists told KFF Health News, which agreed not to identify them because they fear retaliation.

“Typically, we’d be asked to provide information and review the report for accuracy, but we’ve had absolutely no contact with anyone,” one CDC researcher said. “It is very unusual.”

Trump and Kennedy promised this year that under their leadership the federal government would swiftly figure out what causes autism. Scientists who work in the field have been skeptical, noting that decades of research has shown that no single drug, chemical, or other environmental factor is strongly linked to the developmental disorder. In addition, both Trump and Kennedy have repeated the scientifically debunked notion that childhood vaccines may cause autism.

Helen Tager-Flusberg, director of the Center for Autism Research Excellence at Boston University, called Trump’s comments dangerous. Fevers can harm the mother and the developing fetus, she said, adding that fevers are more strongly associated with autism than Tylenol.

In an emailed response to queries, HHS spokesperson Andrew Nixon said, “We are using gold-standard science to get to the bottom of America’s unprecedented rise in autism rates.”

White House spokesperson Kush Desai wrote, “President Trump pledged to address America’s rising rate of autism, and to do so with Gold Standard Science.”

Had CDC scientists been allowed to brief Kennedy, they say they would have cautioned that simple fixes won’t make a dent in the number of autism cases in the United States: As many as 1 in 31 8-year-old children had autism spectrum disorder in 2022.

Systemic changes, such as regulations on air pollution, which has been linked to asthma and developmental disabilities including autism, and assistance for parents of disabled children, could improve lives for far more Americans with autism and other conditions than actions taken by the Trump administration on Monday, researchers say.

One federal action is to consider updating the label on Tylenol and to “encourage clinicians to exercise their best judgment in use of acetaminophen for fevers and pain in pregnancy by prescribing the lowest effective dose for the shortest duration.” The American College of Obstetricians and Gynecologists already recommends acetaminophen “as needed, in moderation, and after consultation with a doctor.”

‘Genetics is the most significant risk factor’ for autism

Despite Kennedy’s many years of speaking about autism, he rarely cites credible autism research or expert recommendations, Tager-Flusberg said. Instead, Kennedy repeats fringe, scientifically debunked theories linking vaccines to autism, despite rigorous studies published in peer-reviewed journals that refute a link.

At the Monday briefing, Trump said he spoke with Kennedy about autism 20 years ago: “We understood a lot more than a lot of people who studied it,” he said. Ahead of Trump’s first term in 2017, Kennedy said he met with the president to consider a commission on vaccine safety and autism. It didn’t happen then. But soon after Kennedy was confirmed as health secretary, he called autism “preventable,” pointed to “environmental toxins,” and contradicted the results of a CDC study finding that the main driver of rising autism diagnoses was that doctors increasingly recognize the disorder.

At a televised Cabinet meeting in April, Kennedy told Trump, “By September, we will know what has caused the autism epidemic and we’ll be able to eliminate those exposures.”

“You stop taking something, you stop eating something, or maybe it’s a shot,” Trump replied.

“He is on a political crusade,” Tager-Flusberg said of Kennedy, adding that vaccines, Tylenol, aluminum, and food dyes make for simple targets to rally against. “We know genetics is the most significant risk factor,” she said, “but you can’t blame Big Pharma for genetics, and you can’t build a political movement on genetics research and ride to victory.”

“RFK makes our work harder,” said Peter Hotez, a vaccine researcher and the author of a book about his autistic daughter, “Vaccines Did Not Cause Rachel’s Autism.” He said the book stemmed from conversations with Kennedy in 2017, in which Hotez shared studies pinpointing more than a hundred genes linked to autism, and research into the complex interplay between genetics, biological processes, and things that children and fetuses encounter during development.

“I sat down with him and explained what the science says, but he was unwilling or incapable of thinking deeply about it,” Hotez said. “He is extremely careless.”

In addition to its focus on Tylenol, the White House said it would move to update “prescribing information” on leucovorin — a medication related to the B vitamin folate — to reflect its use as an autism treatment. A small clinical trial in 2012-13 suggested the drug may help treat language problems in some children with autism. Tager-Flusberg said the findings warrant further study but clarified these were “old data, not a breakthrough.”

Likewise, studies finding a modest association between autism and prolonged Tylenol use were published years ago. Researchers have suggested the medicine might occasionally exacerbate factors associated with autism, such as genetics and oxidative stress, a biological condition that occurs for a variety of reasons that scientists are still unraveling.

Still, these studies couldn’t rule out the possibility that fevers prompting women to take Tylenol, rather than the medicine itself, might instead be to blame. Fevers and infections — including those prevented by vaccines — have also been linked to autism.

Nonetheless, Bauer’s recommendation would be to pause before taking acetaminophen while pregnant — blanket advice that doctors give for all medications during that period, but which may be ignored. “Try to alleviate discomfort in some other ways, like with a cold compress, hydration, or massage, before taking it,” Bauer said.

She welcomed the White House’s motion to consider labeling Tylenol to emphasize judicious use of the drug but worries about how the MAHA movement might distort a careful message. On Sept. 2, the right-wing news outlet One America News Network posted an interview with newly appointed CDC vaccine adviser Robert Malone, writing that Malone “speculates RFK Jr. may have an important announcement this month regarding a potential link between Tylenol, multiple vaccinations, and autism in children.”

“I was sick to my stomach,” Bauer said, concerned that Kennedy would link her study to discredited theories, causing doctors and scientists to reject her far more measured work.

RFK Jr. is ‘like the boy who cried wolf’

Several medical and scientific associations have called for Kennedy’s removal or resignation. Many scientists are skeptical of what he says because much of it has been misleading or wrong. For example, he’s said HIV isn’t the only cause of AIDS (it is), that antidepressant drugs cause mass shootings (they don’t), that older adults don’t have severe autism (some do), that the measles vaccine causes brain swelling (it doesn’t), that Covid vaccines were the deadliest vaccines ever made (they aren’t), that vaccines aren’t safety-tested (they are), and that vaccines contribute to autism (they don’t).

“This is like the boy who cried wolf,” said Brian Lee, an epidemiologist at Drexel University. “One day he might be right about something and Americans who are not prone to conspiracies won’t trust it because it’s coming from RFK’s mouth. And that could be a problem.”

What’s more, the Trump administration is eroding scientists’ ability to probe the safety of pharmaceuticals, said Robert Steinbrook, head of health research at Public Citizen, a nonprofit consumer protection group.

“Public Citizen is very supportive of research on medications that could be linked to diseases,” he said. “But it needs to be through an open process, which looks at scientific evidence, and which doesn’t cherry-pick studies to support a preconceived point of view.”

Steinbrook said the administration has undermined his confidence in the government’s ability to conduct credible work. The Food and Drug Administration has held less than a third the number of advisory committee meetings this year as it did last, meaning fewer opportunities for experts to discuss research on the risks and benefits of drugs. The Trump administration has fired hundreds of career scientists at the CDC and FDA and cut millions of dollars in research funds, including to projects studying autism.

In early September, the CDC issued an unusual contract with the Rensselaer Polytechnic Institute to analyze datasets for signs that vaccinated children were more likely to have autism. Unlike with other research initiatives, the CDC didn’t post an open call for applications in advance. This allows agency experts to review proposals and select studies best designed to answer the question at hand.

CDC researchers told KFF Health News that experts in the agency’s autism and disability group weren’t aware of the contract or asked to review the proposal. That’s important, they said, because researchers digging through data to find clues about autism must show how they’ll rule out biological and environmental exposures that muddy the results, and ensure that children have been accurately diagnosed. One researcher said, “It absolutely looks like Kennedy has subverted the grantmaking process.”

The CDC and HHS did not respond to KFF Health News’ requests for information on the grant, including through a Freedom of Information Act request.

The new vaccine study is separate from Kennedy’s autism data-science initiative, which was posted as an open call at the National Institutes of Health. “The hope is that something good comes of it, and that the government won’t cherry-pick or censor what scientists find out,” Lee said.

Bauer said she didn’t apply to be part of the initiative because of Kennedy’s outsize presence at HHS.

“I would not take his funding because it could take away from the credibility of my study,” she said, “in the same way that taking money from pharmaceutical companies does.”

Amy Maxmen is Healthbeat’s national reporter in partnership with KFF Health News.

Georgia gets low grades for maternal health. Here are some resources that can help with pregnancy.

2025-09-09T13:09:03+00:00

This guide is written for Healthbeat by experts in the field. Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

For many people, pregnancy can be a time of excitement, nerves — and information overload. Google “maternal health,” and you’ll find news stories, documentaries, and star-athlete testimonials about our nation’s maternal health crisis.

Georgia, in particular, has some of the worst pregnancy outcomes in the United States, but our community health organizations are working hard to change that.

“We are advocating for policies and programs — and creating powerful resources — for pregnant women and families here in Georgia,” said Fowzio Jama, formerly of the Healthy Mothers Healthy Babies Coalition of Georgia, a statewide maternal health organization.

There are new and emerging resources to help people feel safer and more confident in their pregnancy journeys. Are you pregnant or caring for someone who is having a baby in Georgia? Here are some facts and resources to help ensure a safe pregnancy.

A healthy mouth helps make a healthy pregnancy

Did you know that oral health — the condition of your mouth, teeth, and gums — is key during pregnancy? Research suggests a strong connection between oral health conditions like gum disease and complications like preterm birth and high blood pressure. What’s more, you can’t eat well (and feed your growing baby) if you experience pain with each bite.

And yet, it’s not typical for prenatal clinicians to pay attention to what’s happening inside your mouth, said Irene Yang, PhD, an oral health researcher at Emory University’s Nell Hodgson Woodruff School of Nursing. “Regular dental checkups are therefore not only safe during pregnancy but essential,” she said.

At least 3 babies have died of congenital syphilis in NY this year amid rise in cases

If you have a dentist but haven’t seen them in a while, make an appointment, Yang advises. Routine cleanings and exams are important but often overlooked ways to lower your pregnancy risk. If you don’t have a dentist — or are experiencing active dental issues — share your concerns at your next prenatal visit. Most obstetricians and midwives understand the importance of oral health and can work with you to find help.

Worried about dental insurance? There are options for coverage, even if you’re uninsured or underinsured. Medicaid covers dental care, for instance, and you can find a dentist who accepts it or your private insurance using this public portal from Find Help Georgia.

“If you don’t qualify for Medicaid, and you don’t have insurance, ask your prenatal clinician to help you find a dentist who works with people on a ‘sliding scale,’” Yang said. This means the office will charge you for services according to your ability to pay.

Setting a strong oral health routine — like brushing twice a day and flossing daily — can help you protect your teeth and gums between dental visits. Need to “brush up” on flossing? Here’s a video refresher.

Being heart healthy doesn’t have to be hard work

Pregnancy changes your body a lot, including by stressing your heart. At this point, you may be exhausted by the endless advice to “eat right and exercise” — at a time when you just want to rest and feed your cravings. But keeping your heart healthy doesn’t have to be hard work.

“Walking for just 30 minutes a day, five days a week, can boost your circulation, strengthen your heart, and even improve your sleep and mental health,” Jama said. “Think of your walking time as ‘me time’ and a much-needed break.”

How connecting with nature helps Black women have healthier pregnancies

Simple ways to work walking into your day can include setting up walking dates with friends, joining a walking group for expecting parents, or walking instead of driving to a place you regularly visit, such as the pharmacy (if safe).

Equally essential are your prenatal visits, where your clinician will monitor your blood pressure and heart health. Between visits, it’s highly recommended to regularly check your own blood pressure. Many pharmacies offer free blood pressure checks, and certain clinics offer free take-home blood pressure cuffs.

Knowing what’s standard for you — and when something might be wrong — can prompt you to get help when you need it. Call 911 or go to a nearby emergency room if you notice any of these life-threatening pregnancy warning signs from the Centers for Disease Control and Prevention:

Headache that won’t go away or gets worse over time
Dizziness or fainting
Changes in your vision
Fever of 100.4 degrees F or higher
Extreme swelling of your hands or face
Thoughts of harming yourself or your baby
Trouble breathing
Chest pain or fast beating heart
Severe nausea and vomiting
Severe belly pain that doesn’t go away
Baby’s movement stopping or slowing during pregnancy
Severe swelling, discoloration, or pain in your leg or arm
Vaginal bleeding or fluid leaking during pregnancy
Heavy discharge after pregnancy
Overwhelming tiredness

How to access help for mental health

While pregnancy and childbirth can be filled with joy, the reality for many parents is that this time can also bring anxiety, depression, and serious mental challenges. Even though mental health conditions are treatable with proper care and support, odds are — if you live in Georgia — you or someone you know has had trouble accessing our mental health system.

In 2024, Georgia received a grade D from the Policy Center for Maternal Mental Health, showing that there is great room for improvement during pregnancy and beyond. At your checkups, your clinician might not always ask about stress or depression, so it’s important to bring up any mental health concerns you may have — and ask for clear, actionable steps for accessing support.

Here are some resources that can help:

Locate a counselor using this easy-to-search registry from Postpartum Support International
Review this guide from the Georgia Perinatal Mental Health Task Force.
Call or text the PSI helpline, available from 8 a.m. to 11 p.m. ET, at 1-800-944-4773
In crisis? Call or text the 988 Suicide and Crisis Lifeline any time to reach a dedicated counselor

The Georgia Adult Mental Health Crisis Line is available 24/7 at 1-800-715-4225, as well. In addition to offering toll-free support via phone, this helpline can dispatch a mobile crisis response team to your home or help you find the nearest walk-in center for in-person help.

Doula support is for everyone

A little extra help can make all the difference in the journey to childbirth and beyond, and a doula can provide this much-needed added layer of care.

Why this Black man became a doula: ‘Every death was preventable’

What is a doula? A doula is a trained professional who provides emotional, physical, and informational support throughout pregnancy, birth, and postpartum recovery.

“While doulas are not necessarily medically trained [though some are], they do provide essential prenatal education, birth advocacy, and postpartum support,” said Thomecia Busby, workforce development manager at HMHBGA. “Your doula can help you feel empowered, with a sense of control over the choices made during your pregnancy, labor, and delivery.”

Working with a doula can:

Shorten your labor time
Reduce your chances of a Cesarean birth (C-section)
Decrease the need for pain medications
Reduce your risk of a mood disorder before or after childbirth
Increase the likelihood that you’ll have a positive birth experience

Whether you plan to give birth at your local hospital, a birth center, or at home, you, too, can have a doula, Busby said. “Families can start their search for an independent doula with HMHBGA or qualify for a doula reimbursement program. Other local doulas offer flexible payment plans or package options, with some insurance plan reimbursement for these services.”

Doulas are part of a larger vision for enhanced pregnancy care in Georgia and can support you in making informed choices, Busby said. “A doula can help you feel safe, seen, and heard.”

Community organizations can help find resources

Navigating pregnancy can feel overwhelming, to say the least. Organizations like PSI and HMHBGA are available to connect you with resources, from dentist and doula recommendations to free blood pressure cuffs. Your local hospital or community clinic may also offer free prenatal classes.

“You are not alone in this journey,” Busby said. “With the right support, you can thrive during pregnancy and beyond. Pregnancy can be challenging, but it can also be a deeply empowering experience when you feel supported and have the help you need.”

Margaret Master, MBA, MPH, is a maternal health researcher and advocate who serves as executive director of Healthy Mothers Healthy Babies Coalition of Georgia. Shannon Stevenson, EdD, MSN, RNC-MNN, PMH-C, is an associate clinical professor of nursing at Emory University who co-founded the Georgia Perinatal Mental Health Task Force.

At least 3 babies have died of congenital syphilis in NY this year amid rise in cases

2025-08-12T22:23:34+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

At least three babies have died of presumed congenital syphilis in New York state this year as cases continue to rise, the state Health Department announced on Tuesday.

Congenital syphilis, which is passed to a fetus during pregnancy, is a curable infection, but can be harmful or fatal if not caught and treated early. Without treatment, the infection can lead to miscarriage, stillbirth, prematurity and infant death; babies born with it can have deformed bones, severe anemia, brain and nerve problems.

The recent infant deaths — which occurred in counties outside of New York City — underscore the continued challenge of preventing congenital syphilis infections, which physicians and public health experts in New York raised alarms about last year.

Resurgence of congenital syphilis signals ‘urgent need’ for testing, treatment

“Congenital syphilis cases are definitely continuing to increase not only across the city but across the state, and to date, we overall have not been able to successfully bring those numbers down,” Dr. Rodney Wright, vice chair of obstetrics at Montefiore Medical Center in the Bronx and a member of the New York State AIDS Advisory Council, told Healthbeat.

Until last year, cases of congenital syphilis were rare in the counties outside of New York City, according to the Health Department. In 2024, the state recorded 36 cases, including five stillbirths and one infant death, outside of the city. By comparison, from 2019 to 2023, there were a total of eight infant deaths suspected to be linked to syphilis in that region.

The third infant death marks the 21st congenital syphilis case reported in New York state, excluding New York City, according to the Health Department. To explain the rising number of cases, the Health Department pointed to an increase in reported syphilis cases among women statewide.

“No baby should die from syphilis in New York state or anywhere in this country; it is completely preventable,” state health commissioner Dr. James McDonald said in a statement. “Detecting syphilis early in pregnancy with a simple blood test is important to ensure rapid diagnosis and treatment, so you have a healthy baby.”

In New York City, the Department of Health and Mental Hygiene reported that cases of congenital syphilis were low prior to 2018, but by 2023 had increased by 75%. The city reported 35 congenital syphilis cases in 2023 and 15 cases in the first half of 2024, according to its 2023 surveillance report on sexually transmitted infections.

The increase in congenital syphilis cases in New York mirrors nationwide trends. Congenital syphilis cases have spiked across the country in recent years, rising from 334 cases reported nationwide in 2012 to 3,761 in 2022, according to the Centers for Disease Control and Prevention. The upward trend in congenital syphilis cases also corresponds to nationwide increases in cases of syphilis, which was close to being eliminated in the late 1990s and early 2000s, but has since surged.

If caught early, syphilis is treatable during pregnancy with penicillin. But there has been an unstable supply of the antibiotic in recent years. Shortages of penicillin in the United States began in 2023, which the Food and Drug Administration attributed to rising demand.

In July, the CDC reported a voluntary recall of Bicillin L-A, a long-acting injectable form of penicillin G benzathine, and urged providers to save use of the product for pregnant patients. Penicillin G benzathine is the only effective treatment for syphilis in pregnancy and for the prevention of congenital syphilis, according to the American College of Obstetricians and Gynecologists.

On Aug. 1, in a letter to health care providers, the state Health Department’s AIDS Institute noted that the recall is “expected to last until the fall of 2025 or possibly longer.”

To address the rise in congenital syphilis cases, experts and physicians point to the need for increased public awareness of sexually transmitted infections like syphilis, expanded access to prenatal care, and timely syphilis screenings.

Last year, New York state took additional measures to expand testing, with mandated syphilis testing during the third trimester of pregnancy, in addition to screening at first exam and delivery. New York City has required third trimester syphilis testing since 2019.

Wright, the obstetrician, said while the penicillin shortage has not directly affected his practice, preserving the antibiotic for pregnant people can make it harder to ensure that partners are also adequately treated.

To successfully prevent congenital syphilis, he said, it’s crucial that both the pregnant person and their partner are tested and treated.

“There have been cases where the pregnant patient has been treated, but their partner has not been able to be successfully treated, which can allow for reinfection,” he said.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

How AI can help public health agencies improve screening, prevention, and treatment of diseases

2025-08-05T13:33:05+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

While public health agencies focus primarily on assessment, policy development, and assurance of services, they are also frequently tasked with the primary prevention and control of high-priority infectious and chronic diseases and with supporting maternal-child health.

Artificial intelligence can improve disease control by improving patient communication, supporting clinical decision-making, and managing resources and data more effectively.

AI can improve immunization logistics and uptake

Public health agencies often manage the ordering, distribution, and monitoring of recommended childhood vaccines and some adult vaccines, such as influenza. The Covid-19 pandemic exposed important weaknesses in these systems, including patient registration and eligibility assessments, recall reminders, and inventory management.

Many immunization information systems also have gaps in their ability to integrate with electronic health records, and, in some states, legal barriers restrict the completeness of recording and reporting. AI can help clean and standardize these records, filling in missing data and identifying children who have missed routine vaccines.

Several examples of using AI for immunization systems have been documented outside the United States. In DataKind’s collaboration with Gavi, an AI-supported system used natural language processing to scan paper-based health records and extract vaccine histories, helping outreach workers locate unvaccinated children. It also used machine learning to predict where vaccine stocks would run low and which areas were likely to have higher dropout rates.

These insights help immunization programs pre-position supplies, organize mobile clinics, and target community education campaigns. They also help prevent waste and shortages of vaccines.

AI can strengthen HIV, STI, and TB prevention and treatment

Public health departments operate some of the longest-running, most comprehensive programs to screen and treat tuberculosis, sexually transmitted infections, and HIV. Despite tremendous advances in biomedicine — from rapid testing systems to improved prevention and treatment regimens for all three conditions — many health departments still rely on antiquated systems for other aspects of disease control. Registering, tracing, and tracking patients and exposed persons often requires the use of paper forms, faxed results, and manual data entry.

How AI can help strengthen emergency response to public health threats

Digital chatbots, already tested in HIV and STI programs in South Africa, can improve outreach by answering common questions, booking appointments, and conducting eligibility screening. AI can also analyze surveillance data to identify geographic clusters of new cases or detect unusual patterns that might indicate a gap in prevention services.

For TB, computer vision algorithms can now interpret chest X-rays more accurately than non-specialist clinicians. While these tools do not replace clinicians or case managers, they could be used to triage patients faster, support decision-making, and flag anomalies in real time.

That, in turn, allows skilled public health workers to focus on activities that require human interaction, empathy, and judgment, such as interviewing patients about highly sensitive topics, counseling them on treatment options and social services, and supporting them emotionally.

AI can strengthen services to pregnant patients and infants

Public health systems have long prioritized linking people to care as soon as they become pregnant and supporting them through pregnancy and the first weeks of a baby’s life. Delays in accessing care, poor follow-up, and low-quality care can lead to complications, disability, or death, as demonstrated by persistently high infant mortality rates and a growing epidemic of congenital syphilis.

Digital assistants powered by AI can help frontline health workers deliver timely information to pregnant people and new parents, including personalized messages about antenatal visits, warning signs, and infant feeding. When integrated with electronic health records, these systems can alert providers when patients miss appointments or when risk factors suggest the need for more frequent monitoring.

New York City leaders tout doula initiative progress, though gaps remain

In Rwanda, an AI algorithm used data from routine prenatal visits to predict which pregnancies were most likely to result in adverse outcomes. When applied, this could help nurses and midwives prioritize specific patients for follow-up care, reducing their workload and improving outcomes. Similarly, AI-supported triage tools can help differentiate normal from high-risk deliveries, ensuring that women are routed to the most appropriate facility for their pregnancy.

Postnatal care may offer the most immediate opportunity to improve outcomes. Many deaths among mothers and newborns occur in the weeks immediately after birth. AI-powered mobile apps or voice-based tools can help monitor symptoms, guide self-care, and prompt clinic visits when needed.

AI can help expand reach and reduce inequity in chronic disease care

While screening for hypertension, diabetes, and cancer is primarily carried out by clinics and hospitals, public health agencies often organize mass screening events, promulgate guidelines, and work to connect underserved populations to care. AI can help improve the efficiency and equity of these efforts.

Algorithms can analyze electronic health records and insurance claims to identify people who are overdue for screening. AI tools can also support mobile screening units by rapidly interpreting test results and flagging high-risk individuals for follow-up. In India, researchers developed a smartphone-based retinal scanner paired with an AI system that screens for diabetic retinopathy, allowing trained technicians, not ophthalmologists, to provide service in rural areas.

For cancer screening, AI can support interpretation of mammograms, Pap smears, or stool-based tests. Chatbots, phone-based reminders, and predictive risk models can help ensure that people complete initial testing and follow through with diagnostic evaluation and treatment.

AI implementation requires funding, leadership, and oversight

One of the most critical unanswered questions is whether AI applications will improve services and disease control in populations who distrust health institutions or face barriers to care. AI evangelists argue that AI can help health care workers personalize their outreach messages, identify the highest priority persons or populations for intervention, and offload some routine tasks to increase the amount of direct human contact with persons in need of services.

The risks, however, remain substantial. AI in public health raises concerns about data privacy, surveillance, bias, and accountability. Systems trained on incomplete or biased data can reinforce inequities. Tools designed without community input may be rejected by those they aim to serve. And commercial AI systems may be unaffordable for public agencies unless open-source models or shared infrastructure are developed.

Realizing the benefits of AI, while limiting the harms, will require public health agencies to have a combination of funding to modernize data systems, leadership willing to take chances, and ongoing technical, ethical, legal review about patient rights and equitable application.

Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

New York City leaders tout doula initiative progress, though gaps remain

2025-07-07T23:46:48+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

A New York City initiative to expand access to doulas in underserved neighborhoods has made progress in its early years, though inequities persist across the city, a new report shows.

On Monday, city leaders touted the achievements of the Citywide Doula Initiative, which launched in 2022. The program works with community-based organizations to provide free support during pregnancy, childbirth and the postpartum period to residents of marginalized communities, as well as to those who live in homeless shelters and foster homes.

Over the last three years, the program has served 3,245 clients and has reported no deaths among its participants, city leaders said. Last year, doulas from Citywide Doula Initiative supported 884 births, accounting for almost half of all doula-attended births in communities identified by the city as marginalized, according to the new report from the Department of Health and Mental Hygiene.

“Our doula program is working,” Mayor Eric Adams said during a press conference at the East Harlem Neighborhood Health Action Center.

In recent years, reducing pregnancy-associated deaths has been a key priority for city leaders. In New York City, maternal mortality rates are significantly higher for Black people; Black women are four times more likely than white women to die from pregnancy-associated causes. As part of its HealthyNYC initiative, which aims to increase New Yorkers’ life expectancy, the city is targeting a 10% reduction in maternal death rates by 2030.

“No one should die bringing life into the world,” said Dr. Michelle Morse, the Health Department’s acting commissioner. “Every child deserves to celebrate their birthday. Every parent should have a childbirth free of trauma.”

Data on nearly all New York City births last year show that the proportion of residents who had doula support during birth rose from 4.9% in 2022 to 6.1% in 2024 — a 25% increase, though reflecting a small proportion of New York City births —according to the Health Department report.

Theresa Lasbrey Peters, a doula affiliated with the Northern Manhattan Perinatal Partnership, has helped about 75 women navigate birth through the Citywide Doula Initiative.

“Doulas make a difference,” she said at the press conference. “We listen, advocate, and hold space. We help people find victory, even in moments of fear and uncertainty.”

Still, inequities in access to doula care through the city persist, the report shows. Between 2022 and 2024, doula coverage increased in most boroughs, rising particularly in Brooklyn and Manhattan, though remaining stagnant on Staten Island. In Brooklyn, 8.6% of births received doula support in 2022, rising to 10.1% in 2024; in Staten Island, that same figure was 2.1% in 2022 and 2.0% in 2024.

While the vast majority of clients served through the Citywide Doula Initiative are Black or Hispanic, disparities in access also endure among New Yorkers more broadly. Last year, white New Yorkers had disproportionately high rates of doula support during pregnancy — accounting for 34% of overall births, but 60% of births with doula support — while Hispanic and Asian New Yorkers were underrepresented among births with doula support.

Questions about the impact of significant Medicaid cuts included in the Republican megabill, which President Donald Trump signed into law last week, hung over Monday’s press conference about the doula program. The New York state Medicaid program began covering doula support starting last year, and Medicaid covers 60% of births in New York City.

“We know doula services are just a piece of a safety net,” said Suzanne Miles-Gustave, the city’s deputy mayor for health and human services. “We need to ensure everyone has a safe pregnancy, and the means they need to raise a family. Access to healthy food and all forms of preventive and emergency care are also critical.”

Adams expressed disappointment in the legislation, and said that his administration was in the process of analyzing its local impacts. Pressed by reporters, he said that he was committed to seeing the doula initiative succeed.

“We’re not going to end this program,” he said. “This is one of the vital entities for me.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

How connecting with nature helps Black women have healthier pregnancies

2025-07-07T13:26:18+00:00

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At the start of her pregnancy with her now 10-month-old daughter, Marica Lowe was consumed by fear. She was so worried for her safety and that of her unborn baby that she holed up in her bedroom most days. She even skipped Mardi Gras, the vibrant but notoriously crowded festival that is normally the highlight of her year.

But as spring began, and the streets filled with flowering trees, Lowe reconnected with what had lured her to move to New Orleans from her hometown of New York City two years earlier: nature.

“The first time I visited New Orleans, I went on a walk, and I saw limes growing on the tree,” Lowe said. “Fruit doesn’t grow on trees in New York, so that really drew me here.”

She organized a community “sensory walk” through Couturie Forest, a 60-acre nature preserve. The aim was to take in the beauty of the natural environment by listening to birdsong, smelling fragrant plants, touching tree bark, and grounding themselves in the earth.

It was the second trimester of her pregnancy, and something unexpected happened. As she led the group through the forest, she experienced a profound mental shift, feeling peaceful and centered.

“I felt connected to nature. I felt protected. I felt more excited. I felt connected to my baby,” recalled Lowe, 39, who is now the wellness director at Dream House Lounge in New Orleans, a nonprofit organization committed to expanding access to mental and spiritual wellness services. “It just was life-giving.”

Keturah Queen, GirlTREK recruitment specialist, takes part in a midday group walk through New York City with her young daughter.

Research increasingly shows that women who participate in nature-based activities have healthier pregnancies — information that is especially critical for Black women, who nationwide have a maternal mortality rate that is more than three times the rate for white women, according to the Policy Center for Maternal Mental Health. In New York City, Black women face a fourfold higher risk of dying from pregnancy-related complications than white women — and research shows that more than 80% of these deaths are preventable.

For Black women, though, getting out into nature can be a challenge. Decades of discriminatory housing policies and disinvestment have resulted in many Black women living in communities with limited access to parks and green spaces, walkable streets, vegetation, or shade trees. These inequalities don’t just degrade the quality of life in these neighborhoods, they contribute to physical and psychological health disparities that disproportionately affect Black women of childbearing age.

In response, health advocacy groups and community-focused birth workers are creating opportunities for Black women to connect with nature, recognizing it as a vital tool in maternal health and wellness.

“When a Black pregnant woman walks through a park or sits under a tree, she’s not just relaxing — she’s reclaiming a piece of her health and her power,” said Keturah Queen, recruitment specialist at GirlTREK, a national health justice movement that aims to combat systemic racism and extend Black people’s lives through nature walks for women. “Nature gives us a chance to reset.”

Research shows link between green space and maternal health

Queen, 40, joined GirlTREK in 2016, when her first child turned 1. Hoping to lose weight and connect with like-minded women, she began walking regularly and along the way, cultivated a deep love for nature.

“When I got involved with GirlTREK, I started to plan nature walks,” Queen said. “And then I found myself being at such a place of calm, feeling stress-free and just loving to be under the skies, or just in the grass, barefoot walking — different things that brought me joy.”

A 2023 study led by a multidisciplinary team of researchers from the University of California, Irvine, among other institutions, found a measurable link between green space and maternal mental health. Analyzing more than 415,000 singleton births in Southern California, researchers found that for every 10% increase in visible street-level greenery, the risk of postpartum depression dropped by more than 4%.

Marica Lowe explores the natural corners of Tremé in New Orleans during her third trimester of pregnancy.

One in eight women who have recently given birth experience symptoms of postpartum depression, according to the Centers for Disease Control and Prevention, and Black women are much more susceptible. Without treatment, the condition can affect a mother’s well-being, her ability to care for her baby, and even the child’s development, including sleep, feeding, and behavior.

The health impacts of green space also extend to physical complications during pregnancy. Pregnant women residing in urban areas with sparse tree coverage face more than twice the risk of hypertensive disorders such as preeclampsia, a study by the March of Dimes Prematurity Research Center at the University of Pennsylvania found.

Preeclampsia — a condition that typically develops after 20 weeks of pregnancy involves high blood pressure and can lead to organ damage — affects about 1 in 25 pregnancies, and Black women are more than 50% more likely than white women to develop it.

Surviving childbirth: NYC nonprofit equips patients to track vital signs, advocate for their health

The same study found that those living within 100 meters of areas with less than 10% tree canopy had more than twice the odds of developing complications related to hypertension — especially non-Hispanic Black women — compared to those living near green spaces with more than 30% tree cover.

Black neighborhoods across the country have steadily lost trees over the years — a trend driven by environmental neglect, which closely ties to the legacy of housing discrimination.

“People who are Black, people who have historically been marginalized, live in neighborhoods that continue to experience disinvestment and dispossession,” said Dr. Max Jordan Nguemeni, an assistant professor in general internal medicine and health services research at the David Geffen School of Medicine at the University of California, Los Angeles.

In his latest research, Nguemeni is examining whether there is a direct link between tree canopy coverage and health outcomes before and after pregnancy in underserved Black neighborhoods. He and his team began by analyzing data from a tree-planting initiative in Philadelphia, where some predominantly Black neighborhoods received new trees and others with similar demographics did not.

Marica Lowe soaks up the sun at Pontchartrain Park in New Orleans with her then 8-month-old daughter, Orí Jenovah Lowe, during their daily time outdoors.

Nguemeni’s study aims to determine whether differences in green space impacted not just the broader Black community, but Black pregnant women in particular.

This focus on environmental factors and the effects of these disparities resonates deeply with Michele Akosua Chin-On, a New York City doula, private duty nurse, and co-founder of The After Birth Initiative created by the grassroots organization Our Bodies Our Births. She has witnessed firsthand how environmental and systemic stress affects Black mothers — from elevated cortisol and blood pressure to lower vitamin D levels linked to depression and higher-risk pregnancies.

“These inequalities are like a visceral pain,” she said. “It’s proof that Black women are not heard, taken care of and seen. If you nurture a mother, you nurture a nation.”

GirlTREK recruiting for Harlem walking group

Chin-On is committed to helping Black women reconnect with nature throughout their motherhood journey — a message she often shares with the women she supports, including 26-year-old Amanah Brookins, whom she encourages to spend time outdoors, especially during her postnatal recovery period.

“When you walk out in nature, and you’re touching Mother Earth, and you’re looking up, you see that you’re part of the moon, you’re part of the sunshine, you’re part of life,” Chin-On said. “When you see flowers actually reproducing these beautiful buds, that’s symbolic. You’re one with the universe and one with motherhood.”

Proposed NYC Council measure aims to reduce overdose-related pregnancy deaths

Brookins, along with her husband and firstborn, used to live in Jamaica. Her home there was surrounded by a river, a garden, and a plethora of trees.

“Getting that fresh air and that sun on your skin not just prepared my body physically, but just lifted my mood,” she said.

But in September 2024, early in her pregnancy with her second child, Brookins moved back to New Jersey and began working 11-hour shifts at a call center in Essex County.

“By the time you get out of work, it’s already dark outside. You haven’t spent any time in the sun,” Brookins said. “You’re just behind a desk all day, and it’s not only just the physical aspects of having pains throughout the day, like your feet swelling up, but just mentally and emotionally, it’s taxing.”

Determined to maximize her income before her baby’s arrival, Brookins delayed starting maternity leave until less than two weeks before giving birth — a difficult choice, as the long indoor hours had become a source of increased loneliness and stress.

As GirlTREK, founded in 2010, expands, Queen is recruiting for a new Harlem walking group specifically for Black mothers, who she said because of pressures and responsibilities are vulnerable to “the three deadly I’s: isolation, inactivity, and injustice.”

“We find that women who are in isolation, their health is failing more, because they feel like they’re doing it by themselves,” she said. “They’re overwhelmed, they’re stressed out, and some of them don’t have an outlet.”

Walking with a “sister friend” alleviates stress, boosts social skills, and motivates women to have a set structure, as well as an accountability partner — fostering trust and deepening their connection with nature, Queen said.

“How many times do we just not feel like it? But if you have someone who’s encouraging you, pulling you along, that’s just life-saving within itself.”

Queen, Lowe, and Brookins — alongside organizations like WE ACT for Environmental Justice and Outdoor Afro — emphasize that the movement to connect Black pregnant women with nature must go beyond individual healing. They are demanding urgent policy changes that confront the environmental consequences of structural racism. They call for halting development in urban green spaces and investing in community gardens, parks, and walkable areas that support Black families’ health and well-being.

‘This Side Up’ onesies and crib distribution: Infant sleep safety efforts central in Queens

Lowe’s advocacy for environmental justice was strengthened by negative medical experiences she had during her pregnancy. Her doctor kept warning her about potential complications as a Black woman, statements that felt impersonal and disconnected.

“The doctor kept telling me these things that were statistics around my age, around like just being Black and the things that could happen, all these risk factors,” Lowe said. “And in the last conversation I had with the doctor, I was just like, ‘Are you talking about me, or are you talking about the statistics? Because I’m in great health.’”

Nature became her remedy, a break from the unjust but common realities Black women across the United States face within the health care system. During checkups and even in labor, Lowe’s heart rate never spiked — something she attributes to the calming effects of her connection to nature.

“It helped to regulate both me and my baby,” she said.

This story has been updated to include more recent data on the maternal mortality rate for Black women in New York City and to include a new name for The After Birth Initiative.

This story was produced in partnership with the Health & Science Reporting Program at the Craig Newmark Graduate School of Journalism at CUNY.

Why this Black man became a doula: ‘Every death was preventable’

2025-07-01T14:57:44+00:00

This story was originally published at Capital B Atlanta. Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

While many doulas are women, one man is working to change the narrative about who can support families during childbirth.

Sylvester Pierce, 44, operates a doula business called Younity Birthwork, where he provides services ranging from childbirth education, postpartum care, and more.

“Doulas are there for the emotional, spiritual, and physical support of birthing parents. We operate as a comfort measure. We operate as a sounding board. My doula work is for families,” Pierce told Capital B Atlanta.

Since opening his business in 2023, Pierce said he has helped 12 different families, but he said his work began in an unprofessional capacity many years before as he helped members within his own family navigate pregnancy.

He said one of the events that drove him to get certification and training for birth work was helping his older sister cope with a miscarriage.

“The psychological effects, the physical pain, even having to go through burying a baby that you literally didn’t get a chance to see their eyes open, was hard,” said Pierce.

Pierce said his mission is to offer support and guidance for the Black women not just in his family, but for others in the community who face barriers and discrimination in the health care system during their pregnancies.

Sylvester Pierce opened Younity Birthwork in Atlanta 2023, but prior to that he helped members within his own family navigate pregnancy.

“Often Black women are not listened to, totally ignored. … Fear is with families knowing that you may die in these [hospitals] that are supposed to keep you alive — that’s horrible and scary,” said Pierce.

In 2021, Georgia had one of the highest maternal mortality rates in the United States, according to the Centers for Disease Control and Prevention. That same year, there were more than twice as many pregnancy-related deaths among Black women as white women in the state, according to the Georgia Department of Public Health.

Surviving childbirth: NYC nonprofit equips patients to track vital signs, advocate for their health

“Having a doula has been shown to significantly reduce maternal death rates. Having us in hospitals has been shown to create a better environment for mothers when they’re coming in,” Pierce said.

In a conversation with Capital B Atlanta, Pierce talks about his journey as a male doula and how he’s working to ensure that every family, especially Black families, feels heard, supported, and safe on their birthing journey.

Capital B: What are some of your responsibilities as a doula?

So let’s say I’m working with a family. I want to give them as much education as possible. So my job is to answer questions that they have before they get into a situation where they are forced to make a life-changing decision immediately, without having all the information. I’m in hospital visits with them early on, I’m meeting with physicians early, we’re laying out every option that they have, and we listen to what they want.

How long have you been a doula?

I’ve been doing the work for about 20 years. … I just assisted the families around me as much as I could, starting with my sisters and then going to friends of mine that had children or were pregnant, and as I kept trying to assist more and started seeing some of the issues the community was having, that’s when I learned that I needed to get some actual training done. … So that was about maybe four or five years ago when I started actually taking the path to understanding more seriously, and I’ve been in about three years of training so far.

What propelled you to start getting professionally trained as a doula?

Watching Black women die unnecessarily. Every death that I saw was preventable: Either it was families not understanding that they really were in pain, or hospitals releasing them early. The amount of women that I knew, at least two women, that literally just bled to death. They had cycles that didn’t stop, and over the course of six months or a year, they just bled out.

For people interested in hiring a doula, what should they know?

I’m a community doula, and one of the groups that I associate with is the Georgia Community Doula Coalition, and we are there for the people first. We’re there for families first.

Consult a doula. Find one in your neighborhood. Find one that fits you. We come in all shapes and sizes — and a few of us come in different genders — but find one that fits you, and then consult with the midwife as well. Build your birth team, and actually have a plan and a process set up as you go through your journey. Look through programs that can take care of the fees for you, because we do have programs in Georgia that can pay us.

How has being a man shaped your experience in doing this work?

I’ve gotten my pushback here and there, and I am indebted to and grateful for the women who knew why I was on this journey and showed me that I was already on the path and also those who could say, “This brother was helping me as a doula, before he was a doula. He was helping me feed my baby, he himself had changed diapers, he was coming over, washing dishes and cutting the grass.” … I think if we allow the proper education, if we get men out of this tunnel vision of what they’re supposed to be, and let everyone operate in their natural state, if we dispel the homophobic views of what a family is supposed to look like … then we can have a space where it really won’t matter what your gender is; it will literally just be who’s here to help, and who’s here to keep this family healthy.

Alyssa Johnson is Capital B Atlanta’s enterprise reporter.

From Kenya to New York: How a global nonprofit is addressing local maternal health needs

2025-06-16T13:48:41+00:00

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A nonprofit that works to help women survive childbirth in Guatemala, Kenya, and the Dominican Republic is expanding work in its only location in a developed country: New York City.

Saving Mothers, founded by New York University gynecologist and professor Taraneh Shirazian, is among several initiatives working to ease a maternal mortality crisis in the city, where deaths per 100,000 live births reached 19 last year.

Women in underserved areas of New York City are dying under many of the same conditions seen in less-developed countries - high blood pressure, infection and severe bleeding due to limited access to health care, poverty, social inequities, fear of medical devices, and mistrust of hospital staff, said Reham Perry, the programs coordinator at Saving Mothers. (Many others are also dying of drug overdose).

Saving Mothers aims to ease the crisis by equipping pregnant patients in underserved communities to advocate for themselves in the health care system and track their own vital signs for early indications of dangerous conditions like preeclampsia.

Globally, more than 343,000 women die in pregnancy or childbirth yearly, the majority in Sub-Saharan Africa and southern Asia. In the United States, 80% of pregnancy-related deaths are preventable, and of those deaths, Black women are three times more likely to die than white women, according to the Centers for Disease Control and Prevention.

How New York is addressing health disparities in pregnancy-associated deaths

While global maternal mortality rates have seen a reduction of 40% between 2000 and 2023, some areas, like New York City, have maintained steady or slight increases.

Part of the reason is that the city is home to so many people from various backgrounds, creating more factors that contribute to deaths associated with pregnancy and childbirth, Perry said.

“Even when we have statistics about Black women, and we say that they are more likely to die than white women that are laboring in the same hospitals, Black women aren’t a monolith,” she said.

They may encounter language barriers, doctors who don’t take their pain seriously, or assume they are using drugs, she said.

Saving Mothers steps in with its mPOWHER kit, designed to help pregnant New Yorkers help themselves.

Kits help patients track vital signs, monitor for dangerous symptoms

Preeclampsia, a high blood pressure disorder that occurs during and after pregnancy, is 60% more likely to occur in Black women than white women, according to the Preeclampsia Foundation. It can be caused by a pre-existing condition such as high blood pressure, which Black people are predisposed to.

Preeclampsia patients are at risk of seizures, kidney/liver failure, and cardiovascular events, such as stroke. Their babies are at risk of preterm birth, low birth weight, or stillbirth, as well as neurological and psychological defects.

Women being trained as birth attendants attend graduation at New York-based Saving Mothers' school in Guatemala. The birth attendants are known as "comadronas," trained to deliver babies and assess and recognize high-risk situations.

Saving Mothers’ medical team – a health literacy expert, health care providers, and a doula – help curate the mPOWHER kit with items aimed at preventing three conditions: cardiovascular disease, embolism and hemorrhage, the three leading causes of death among expecting mothers. The kit includes a Fitbit or other tracker, a blood pressure cuff, and compression socks to reduce swelling.

The Fitbit tracks heart rate and exercise, as well as helps prevent embolisms by encouraging movement. The blood pressure cuff helps patients monitor for random spikes they can report to their medical providers to help to catch conditions like preeclampsia, Perry said.

Patients get guidance on how to advocate for themselves

The kit also includes guides with information to help patients advocate for their health, like suggestions for different ways to communicate with their doctor. The tips aim to empower them to speak up in their appointments so they don’t feel overpowered or dismissed.

Teneisha “Adwoa” Olivierre recalls the difficulties of her first pregnancy in 2005, exacerbated by a lack of support from her obstetrician.

“He didn’t answer my questions, he brushed me off, gave me the wrong due date, he sent me for all my tests and things very late in the pregnancy,” she said. “The most he would do is put the stethoscope to my stomach, listen for the heartbeat, weigh me, and send me home. There was no measuring of the stomach, there was nothing.”

A midwife paid more attention: “She actually took her time and asked questions.”

Perry said the ability to self-advocate is important in a vulnerable condition like pregnancy and helps patients make the most of their doctor visits.

‘This Side Up’ onesies and crib distribution: Infant sleep safety efforts central in Queens

“They really empower the mom to take up space in those appointments and not feel like, okay the doctor is rushing, so I can’t ask these questions,” she said.

Saving Mothers also trains doulas to address health issues like preeclampsia and gestational diabetes.

The group plans to update the kits this summer with guidance on how to talk to doctors about postpartum mental health needs.

The organization distributes the kits at baby showers hosted by organizations including the New York Public Library, the New York City Housing Authority, and Healthy Start Brooklyn.

A second version, a safe birth kit, is designed for expectant mothers abroad who may need to give birth at home. It includes an umbilical clamp and razor blade to remove the cord after birth, a sterile sheet for delivering the baby, a glove, a bar of soap, illustrated directions for delivering the baby, and a hat and blanket for the baby.

How stress and access to health care can affect maternal health

Stress can play just as big a role in Black maternal mortality as any medical condition, Perry said, pointing to microaggressions and bias that affect Black women.

Rewa Thompson, a nurse educator of 20 years and a clinical associate professor at Stony Brook University’s School of Nursing, said social determinants of health – income, education and access to health care – factor in, as well.

For example, many low-income pregnant patients rely on Medicaid, which offers limited resources.

A team from New York nonprofit Saving Mothers works with pregnant patients at Kapenguria Regional Hospital in Kenya.

“There are more Black women who use these public hospitals,” Thompson said. “The hospitals are short staffed.” Bias and fatigue can lead staff to dismiss concerns of Black mothers. “So they become desensitized to the complaints, and then they’re like, she’s fine, and next thing you know, she has a massive blood clot in her lungs, and she’s dead.”

Thompson recommends that Black mothers have a trusted representative with them for the birth experience, to speak up for them in the event that they cannot advocate for themselves.

How federal funding cuts affect maternal health

Perry says recent cutbacks from a restructuring and reorganization of federal health agencies ordered by the new Trump administration have put maternal resources in jeopardy.

In January, data collection for the Pregnancy Risk Assessment Monitoring System was cut, and the 17 employees who worked in the CDC program were laid off on April 1.

New York state has taken steps to expand affordable health care for pregnant patients and offer free doula services under Medicaid.

Olivierre, who now works as a doula, said she was much more prepared for her second pregnancy, in 2023. She used a kit provided by Saving Mothers and took care in choosing her providers.

A week after giving birth, Olivierre noticed a spike in her blood pressure. After an emergency room checkup, it was confirmed that she had developed preeclampsia.

“If I didn’t have the blood pressure cuff, I wouldn’t have known that I needed to go to the emergency room,” she said.

This story was produced in partnership with the Health & Science Reporting Program at the Craig Newmark Graduate School of Journalism at CUNY.

RFK Jr. says healthy pregnant women don’t need Covid boosters. What the science says.

2025-06-02T14:15:06+00:00

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You’re pregnant, healthy, and hearing mixed messages: Health and Human Services Secretary Robert F. Kennedy Jr., who is not a scientist or doctor, says you don’t need the Covid vaccine, but experts at the Centers for Disease Control and Protection still put you in a high-risk group of people who ought to receive boosters. The science is on the side of the shots.

Pregnant women who contracted Covid-19 were more likely to become severely ill and to be hospitalized than non-pregnant women of the same age and demographics, especially early in the Covid pandemic.

A meta-analysis of 435 studies found that pregnant and recently pregnant women who were infected with the virus that causes Covid were more likely to end up in intensive care units, be on invasive ventilation, and die than women who weren’t pregnant but had a similar health profile. This was before Covid vaccines were available.

Neil Silverman, a professor of clinical obstetrics and gynecology and the director of the Infectious Diseases in Pregnancy Program at the David Geffen School of Medicine at UCLA, said he still sees more bad outcomes in pregnant patients who have Covid. The risk of severe Covid fluctuated as new variants arose and vaccinations became available, Silverman said, but the threat is still meaningful. “No matter what the politics say, the science is the science, and we know that, objectively, pregnant patients are at substantially increased risk of having complications,” Silverman said.

Restrictions on healthy people's Covid vaccine access fuel worry

A request for comment regarding the scientific literature that supports Covid vaccination for pregnant women sent to HHS’s public affairs office elicited an unsigned email unrelated to the question. The office did not respond when asked for an on-the-record comment.

Kennedy, a longtime anti-vaccine activist before joining the Trump administration, announced Tuesday that Covid vaccines would be removed from the CDC’s immunization schedule for healthy pregnant women and healthy children. His announcement, made in a video posted on the social media platform X, blindsided CDC officials and circumvented the agency’s established, scientific processes for adding and removing shots from its recommended schedules, The Washington Post reported.

There’s still much unknown about how Covid affects a pregnant person. The physiological relationship between Covid infections and mothers and fetuses at different stages of a pregnancy is complex, said Angela Rasmussen, a virologist at the University of Saskatchewan.

How pregnancy changes the immune system

The increased risk to pregnant patients comes in part because pregnancy changes the immune system, Rasmussen said.

“There is natural immune suppression so that the mother’s body doesn’t attack the developing fetus,” Rasmussen said. “While the mother does still have a functioning immune system, it’s not functioning at full capacity.”

Pregnant patients are more likely to get sick and have a harder time fighting off any infection as a result.

In addition to changing how the immune system works, being pregnant also makes women five times as likely to have blood clots. That risk is increased if they contract Covid, said Sallie Permar, chair of pediatrics at Weill Cornell Medicine.

CDC funding cuts impact Georgia vaccine access, other public health programs

The virus that causes Covid can affect the vascular endothelium — specialized cells that line blood vessels and help with blood flow, Rasmussen said. In a healthy person, the endothelium helps prevent blood clots by producing chemicals that tweak the vascular system to keep it running. In a person infected with the Covid virus, the balance is thrown off and the production of those molecules is disrupted, which research shows can lead to blood clots or other blood disorders.

Permar said those clots can be especially dangerous to both pregnant women and fetuses. Inflammation and blood clots in the placenta could be connected to an increased risk of stillbirth, especially from certain Covid variants, according to studies published in major medical journals as well as by the CDC.

When the placenta is inflamed, it’s harder for blood carrying oxygen and nutrients to get to the developing baby, said Mary Prahl, an associate professor of pediatrics at the University of California-San Francisco School of Medicine.

“If anything is interrupting those functions — inflammation or clotting or differences in how the blood is flowing — that’s really going to affect how the placenta is working and being able to allow the fetus to grow and develop appropriately,” she said.

It makes sense that we see the effects of Covid in the placenta, Silverman said. “The placenta is nothing more than a hyper-specialized collection of blood vessels, so it is like a magnetic target for the virus.”

Blood vessels in the placenta are smaller and may clot more easily than in the mother’s circulatory system, he said.

How Covid can complicate pregnancy

Permar said recent data suggests that pregnant women sick with Covid still have a higher risk of pregnancy complications such as preeclampsia, preterm birth, and miscarriage, even with existing immunity from previous infection or vaccination. Covid, she said, can still land women in the hospital with pregnancy complications.

Prahl said the connection between stillbirth and Covid may be changing given the immunity many people have developed from vaccination or prior infection. It’s an area in which she’d like to see more research.

There’s already strong evidence that both mRNA-based and non-mRNA Covid vaccines are safe for pregnant women.

Prahl co-authored a small, early study that found no adverse outcomes and showed antibody protection persisted for both the mother and the baby after birth. “What we learned very quickly is that pregnant individuals want answers, and many of them want to be involved in research,” she said. Later studies, including one published in the journal Nature Medicine showing that getting a booster in pregnancy cut newborn hospitalizations in the first four months of life, backed up her team’s findings.

Prahl expects more evidence will be available soon to support the benefits of mothers receiving a Covid booster during pregnancy.

“I can say, kind of behind the scenes, I’m seeing a lot of this preliminary data,” she said.

She blames the delay in part on the Biden administration’s scaling back of federal efforts to track Covid. “A lot of the surveillance of these data were pulled back,” she said. The Trump administration is further cutting money used to track Covid.

But because the vaccines give a pregnant woman’s immune system a boost by increasing neutralizing antibodies, virologist Rasmussen is confident that getting one while pregnant makes it less likely a pregnant woman will end up in the hospital if she gets Covid.

“It will protect the pregnant person from more severe disease,” she said.

How Covid vaccine in pregnancy protects newborns

Getting a Covid vaccine while pregnant also helps protect newborns after birth. Pregnant women who get vaccinated pass that protection to their young babies, who can’t get their own shots until they are at least 6 months old.

According to data released by the CDC in 2024, nearly 90% of babies who had to be hospitalized with Covid had mothers who didn’t get the vaccine while they were pregnant.

As recently as April 2024, research showed that babies too young to be vaccinated had the highest Covid hospitalization rate of any age group except people 75 and older.

The Trump administration’s decision to remove the Covid vaccine from the list of shots it recommends for pregnant women means insurance companies might no longer cover it. Pregnant women who want to get it anyway may have to pay hundreds of dollars out-of-pocket.

“I don’t want to be that doctor who just says, ‘Well, it’s really important. You have to vaccinate yourself and your kids no matter what, even if you have to pay for it out-of-pocket,’ because everyone has their own priorities and budgetary concerns, especially in the current economic climate,” Silverman said. “I can’t tell a family that the vaccine is more important than feeding their kids.”

But he and his colleagues will keep advising pregnant women to try to get the shots anyway.

“Newborns will be completely naive to Covid exposure,” he said. “Vaccinating pregnant women to protect their newborns is still a valid reason to continue this effort.”

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Proposed NYC Council measure aims to reduce overdose-related pregnancy deaths

2025-05-28T11:00:00+00:00

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The New York City Department of Health and Mental Hygiene recently identified an alarming pattern: Overdose is the city’s leading driver of pregnancy-associated death. A new measure poised to be introduced in the New York City Council on Wednesday aims to reverse that trend.

Overdoses accounted for 20 of the city’s 58 total pregnancy-associated deaths — deaths due to any cause during pregnancy or within a year from the end of pregnancy — in 2021, the most recent data available. That year, overdoses accounted for 34.5% of the city’s pregnancy-associated deaths, compared to 14.1% for the total five-year period from 2016 to 2020.

“This is something that the city can invest in. We can prevent this,” said Council Member Jennifer Gutiérrez, a Democrat representing parts of Brooklyn and Queens, and the bill’s prime sponsor.

For the City Council, reducing maternal mortality — which disproportionately impacts Black New Yorkers — has been a priority in recent years. Gutiérrez’s measure would narrow in on the intersection of maternal mortality and the opioid crisis, requiring the Health Department to create an educational campaign for health care providers, developed by medical professional organizations, about how to treat opioid use disorder during and after pregnancy. The bill would also expand the availability of naloxone, a medication that reverses opioid overdose, at neighborhood health centers.

New York sees sharp decline in overdose deaths, according to new data

Dr. Leah Habersham, a physician-scientist at Mount Sinai, works with the patient population at the center of this issue: pregnant people with substance use disorders. Overdose-related deaths during or after pregnancy are preventable, she said, and increasing awareness of this issue is critical — for health care providers, patients’ family members, and the broader public.

“We need to destigmatize this medical condition and get people to realize that this is a medical problem that is treatable,” said Habersham, who is also a member of the city’s Maternal Mortality and Morbidity Review Committee, which reviews pregnancy-related deaths.

Habersham directs the Bridge Program, a Mount Sinai initiative launched in 2022, that offers patients a unique combination of prenatal care and substance abuse treatment. By prescribing medications for opioid use disorders, like methadone, she helps patients avoid withdrawal, which can make the pregnant person and their baby ill, or heighten the risk of preterm labor and delivery.

The patients that Habersham works with tend to be overlooked and ostracized, she said. Distrust of medical providers or fears around disclosing drug use can keep pregnant people from seeking help, and the consequences can be deadly, with a heightened risk of overdose seven to 12 months after delivery.

“If they find out about my program, many of them are oftentimes relieved to find out that there’s this doctor who actually will help them,” said Habersham, an assistant professor of psychiatry and assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai.

In its alert last year, the Health Department described medications for opioid use disorder as “lifesaving” and encouraged health care providers to initiate discussions with patients about the treatment as soon as possible. The alert also noted that postpartum people should be encouraged to breastfeed, given its associations with reductions in neonatal abstinence syndrome.

The 20 pregnancy-associated deaths related to overdoses reported in 2021 reflected a sharp increase from the nine deaths reported in 2020 — as well as from the 34 pregnancy-associated overdose deaths that were reported out of a total of 241 pregnancy-associated deaths from 2016 to 2020. The Health Department pointed to heightened isolation during the pandemic and a fentanyl-laced drug supply as drivers of the increased mortality.

Gutiérrez hopes that with a robust educational campaign around overdose and pregnancy, the city could make progress in its efforts to reduce these deaths — as well as the “ultimate goal of reversing Black maternal morbidity.”

Her measure would require the educational campaign to be developed with medical professional organizations and local health agencies, and focus on the benefits of using medications for opioid use disorder, as well as the dangers of withdrawal during pregnancy.

Habersham says that part of what makes her work meaningful is that pregnancy is often a catalyst for a patient to try to stop using substances — for their own health and their baby’s.

“It’s the one time that they’re really, really motivated to get help, even if it’s initially not for themselves,” she said. “Oftentimes, it does become for themselves, because they know they have to get better in order to be a better parent.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

‘This Side Up’ onesies and crib distribution: Infant sleep safety efforts central in Queens

2025-05-19T10:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

At Elmhurst Hospital Center in Queens, new parents head home with more than just a baby.

Upon discharge, families are given a Safe Sleep Toolkit, with resources aimed at preventing infant deaths. There’s a sleep sack, a onesie stamped “This Side Up” — a reminder not to let babies sleep on their bellies — and a pamphlet that lists the ABCs of sleep safety: Alone, on their Back, in a Crib.

A Safe Sleep Toolkit is distributed to new parents.

The toolkit program, which piloted in 2018 at Elmhurst and other public hospitals, emerged from a citywide effort to prevent sleep-related infant deaths, and remains a key part of newborn care at the Queens facility.

Still, sleep-related injury deaths among infants continue to present a complex public health challenge for New York City, according to a recent report from the Department of Health and Mental Hygiene. The rate of such deaths has been stagnant for years, and clinicians and advocates say reducing mortality requires not only public education, but also addressing systemic issues like poverty and overcrowded housing.

New York has relatively low rates of infant mortality in comparison to other states, according to data from the Centers for Disease Control and Prevention. While the statewide infant mortality rate decreased from 2016 to 2019, the rate of Sudden Unexpected Infant Death (SUID), which often occurs during sleep, increased by 35%, according to state data.

In New York City, there were 185 sleep-related infant deaths due to injury — a category that includes accidental suffocation and strangulation in bed, an unspecified breathing issue, and undetermined causes — from 2016 to 2020, an average of 37 per year. The Health Department reported 32.9 deaths per 100,000 live births from 2016 to 2020, nearly unchanged from the rate of 32.7 deaths per 100,000 live births from 2012 to 2016.

Clinicians stress the ABCs of infant sleep safety

Elmhurst Hospital Center, part of the NYC Health + Hospitals system, serves one of the city’s most diverse populations. Many families are new arrivals to the United States, with limited health literacy, said Dr. Uday Patil, director of the neonatal intensive-care unit and newborn services.

Hospital workers educate new parents about sleep safety practices for infants.

“We feel a greater responsibility to make sure that they start their journey, especially their baby journey, with messages that align with having a healthy baby and a safe sleeping environment,” he said.

The basics of infant sleep safety can be counterintuitive for some families, who want to surround their baby with toys and blankets, or sleep side-by-side. But those practices are dangerous, said Liberty Abelido, the nurse manager of the neonatal ICU at Elmhurst.

Babies should always sleep alone in their cribs, without bumpers or blankets that could lead to suffocation, she said. They should never sleep on their stomachs, which can result in milk blocking their airways. And sharing a bed with an infant can lead to a baby’s accidental suffocation, or to the baby falling. It’s safer to have the baby within reach, but in their own crib, with a firm mattress and fitted sheet.

“If you’re tired, you have to put the baby back to the crib,” Abelido said.

Along with the Safe Sleep Toolkit and community programming around sleep safety, Elmhurst presents parents with a “Safe Babies Commitment Statement.” On the form, a parent indicates awareness of the dangers of shaking infants and young children, as well as the importance of the sleep safety ABCs. Signing the form is optional, but adds a meaningful layer of accountability, said Dr. Randi Wasserman, a neonatologist and director of pediatrics.

“It’s a shared responsibility,” she said.

Safety efforts center ‘harm reduction’

In New York City, sleep-related infant injury deaths reflect divides of race, class, and educational opportunity.

Rates of such deaths are significantly higher for babies born to mothers living in high-poverty neighborhoods, mothers with high school diplomas or less education, and young mothers, according to the city’s report. Additionally, from 2016 to 2020, the rate of sleep-related injury deaths among infants born to Black mothers was four times higher than that of white mothers and Asian and Pacific Islander mothers.

The three-year average infant mortality rate was highest in Brownsville, Brooklyn; Williamsbridge, Mott Haven, and Morrisania in the Bronx; and Jamaica and St. Albans in Queens, according to the city’s data from 2020 to 2022.

When it comes to sleep-related infant injury deaths, the top drivers of mortality include unsafe sleep surfaces or locations, excess bedding, and co-sleeping, according to the city’s report. Those circumstances can sometimes reflect unstable or cramped housing conditions.

Overcrowding is the reality for many families in the Queens neighborhood of Corona, said Rachel Schwartz, the senior director of maternal child health at Public Health Solutions.

“In a two-bedroom apartment, you very commonly have three families living there — an entire family living in one bedroom — and there is no space, literally, for a Pack ‘n Play,” she said.

Among a range of maternal and child health programs, Public Health Solutions provides community education and distributes cribs to local families, Schwartz said. Community health workers and home visitors also work directly with families to help them create safe environments — a form of “harm reduction,” she said.

The goal is to help families balance evidence-based recommendations with the resources that are available, she said, so that infants sleep “as best as possible and as safely as possible.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Fate of Black maternal health programs is unclear amid federal cuts

2025-04-18T11:00:00+00:00

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Eboni Tomasek expected to take home her newborn the day after he was born in a San Jose hospital. But, without explanation, hospital staff said they needed to stay a second night. Then a third. A nurse said her son had jaundice. Then said that he didn’t. She wondered if they had confused her with another African American mother. In any event, why couldn’t she and the baby boy she’d named Ezekiel go home?

No one would say. “I asked like three times a day. It was brushed off,” Tomasek said, relaying her story by phone as she cradled Ezekiel, now 6 months old, in their San Jose apartment. She was told only that more tests were being run to ensure “everything’s good before you leave.”

She knew that her intensifying anger and fear about the holdup could raise her blood pressure, that Black pregnant women and new mothers are especially vulnerable to hypertension, and that it could kill her. Distraught, she called the person she most trusted to calm her, a caseworker for Santa Clara County’s Black Infant Health program.

“She really did help me to stay centered,” Tomasek said of the caseworker, who tracked her health throughout the pregnancy. “I felt a lot better.”

Since 2000, about 14,000 families have participated in Santa Clara County’s Black Infant Health program and related Perinatal Equity Initiative, both aimed at decreasing racial disparities in maternal and infant health. Enrolled mothers are assigned caseworkers and nurses who visit them at home to monitor blood pressure and other vital signs, help with breastfeeding, and screen infants for developmental delays. The mothers also attend support groups to learn skills to buffer the well-documented effects of racism in obstetric care.

The programs have measurably improved the health of enrolled women over the past decade, county data from 2024 shows, reducing rates of maternal hypertension — a leading cause of pregnancy-related deaths — by at least 30% and increasing screenings for other potentially life-threatening conditions.

Experts in the field and program participants stress that this work is urgent — in California, Black women are at least three times as likely as white women to die from pregnancy-related causes, and, nationally, Black infants have the highest rates of preterm birth and mortality.

Maternal programs threatened by DEI cuts

While advocates for Black mothers laud the programs’ results as cause for optimism, they are concerned that the climate against diversity, equity, and inclusion, or DEI, initiatives could impede progress. Efforts to improve the health of this at-risk population have been targets of private lawsuits before, but since President Donald Trump took office, he has demanded the termination of all “‘equity-related’ grants” and threatened federal litigation against programs he claims illegally favor one racial group over another — even when they are designed to save lives, as is the case with the Santa Clara efforts.

Eboni Tomasek with her doula, Keosha McLamb, at the San Jose, California, hospital last year after giving birth to Ezekiel.

Santa Clara County has received most of the $1 million-plus in federal funding it expects for Black Infant Health and the Perinatal Equity Initiative programs for the fiscal year ending in June. But county officials say it’s unclear how much, if any, of the remaining money — which comes from the federal health department’s Health Resources and Services Administration and Centers for Medicare & Medicaid Services — is at risk amid federal anti-DEI policies and the recent cuts at the Department of Health and Human Services. The status on funding for the coming fiscal year is also unknown, county officials said.

Santa Clara stands to lose more than $11 million in public health funds due to the federal cuts, including money used to help deliver health services to underserved communities. A list of some of the federal grants already terminated includes millions of dollars from at least three programs in other states focused on Black birth outcomes.

Any decrease in federal funding for these types of programs could have dire consequences, said Angela Aina, co-founder and executive director of Black Mamas Matter Alliance. “We will likely see an increase in deaths,” she predicted.

Aina’s group pilots research and promotes public policy on behalf of 40 U.S. community-based organizations focused on Black maternal health. Member programs connect pregnant women to health care, counseling, and nutritional and breastfeeding advice, among other things.

If these services are cut, advocates fear, the progress made toward reducing racial disparities in birth outcomes could backslide. KFF research has found that eliminating such focused efforts could exacerbate the inequities, worsen the nation’s health, and increase health care costs overall.

“Our stakeholders are in a state of confusion right now because the federal workers that still have a job are not allowed to communicate, or there’s some kind of muzzle on their communication,” Aina said. “We don’t know — are we going to receive the rest of those grant funds?”

When asked how the state would respond to federal budget cuts to programs like Black Infant Health, Brian Micek, a California Department of Public Health spokesperson, said only that the agency remains “committed to protecting Californians’ access to the critical services and programs they need” and steadfast in its mission to “advance the health and well-being of California’s diverse people and communities.”

Requests for comment from the federal departments responsible for the grants funding Santa Clara’s programs went unanswered.

Communications directors from groups working on reducing racial disparities in birth outcomes declined to be interviewed for this article, citing fears of retribution.

Tonya Robinson, program manager for Black Infant Health, stands defiant in the face of these threats. She sees the federal government’s anti-DEI crusade as an invitation to practice the very skills they teach.

“Our program is working,” Robinson said. “And the way it’s working is by empowering women, giving women voices to help them stand up for what is right, and to recognize discrimination and the impact of structural racism on their bodies.”

The government’s antagonism toward her work inspires Robinson to soldier on calmly as a role model for the women she serves.

“We’re continuing to forge ahead,” Robinson said. “We want to make sure that we can be an example of how to manage stress at this time, in front of our clients.”

Black women often ‘dismissed or ignored’ in health care settings

Evidence surfaced that childbirth was deadlier for African American women than white women more than a century ago. But the issue did not gain significant public attention until 2018, when celebrities like Beyoncé and Serena Williams began airing their harrowing birth stories, highlighting the striking vulnerability of Black pregnant women and new mothers, even those with unlimited means.

In 2021, then-President Joe Biden proclaimed a week in April Black Maternal Health Week. A presidential proclamation marking that week in 2024 read that “when Black women suffer from severe injuries or pregnancy complications or simply ask for assistance, they are often dismissed or ignored in the health care settings that are supposed to care for them.”

Eboni Tomasek certainly felt ignored.

Three days after giving birth in September — and after her Santa Clara caseworker reminded her she had a right to know why she wasn’t being released — a nurse finally explained that Tomasek’s blood pressure had been too high for the hospital to safely discharge her.

Had she been white, Tomasek believes, the staff would have informed her sooner. “I feel like they were being racist,” she said. She credited her training through Black Infant Health with her ability to calm herself and help lower her blood pressure, allowing her to leave that day with Ezekiel.

Jamila Perritt, president and CEO of Physicians for Reproductive Health, believes that the poor health outcomes Black women and infants face have historical roots and will change only with the help of programs that, like those in Santa Clara, address conditions facing Black women.

“What we’re seeing in terms of maternal mortality are race-bound conditions,” said Perritt, an obstetrician who co-chairs Washington, D.C.’s Maternal Mortality Review Committee. “Our policies cannot be race-blind if we’re attempting to address them.”

This article was produced by KFF Health News, Healthbeat’s national reporting partner. KFF Health News is the publisher of California Healthline, an editorially independent service of the California Health Care Foundation.

Crossover Day 2025: Georgia legislature advances community health worker bill, gun safety tax credit

2025-03-08T10:00:00+00:00

The Georgia General Assembly this week took a major step toward creating a certification program for the state’s community health workers, who work with hospitals and nonprofits to help people navigate the health care system and find needed resources.

The bill got a crucial “yes” vote on Thursday night just hours before the legislature’s deadline for the Senate and the House to approve a bill – the “Crossover Day” deadline – for it to continue to the other chamber.

Rep. Darlene Taylor, R-Thomasville, sponsored the community health worker bill, which passed nearly unanimously in the House Thursday. The measure must now obtain approval from the Senate.

“It’s going to help our underserved and rural areas,” Taylor said on the House floor Thursday night. “It’s going to be very beneficial for maternal care and even our mental health.”

Community health workers are not certified medical professionals; instead, they focus on helping guide people through the health care system.

Taylor said the workers can help relieve the strain on medical professionals and ensure that Georgians have the care they need.

A certification for the profession would regularize training for these workers and could be a “a game-changer for workforce development,” Natasha Taylor, deputy director of Georgia Watch, a nonprofit consumer advocacy group, told Healthbeat earlier this year.

Currently, Emory University, Morehouse School of Medicine, and the Georgia Department of Public Health (DPH) offer community health worker training.

DPH would administer the certification program. The bill must now obtain Senate approval prior to the final day of the legislative session April 4.

Bills that would promote gun safety through a tax credit and increase Medicaid coverage of stop-smoking treatments moved ahead prior to the crossover deadline, giving them a shot at final passage before the end of session.

Others, like proposals to require schools to provide information about vaccines for teenagers and make it easier for foreign doctors to practice in Georgia, have stalled out for the moment. Such language, though, can still be attached to legislation that remains alive.

Vaccine information bill falters

A separate measure from Taylor, centering on vaccine information, gained committee approval but failed to get a vote on the House floor by Thursday night’s deadline.

The bill would have required schools to provide parents of students entering the 7th grade with information about meningitis, HPV, and tetanus, diphtheria, and pertussis (TDAP).

Lawmakers discuss Maternal Mortality Review Committee

The Georgia Maternal Mortality Review Committee was disbanded last fall after ProPublica obtained internal reports about women who died from pregnancy- and abortion-related complications.

Advocates and lawmakers at the Georgia State Capitol on "Crossover Day," the deadline by which lawmakers must advance their bills, on Thurs., March 6.

The committee has now been reconstituted, and ProPublica this week reported that the Georgia Department of Public Health refuses to release a list of the names of the members.

A bill sponsored by Democratic Rep. Viola Davis of Stone Mountain would compel the public health agency to release the names; however, the bill failed to get a committee hearing.

In contrast, Rep. Sharon Cooper of Marietta, the Republican chairperson of the House’s Public and Community Health committee, has been able to move ahead a bill focused on the maternal mortality issue.

House Bill 89 specifies that psychiatric records of deceased patients can be released to the Maternal Mortality Review Committee, with some exceptions for privileged materials.

“We have had a problem when a mother has died after a delivery that getting psychiatric information about them. People and physicians and hospitals have been very reluctant to give us that information,” Cooper said when speaking about the bill in the House vote earlier this week.

The bill also establishes a Regional Perinatal Center Advisory Committee to make recommendations about these centers, which ensure high-risk pregnancies can access the correct level of care and that patients can be transported to higher levels of care as needed.

The bill has now been referred to the Senate Health and Human Services committee, which is scheduled to hear it next week.

Gun safety tax credit advances

A package of bills aimed at improving gun safety sponsored by anesthesiologist Rep. Michelle Au, D-Johns Creek, has failed to move ahead.

But one of Au’s proposals for a safe gun storage tax credit was pushed successfully by Rep. Mark Newton, R-Augusta, an emergency room doctor.

House Bill 79 breezed through the House with only eight “no” votes. The measure would provide taxpayers who purchase a secure storage device for firearms or take a safety course up to a $300 one-time tax credit for their expenses. There’s a $10 million cap on the amount in tax credits the state can issue each year.

The measure now requires approval from the Senate Finance committee and the full chamber.

A separate proposal from Au would create a misdemeanor offense for making a firearm accessible to a child. It would also require gun dealers to post notices that it is illegal to allow children to access unsecured firearms. But that bill never received a committee vote.

No increase on cigarette taxes

House Bill 506, sponsored by Rep. Scott Hilton, R-Peachtree Corners, would require the state’s Medicaid health insurance program to cover tobacco cessation treatment – both counseling and prescribed drugs.

The measure would prohibit any Medicaid insurers from requiring prior authorization for those services or placing a lifetime cap on tobacco cessation services. The House Thursday approved the measure.

Separate proposals from Au and fellow Democrat Rep. Sam Park of Lawrenceville that would have increased taxes on cigarettes failed to get committee hearings. Georgia has the second-lowest cigarette tax rate in the country at $0.37 for a pack of cigarettes, according to the American Lung Association.

Pharmacists could provide HIV prevention drugs

Senate Bill 195, sponsored by Sen. Chuck Hufstetler, R-Rome, would allow Georgia pharmacists to dispense pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) without a prescription if certain conditions are met. These drugs prevent the transmission of HIV. The bill passed unanimously in the Senate and now awaits action in the House.

Certification reforms for foreign doctors stall out

After an unsuccessful effort last year, Sen. Kim Jackson, D-Stone Mountain, made a renewed push to create an easier pathway for foreign doctors to get certified to practice here in Georgia.

The goal is to increase the supply of doctors, especially those with diverse backgrounds who can provide care in underserved areas and communities.

But legislation faltered after technical concerns were raised by the Georgia Composite Medical Board, which manages licensing and regulation for medical professionals, at a committee hearing last month.

Jackson is working with the medical board to come to agreement on those details and is looking for a bill that did pass to attach her language to, she told Healthbeat on Friday. That happened last year as well, when the proposal was attached to a bill related to gangs, but that legislation failed to pass.

A separate bill that would make it easier for foreign-trained veterinarians to practice in Georgia breezed through the House and is awaiting Senate approval.

Measure to regulate recovery residences does not advance

A measure initially proposed by Sen. Randy Robertson, R- Cataula, to create a certification program for residences where people in recovery from alcohol or substance abuse can live in a supported environment, never got started.

Jeff Breedlove, strategic policy advisor for the Georgia Council for Recovery, at the Georgia State Capitol on Thurs., March 6.

Robertson instead plans to introduce the bill next year, said Jeff Breedlove, strategic policy advisor for the Georgia Council on Recovery.

Improving drug testing for illicit drugs

Senate Bill 6, sponsored by Sen. Kay Kirkpatrick, R-Marietta, would change Georgia law to broaden protections for people to use testing kits for illicit drugs without being penalized.

A 2023 reform made it clear that testing strips for fentanyl and other synthetic opioids do not fall under Georgia’s ban on drug paraphernalia. Kirkpatrick’s bill goes further, ensuring that Georgians can also test for non-opioid adulterants like Xyaline, a veterinary sedative found in illegal drugs.

It gained unanimous approval in the Senate and now awaits a hearing and vote in the House Public and Community Health committee.

But failing to get a floor vote in the House was a proposal from Rep. Lee Hawkins, R-Gainesville, to require public higher educational institutions, including technical colleges, to have opioid overdose reversal kits on their campuses.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Georgia won’t say who’s now serving on its maternal mortality committee after dismissing all members last year

2025-03-05T17:00:00+00:00

This story was originally published by ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive their biggest stories as soon as they’re published.

Georgia recently relaunched its maternal mortality review committee after dismissing all 32 of its members last year. But state officials won’t say who the current members are.

The dismissals were in response to ProPublica obtaining internal reports in which the committee detailed the “preventable” deaths of two women who were unable to obtain legal abortions or timely care after Georgia banned abortion.

In September, ProPublica published stories on the deaths of Amber Thurman and Candi Miller. They were the first reported cases of women who died without access to care restricted by a state abortion ban. Before those stories, the state Department of Public Health had released the names of committee members to ProPublica. Now it’s saying that releasing the names would be a violation of state law.

The law states that the work of the committee is confidential and that some records and reports obtained and created by the committee are not covered by public records laws. The law does not state that committee members’ identities are confidential. However, Department of Public Health spokesperson Nancy Nydam said the department’s review of the law “determined that the broad confidentiality protections directed toward the committee should be extended to the identities of the committee members.” She did not respond to questions about why the department could share committee members’ names in August but not now.

The newly appointed committee, which reviews maternal deaths and makes recommendations to improve care for pregnant women, held its first meeting Feb. 21.

If the public doesn’t know who is on a committee, it could create mistrust of its findings, said Elizabeth Dawes, director of maternal and reproductive health at the Century Foundation, a public-policy nonprofit. She has been an advocate for Black mothers, who die from causes related to pregnancy or birth at higher rates than other groups.

“If everything is confidential, there’s no way to really be able to trust what comes out of it,” Dawes said. “They could completely ignore abortion. They could completely ignore race, racism, discrimination, and say what they want to say.”

Dawes said those questions are particularly important in Georgia. The state has one of the nation’s highest rates of maternal death, especially among Black women, who die at twice the rate of white women.

The stories of Thurman and Miller sparked widespread outrage about the effects of abortion bans; Georgia law bans the procedure after six weeks.

Thurman, who traveled to North Carolina and obtained abortion pills, died from sepsis after doctors in Georgia delayed the removal of infected tissue that remained in her uterus. Her case, and others identified in Georgia and Texas, show the dangers women face in states that force hospitals and doctors to weigh criminal laws against abortion before providing care.

Less than two months after ProPublica published the stories, the commissioner of the Georgia Department of Public Health, Dr. Kathleen Toomey, sent a Nov. 8 letter to all members of the committee stating that information had been inappropriately shared with an outside source.

“Even though this disclosure was investigated, the investigation was unable to uncover which individual(s) disclosed confidential information,” Toomey wrote. “Therefore, effective immediately the current MMRC is disbanded, and all member seats will be filled through a new application process.”

That application process ended earlier this year. The Department of Public Health denied ProPublica’s Open Records Act request for the names of new members on Feb. 27, three weeks after the request was made. In a response, a staff member said 30 people had been appointed to the board and attached language from a letter inviting new members to the committee’s first meeting on Feb. 21.

All 50 states, as well as other localities, have maternal mortality review committees. They examine the deaths of pregnant women and new mothers to identify gaps in care and provide recommendations to improve treatment. ProPublica recently found that the names of committee members in 18 states with abortion restrictionswere publicly available, or accessible through a public records request.

Recently, some states have come under fire for allegedly politicizing the work of these committees.

The maternal mortality review committee in Idaho was allowed to go dormant in 2023 after conservative groups attacked its recommendation to expand Medicaid for postpartum women. The state has since revived the committee as an advisory body to the State Board of Medicine.

Also in 2023, Texas lawmakers changed the composition of the state’s committee more than a year after a member spoke out about a delay in releasing a report. She lost her seat. Officials later appointed an anti-abortion obstetrician, Dr. Ingrid Skop, to the group. The Texas MMRC is also not reviewing deaths from 2022 or 2023, a period covering the first year and a half after Roe v. Wade was overturned.

In the letter last year dismissing the members of Georgia’s committee, Toomey wrote that the shake-up of the board would not delay its work. Nydam said in February that Department of Public Health staff members have continued their work while the committee has been inactive.

The work of the MMRC has not stopped,” Nydam wrote in an email. “It has continued with our staff doing case abstractions, which they do regardless, before the cases go to the MMRC.”

However, a person familiar with the committee’s work, who because of her continuing work with the Department of Public Health asked not to be named, said the full committee usually met every other month. Subcommittees met even more frequently to review cases.

“There’s no way there’s not going to be a delay unless they are going to meet every week,” she said.

The Georgia MMRC was beginning to identify deaths from 2023 when all members were dismissed.

Kavitha Surana and Cassandra Jamarillo contributed reporting. Mariam Elba contributed research.

How community programs are working to ease New York’s maternal health crisis

2025-02-25T14:13:31+00:00

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As New York City confronts a self-diagnosed maternal health crisis, community organizations are offering at-home support for new and expecting parents, including mental health care.

Demand for the services has increased since the start of the Covid-19 pandemic, but funding remains a concern. And while every birth story is different, there is a common theme for many: inequities.

About two dozen New Yorkers die related to pregnancy or childbirth in New York City each year. Three in four Black maternal deaths are ruled as preventable by the health department’s Maternal Mortality Review Committee. For white women, it’s about half, said Dr. Michelle Morse, acting commissioner of the Department of Health and Mental Hygiene.

“We’re concerned about the magnitude of the inequity here in New York City,” Morse told Healthbeat. “Somehow we are selectively choosing to save the lives of some women over others. We need to look at what is driving that.”

While most birthing experiences in New York City are healthy, Black women are nine times more likely than white women to die during pregnancy or childbirth, according to the mayor’s office. While this disparity can change slightly depending on when it’s measured and with what reference point, nationally, the disparity is lower, at about three times more likely, according to the Centers for Disease Control and Prevention. Hispanic women in New York City are three times more likely than non-Hispanic white women to die of a cause related to pregnancy or childbirth.

‘Equity and stability’: An interview with Dr. Michelle Morse, NYC’s acting health commissioner

Pregnancy-related deaths, many of which are preventable, have become a priority for the New York City Council. Suicide and overdose are the leading causes, Morse said.

“We need to do an even better job screening for substance use and mental health issues, including risks for suicide, looking at perinatal mental health and anxiety disorder,” she said.

While leaders of community-based maternal health organizations agree that the mental stress that accompanies pregnancy – and the taboo of talking about it – is a top worry, birth emergencies are also a persistent concern.

Woodhull Medical Center is an NYC Health + Hospitals facility between Brooklyn’s Bedford-Stuyvesant and Bushwick neighborhoods.

In September, a pregnant woman who emigrated from Latin America six years ago arrived at Brooklyn’s Woodhull Medical Center, one of 11 city-run public hospitals. Bevorlin Garcia Barrios, 24, arrived at the hospital with nausea and stomach pain. She was sent home. Three days later, she was back, this time to deliver her baby. A day after being admitted, she died following an emergency C-section. She was the third woman to die during childbirth at the hospital since 2020.

City increases access to doulas and midwives

Numerous community-based organizations and city programs offer health support to eligible expecting parents. In December, for the first time, the city funded a $1.5 million guaranteed income program for 161 pregnant women experiencing homelessness.

In recent years, the city and state of New York have increased access to programs that provide at-home care, such as midwives, who provide medical birthing support, and doulas, who provide non-medical support.

The Brooklyn Communities Collaborative, a health equity nonprofit, recently awarded nearly $1 million in grants to 10 community-based organizations that offer a range of maternal health services, from mental health and community outreach to providing diapers and paternal and grandparent education for low-income families.

Around the same time Barrios arrived in New York, a Venezuelan woman moved to the city. Nearly six years later, in 2024, she was also pregnant.

Nervously nearing her unexpected due date, with no family in the city, the Brooklyn resident and paralegal found herself in one of New York’s Presbyterian hospitals. Feeling alone in the pregnancy, she was asked if she’d like a doula.

Leigh Bearden, a registered nurse specializing in maternal child health through New York City’s Medicaid-eligible Nurse-Family Partnership program, helps clients navigate pregnancy.

“What is a doula?” she wondered, recalling the experience for Healthbeat, requesting her identity be withheld over fears about her immigration status.

The woman was partnered with Leigh Bearden, a registered nurse specializing in maternal child health through the city’s Medicaid-eligible Nurse-Family Partnership program. The RN helped ease her anxieties, and she gave birth to a healthy boy.

Bearden was like a therapist, a doula, and a second mom. Eleven months after giving birth, Bearden still meets with her regularly. On a January afternoon, she fielded questions about the normal struggles of finding daycare and returning to work.

New York City tries cash transfers as a way to improve the health of homeless moms

“A person who is pregnant,” Bearden’s client said, “you need economic support, that’s true, but you need emotional and mental support because being pregnant is a process.”

The woman’s experience going from feeling isolated and ill-equipped for an unexpected pregnancy to a successful hospital birth and raising a toddler shows what the city’s programs are intended to do.

Access to health care key factor in maternal mortality

“Most births occur in hospitals,” said Deborah Kaplan, a former assistant commissioner in the city’s Bureau of Maternal, Infant and Reproductive Health. “Hospitals are not the best places to give birth for most people, but birth has been fully medicalized.”

An increased scrutiny of hospital births led the city to launch a doula initiative in 2022, providing free services through Medicaid. The city’s New Family Home Visits programs, which includes NFP and the doula initiative, served nearly 20,000 Medicaid-eligible families since 2022, including about 9,500 in 2024, according to the health department.

City-run services fill up and face financing and staffing complications. Through Medicaid, some programs like NFP have an income requirement.

Research suggests New York City’s maternal health disparity is mostly independent of socioeconomic status, a frequent misconception. It is actually linked to structural racism, policy decisions, and access to healthcare.

Kaplan, who teaches about the context of race in maternal health at the CUNY Graduate School of Public Health, says expanding Medicaid access to doulas isn’t enough. The city, she says, needs to diversify the staffing of such programs so that at-home providers are more representative of the people they serve.

Along with city council members, current and former health department officials like Kaplan and Morse praise community-based organizations for their maternal health work.

The Alex House Project, which recently opened a new office in Brooklyn’s Boerum Hill neighborhood, saw a two-fold jump in demand for its maternal health services during the Covid-19 pandemic.

The Alex House Project, a Boerum Hill-based organization, received over $150,000 from the BCC grant. Demand for the small team’s services have doubled to nearly 150 mothers or expecting parents since the start of the pandemic.

Samora Coles, AHP’s founder and executive director, said that public figures’ conversation on the issue helps drive progress. But organizations like hers that are trying to create their own resource pipeline through grants and donors independent of the city, need more resources, she says.

“We know what to do, but there is not both the political will, the long-term leadership you need, and the resources,” Kaplan said. “We’re nowhere close to investing what needs to be invested in what would truly shift things.”

The health department’s 2025 budget is $140 million less than its 2024 budget of $2.1 billion, with the difference mostly in the family and child health and disease prevention and treatment programs. The city’s hospital system’s 2024 budget was $174 million less than in 2023.

Much of the city’s public health spending comes from the federal government, and President Donald Trump has vowed deep cuts to health and other agencies.

Owen Racer is a freelance writer for Healthbeat, based in New York.

Georgia lawmakers tackle public health proposals amid federal funding uncertainty

2025-01-30T17:55:24+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

More expectant parents could qualify for home health care support, community health workers could get professional certification, and immigrant doctors could find an easier path to practicing in Georgia under proposals being considered by state legislators.

As the Georgia General Assembly session gets underway, bills are expected to address a number of public health policies and set the state’s spending plan.

Chaos at the federal level, as President Donald Trump takes office with moves to cut spending, are injecting uncertainty into the state’s budget process, health agency leaders said during a hearing this week.

Georgia Public Health Commissioner Kathleen Toomey said her agency gets about half its funds from the federal government. Federal funds support the Women, Infants and Children nutrition program, for example, as well as other maternal and child health, and HIV care programs.

Here are some of the public health proposals being considered in the legislative session, which runs through early April. These measures must get approval from a committee and then pass a floor vote in the chamber where they originated before “crossover day” on March 6 in order to move ahead.

Certification could improve training for community health workers

A community health worker helps facilitate care for people in their own community. They educate people about health issues and connect patients to resources.

A broad coalition of advocacy groups want the state to create a formal certification process for community health workers, and they’re optimistic the measure will pass, said Natasha Taylor, deputy director of Georgia Watch, a nonprofit consumer advocacy group.

The purpose is to regularize training for community health workers, and it could have both health and economic benefits, Taylor said. She called the certification program “a game-changer for workforce development.”

“By equipping CHWs with the skills and recognition they need, we are fostering career growth while strengthening the health and well-being of communities across the state,” Taylor said.

East Point’s ‘Miss Morehouse’ works to build trust as community health worker

Taylor also wants to see Medicaid reimburse community health workers but says she and her allies are first focused on getting the certification legislation passed.

The measure has crucial Republican support, and a similar bill last year gained Senate committee approval but stalled before a floor vote.

“We need to look at the use of community health care workers also as a new area, a new idea. I think that can be beneficial,” Rep. Darlene Taylor, R-Thomasville, the chairwoman of the House Health appropriations subcommittee, said at a health policy event earlier this month.

Licensing reforms seek to address doctor shortage

Georgia’s doctor shortage could be ameliorated by legislation making it easier for foreign-trained doctors to practice here.

Sen. Kim Jackson, D-Stone Mountain, last year sponsored a bill that would allow foreign-credentialed doctors who have met American medical standards to train at licensed health care centers and eventually apply to work in medically underserved communities.

Jackson plans to reintroduce the measure and said it has “very strong bipartisan support.”

Georgia has a doctor shortage. Barriers to training keep immigrant physicians from filling the gap.

“I have physicians right now, today, who are driving DoorDash, people who worked in their country, who perhaps even cared for our soldiers, who are not able to get licensed right now because we don’t have a pathway,” Jackson said.

Other states have adopted similar measures, and advocates of the proposal say that allowing immigrant physicians to practice in Georgia would help the state provide culturally and linguistically competent care to its diverse population.

DPH seeks to expand support for expectant parents

Some leaders want to expand a program to provide home visits to expecting and new parents to reduce maternal mortality and improve birth outcomes.

Since its launch in October 2023, the program has expanded to 50 counties. This year Gov. Brian Kemp and the Department of Public Health are requesting an additional $3 million to expand it to 75 counties.

The program targets women at risk for poor pregnancy outcomes, Diane Durrence, director of the Women, Children, and Nursing Services Division at DPH, said during a January DPH board meeting. Doctors, hospitals, and others can refer women to the program.

The home visits include physical and mental checks for women and infants, education about topics like safe sleep, and referrals to needed resources.

The program has served about 520 patients, with over 2,000 home visits completed, Durrence said. It employs about 39 home visiting staff.

Certification for ‘recovery residences’ among opioid, drug use bills

Several bills are expected that aim to help people with opioid and other substance use disorders, said Jeff Breedlove of the Georgia Council for Recovery.

Sen. Randy Robertson, R-Cataula, is expected to introduce a bill that would require certification for “recovery residences.” He introduced a similar bill in 2023 that did not advance.

Recovery residences would need to be inspected at least once every other year and would have to correct identified deficiencies.

Georgia trust awards first $70 million of opioid settlements

“Unfortunately, there are bad actors, and so the Georgia Council for Recovery and the Georgia Association of Recovery Residences are working to make sure there’s legal safeguards in state law,” Breedlove said. “Those bad actors have got to face severe legal consequences when they exploit somebody in crisis.”

Sen. Kay Kirkpatrick, R-Marietta, wants to expand Georgians’ ability to test street drugs for dangerous additives. A 2023 reform made it clear that testing strips for fentanyl and other synthetic opioids do not fall under Georgia’s ban on drug paraphernalia. Kirkpatrick’s bill goes further, ensuring that Georgians can also test for non-opioid adulterants like Xyaline, a veterinary sedative found in illegal drugs.

Breedlove also wants to see legislators create a system for educating “life care specialists,” people who help patients in hospitals learn about and manage pain. That was the top recommendation of last year’s House study committee focused on alternatives to opioids for pain management.

“This exciting concept of expanding the presence of the peer voice during a crisis situation in the hospital - it’s going to save lives, and it’s going to save money, and it’s going to make Georgia a stronger place, medically,” Breedlove said.

Public health budget plan steady, but federal cuts could hurt

DPH’s $900 million budget pays for a wide range of services, from county health department operations to immunizations to vital records management.

Next year’s budget proposals would keep the agency’s spending plan at about the same as this year’s, with no dramatic decreases or additions.

About half of the public health budget comes from federal sources and half from state sources.

That means federal actions, like the sunsetting of Covid relief funds, or freezes like the one the Trump administration briefly ordered this week, can have a big effect.

Most of the federal funding comes from the Department of Health and Human Services and the Department of Agriculture, which pays for the WIC program.

While DPH’s total budget has decreased since the ending of federal Covid relief funds last year, state contributions have increased over the past four years.

The state funds pay for services provided at 18 district offices and 159 county health offices across Georgia. They also cover other services like health promotion, epidemiology, immunizations, and services like restaurant and pool inspections.

Three weeks into session, the General Assembly has started the lengthy process of updating this year’s budget, called “the amended fiscal year 2025 budget” in legislative parlance, and approving next year’s spending plant for fiscal 2026. The state’s fiscal year runs from July 1 to June 30.

The revised public health budget for fiscal 2025 would include an additional $270,000 to study the impact of social media on children and adolescent mental health in Georgia.

Toomey said the request came from Kemp. The agency plans to hire an epidemiologist for the study and work with researchers at Georgia Southern University and the University of Georgia to produce a report.

Some, like Leah Chan at the Georgia Budget and Policy Institute, an Atlanta think tank, say Georgia should increase its public health spending.

Public health funding has decreased since fiscal 2012 from $92 per person to $70 per person, according to a recent report from the institute.

“What Georgia’s state Department of Public Health needs is an intentional, long-term investment that ensures we have a strong public health infrastructure that can tackle ongoing needs while protecting against future health threats,” Chan said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

New York City tries cash transfers as a way to improve the health of homeless moms

2024-12-19T16:55:02+00:00

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In 2020, Daniela DeJesus Gutierrez was barely getting by — and had a baby on the way.

As the Covid-19 pandemic raged, she’d lost most of her employment and was trapped in a harmful relationship. But a lifeline emerged: a pilot program distributing cash to 100 low-income mothers in New York City.

When the first payment arrived in 2021, Gutierrez cried. And the support kept coming: $500 each month, for three years. Bolstered by newfound financial stability, Gutierrez was able to care for her newborn, leave her partner, and eventually find a new job.

“I was able to just go anywhere I wanted to go, and buy whatever food I wanted to get for my kid,” said Gutierrez, now 31, who lives in Central Harlem. “When he was sick, if I needed to get medicine and the insurance didn’t cover it, I could buy it.”

Last week, the New York City Council launched a new version of the initiative, with $1.5 million in city funds. The program, run through The Bridge Project organization, will provide unconditional cash support to 161 pregnant women who are homeless, at risk of losing housing, or facing domestic violence. Participants will receive a $2,500 stipend before giving birth, $1,000 per month for 15 months, and $500 per month for the following 21 months.

Overdose is New York City's leading cause of pregnancy-associated death, Health Department says

It’s the first time that New York City has funded a guaranteed income program, according to local leaders, and reflects an emerging movement in the United States to alleviate poverty and improve health outcomes through the simple act of cash distribution. In recent years, guaranteed income programs have sprung up in cities like Jackson, Mississippi, Gary, Indiana, and Stockton, California, and a growing body of scientific research is exploring the impact of cash transfers on families’ health and early childhood development.

Earlier this year, Dr. Mona Hanna, a Michigan pediatrician, launched Rx Kids, which provides no-strings-attached financial support to every pregnant mother in Flint, through each baby’s first year.

“We haven’t been able to tackle a kind of root-cause pathogen, which is poverty,” Hanna said. “We increasingly know the science of what happens when you are born into, and grow up, in poverty. When it’s early, when it’s chronic and when it’s concentrated — when your neighbors are poor — it is a pathogen. It alters your entire life trajectory, especially in that prenatal, early childhood window.”

A ‘moral’ intervention from city government

New York City’s guaranteed income program is launching in a city where about 1 in 4 children live in poverty, and where more than 146,000 students experienced homelessness during the last school year, a record high. Supporters of the initiative say it’s both an anti-poverty measure and an attempt to reduce rates of maternal mortality, which disproportionately impact Black and Hispanic New Yorkers.

“We always say a budget is a moral document, and by investing in these families, we’re showing that we care about the future, and we want to make sure that everybody has the same opportunity to thrive,” said Council Member Crystal Hudson, who sponsored the bill that enabled city-backed unconditional cash assistance.

In 2021, about a quarter of the 58 people who died of pregnancy-associated mortality in New York City had experienced homelessness at some point, according to city data.

The city’s shelter system is especially difficult to navigate for pregnant women and young mothers, since shelters are often far from prenatal care and children’s schools, said Dave Giffen, the executive director of the Coalition for the Homeless. In 2023, more than 1,700 babies were born into the shelter system, according to city data obtained by Giffen’s organization.

Many people in the shelter system just need a few thousand dollars to get back on track, Giffen added. And while direct cash transfer programs are not a solution for everything, he said, they represent “a solution for a lot of people.”

“It’s the most intuitive response you can think of: somebody doesn’t have resources and money, and you give them money and their life gets better,” he said.

The Bridge Project received more than 1,000 applications for just 161 spots, said Laura Clancy, the organization’s executive director. Participants had to be at least 18 years old, city residents, at least 23 weeks pregnant, and meet the U.S. Department of Housing and Urban Development’s definition of homelessness.

Through previous cohorts of its cash transfer initiatives, The Bridge Project has tracked improvements in participants’ housing security, access to food, and ability to meet day-to-day expenses, Clancy noted. While the program does not provide full case management, it does help participants connect to other organizations and agencies, she said.

The first payment for the city’s new program went out a few weeks ago. Participants can use the funds however they want.

“There’s tremendous dignity in giving people cash and basically saying, ‘We trust you. You’re going to make good decisions,’” Clancy said.

The research behind cash transfer programs

As guaranteed income programs emerge across the country, supporters say they offer common-sense solutions to intractable social and public health issues. Many draw on research conducted throughout the world linking cash transfer programs to improved health outcomes, from fewer preterm births to lower rates of postpartum depression.

Hanna, the pediatrician — who helped expose Flint’s water crisis a decade ago — said she was inspired to create Rx Kids, in part, by the success of the expanded Child Tax Credit, which cut child poverty in half in 2021.

In Flint, Rx Kids has “prescribed” more than $5 million to more than 1,200 mothers and babies this year, Hanna said. Program participants have reported expanded access to prenatal care, decreased postpartum depression, improved food satisfaction — and no evictions. The program, funded through a public-private partnership, will soon expand to other parts of Michigan, Hanna said.

An article published last year in Nature found that large-scale, government-led cash transfer programs in low- and middle-income countries worldwide were associated with “significant reductions” in mortality among women and children under age 5.

In an interview, lead author Dr. Aaron Richterman, an assistant professor of medicine in the Division of Infectious Diseases at the Hospital of the University of Pennsylvania, noted that the cash transfer initiatives that have emerged in America, like New York City’s effort, are far smaller than the large-scale programs his team studied.

“People are trying to figure out, how do these kinds of things fit in, and do they work, and what do they work to do?” Richterman said. “There are some very entrenched issues in the U.S., and I think it’s an open question how a program like this is really going to be able to fight against these sort of structural issues that people are exposed to for their entire lifetime, in terms of our food environment, or racial segregation.”

Gutierrez, for her part, isn’t sure how she would have survived those difficult years of early parenthood without regular cash infusions.

Unpaid utility bills didn’t weigh on her, she said, and she could obtain the early intervention she needed for her son, who has autism. Her self-confidence increased because she wasn’t “so suffocated.”

“I had that financial stability,” she said. “Honestly, those $500 stretched a long way. Now, I’m actually feeling it, because it’s not there anymore.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

How New York is addressing health disparities in pregnancy-associated deaths

2024-12-18T12:00:00+00:00

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Last month, the March of Dimes released its annual report on maternal and infant health in the United States. New York did not score well — a C+ in preterm births, with almost 1 in 10 babies in New York born preterm.

And it’s not just the health of the babies scoring low. Maternal mortality is a huge problem. Two to three women die of pregnancy-associated factors each week in New York, on average. The majority of these deaths are preventable.

Let’s dig into the data to understand how New York is addressing this crisis.

How do we know these stats? All pregnancy-associated deaths are reviewed in New York.

In 2019, New York passed a law requiring all pregnancy-associated deaths to be thoroughly reviewed. Two maternal mortality review boards were formed — one for New York City and one for the rest of the state.

For each pregnancy-associated death, the boards assess preventability, underlying causes, and contributing factors, and then submit a report every other year to identify where and how we must make changes. The most recent reports were released earlier in 2024 using data from 2018-20 (our most recent data).

Maternal mortality in New York state is lower than the national average but still high.

The United States has the highest maternal mortality of all other high-income countries and is one of the only countries where it has risen since 2000. There are also tremendous disparities as to who is most at risk — Black women in the United States die at more than double the rate of white women. Maternal mortality is a public health crisis.

In 2010, New York ranked 46th of 50 states for maternal mortality — meaning New York had some of the highest maternal deaths. In the most recent report, New York is down to 15th.

The reports show that from 2018 to 2020, there were 386 pregnancy-associated deaths in New York. While maternal mortality in New York state has remained relatively stable, significant progress has been made in New York City. Still, we have a long way to go to reach the Healthy People 2030 goal of getting down to 15.7 deaths per 100,000 live births. (For comparison, the U.S. maternal mortality ratio is more than 1.5 times higher than in the United Kingdom — 20.4 vs 13.4 per 100,000 live births.)

Three-year rolling average maternal mortality for New York state (including New York City; red), New York City (green), the rest of the state (excluding New York City; purple), and nationwide (blue).

In New York, the risk is not uniform.

Black women in New York are five times more likely to die when pregnant (or soon after delivery) compared with white women.

Pregnancy-related mortality ratios by race and ethnicity in New York.

Disparities are also seen in infant health. The infant mortality rate for babies born to Black mothers is 2.4 times the average New York state rate.

Infant mortality rates by race and ethnicity in New York.

There has been little improvement in these gaps over the past two decades. Mortality for Black pregnant women in New York has consistently remained higher than the national average for Black pregnant women.

Annual maternal mortality for Black and white women. Colors correspond to Black women in New York (orange), white women in New York (purple), Black women in the U.S. (red), and white women in the U.S. (blue).

There are also stark disparities based on where pregnant women live in New York. Maternal vulnerability (a mom’s risk of poor health outcomes during pregnancy) is highest in the Bronx, Orleans, Cattaraugus, and Chautauqua counties.

Maternal vulnerability by county in New York.

What is causing these high mortality rates, and why are there such substantial disparities?

Bleeding, strokes (embolism), and mental health conditions (including overdoses) are the leading medical causes.

Overdose has recently emerged as a leading cause of pregnancy-associated death. From 2016 to 2020, 14% of pregnancy-associated deaths in New York City were due to overdose, with the vast majority involving an opioid. For context, around 4% of deaths in New York state are due to overdose.

Chronic health conditions are also significant risk factors for poor maternal health outcomes and preterm delivery. Nationally, women with diabetes had a preterm birth rate of 28.8%, and women who had high blood pressure had a similar rate (23.3%).

Discrimination was a probable or definite circumstance for 47.1% of pregnancy-related deaths in New York. This includes the following:

Structural and systemic discrimination, like how care and services are harder to access for people living in low-income communities
Individual discrimination, like not taking patient complaints seriously or dismissing them as normal discomfort due to race, gender, education status, income status, etc.

What is being done to address the maternal mortality crisis in New York?

Public health efforts have to be hyper-focused and evidence-based:

Ensure access to doulas. Doulas are professional perinatal coaches who support pregnant people one-on-one and have been shown to improve pregnancy outcomes. Anyone enrolled in New York State Medicaid can receive doula services at no cost during pregnancy and up to 12 months after, regardless of pregnancy outcome. More information and a doula directory are available here.
Plans of Safe Care to support moms, babies, and families affected by substance use. After screening for substance use and mental health conditions, federal law requires that providers develop personalized plans to identify how a provider, family, and community can support the safety and well-being of the baby and mom. These plans address basic needs, identify support systems, and connect moms to their needed resources. More information on safe care plans is available here.

Gov. Kathy Hochul recently signed legislation to expand coverage and make care more affordable in New York state during and after pregnancy. The new laws include the following:

Permit pregnant women to enroll in health insurance policies at any time without any extra charges or fees. (Before, companies could charge fees for enrolling due to pregnancy.) Resources are available here.
Require commercial health insurers in New York to cover prenatal vitamins when a health care provider prescribes them.
Offer paid prenatal care leave starting Jan. 1, 2025, in New York. More information is available here.

Are these initiatives working?

It’s hard to tell. The data give mixed signals. On one hand, New York has improved its maternal mortality rankings in recent years. On the other hand, the Centers for Disease Control and Prevention estimated that maternal deaths in New York increased by 33% during the pandemic. Many initiatives are just beginning, so time will tell how effective they are.

Bottom line

The health of a health system can be measured by how well it cares for expecting moms. Maternal deaths have profound ripple effects on families and communities and provide an important window into broader health disparities. The loss of any expecting or new mother is a tragedy. We have a lot of work to do to keep our New York mothers and babies safe.

Love,

Your Local Epidemiologist

Dr. Marisa Donnelly, a senior epidemiologist with wastewater monitoring company Biobot Analytics, has worked in applied public health for over a decade, specializing in infectious diseases and emerging public health threats. She holds a PhD in epidemiology and has led multiple outbreak investigations, including at the California Department of Public Health and as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Marisa has conducted research in Peru, focusing on dengue and Zika viruses and the mosquitoes that spread them. She is Healthbeat’s contributing epidemiologist for New York in partnership with Your Local Epidemiologist, a Healthbeat supporter. She lives in New York City. Marisa can be reached at mdonnelly@healthbeat.org.

Overdose is New York City’s leading cause of pregnancy-associated death, Health Department says

2024-12-16T21:49:30+00:00

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Overdose is the leading cause of pregnancy-associated death in New York City, the Department of Health and Mental Hygiene alerted health care providers in an advisory letter on Friday.

Overdoses accounted for 20 out of the city’s 58 total pregnancy-associated deaths (34.5%) in 2021, according to the most recently available city data. Of those 20 overdose deaths, 16 involved an opioid. Infection, cancer, hemorrhage, and seizure disorders were among the less common causes of death.

The Health Department defines a pregnancy-associated death as a death from any cause during pregnancy or within one year from the end of pregnancy. The department has conducted surveillance of those deaths since 2001, releasing annual data, as well as five-year reports from the Maternal Mortality Review Committee.

The city’s 2021 data reflect a significant increase from the nine pregnancy-associated deaths related to overdose reported in 2020 — and a jump in comparison to longer-term trends. From 2016 to 2020, 34 of the city’s 241 pregnancy-associated deaths (14.1%) were due to overdose, according to a Maternal Mortality Review Committee report published this fall.

The recent rise in overdose-related maternal deaths sits at the intersection of two of the city’s persistent public health challenges — maternal mortality and the opioid epidemic — and the racial disparities within both. The city’s maternal health crisis, which disproportionately impacts Black women, has become a top priority for the New York City Council. Meanwhile, recent data show that the overdose epidemic has started to stabilize in the city, but overdose deaths continue, particularly among non-white New Yorkers.

In 2021, Black non-Hispanic and Hispanic birthing parents accounted for the highest proportions of the city’s pregnancy-associated deaths (39.7% and 36.2%, respectively), while accounting for only 17.7% and 28.9%, respectively, of live births, according to city data.

Acting Health Commissioner Dr. Michelle Morse and two of her deputy commissioners said in the advisory letter that the city’s recent maternal mortality data should “serve as a call to action for all providers to play a role in reducing the risk of overdose among New Yorkers, especially for pregnant and postpartum people where the majority of these deaths are preventable.”

The officials attributed the increase in overdose-related pregnancy-associated deaths to increased isolation during the height of the Covid-19 pandemic and an influx of fentanyl in the drug supply in recent years.

The Health Department aims to achieve a 10% reduction in maternal death rates by 2030, through increased access to health care, social support, and sexual and reproductive health care, according to HealthyNYC, the department’s framework for improving life expectancy. Black women are four times more likely than White women to die from pregnancy-associated causes, according to the Health Department.

Morse and the other officials urged providers to screen for substance use, substance use disorders, and co-morbid mental health conditions, and to talk with patients who are pregnant and have opioid use disorder about initiating buprenorphine or methadone as soon as possible. The officials also advised continuing to screen patients for substance use throughout the postpartum period.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Georgia dismissed all members of maternal mortality committee after ProPublica obtained internal details of 2 deaths

2024-11-22T14:28:27+00:00

This story was originally published by ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive their biggest stories as soon as they’re published.

Georgia officials have dismissed all members of a state committee charged with investigating deaths of pregnant women. The move came in response to ProPublica having obtained internal reports detailing two deaths.

ProPublica reported in September on the deaths of Amber Thurman and Candi Miller, which the state maternal mortality review committee had determined were preventable. They were the first reported cases of women who died without access to care restricted by a state abortion ban, and they unleashed a torrent of outrage over the fatal consequences of such laws. The women’s stories became a central discussion in the presidential campaign and ballot initiatives involving abortion access in 10 states.

“Confidential information provided to the Maternal Mortality Review Committee was inappropriately shared with outside individuals,” Dr. Kathleen Toomey, commissioner of the state Department of Public Health, wrote in a letter dated Nov. 8 and addressed to members of the committee. “Even though this disclosure was investigated, the investigation was unable to uncover which individual(s) disclosed confidential information.

“Therefore, effective immediately the current MMRC is disbanded, and all member seats will be filled through a new application process.”

A health department spokesperson declined to comment on the decision to dismiss the committee, saying that the letter, which the department provided to ProPublica, “speaks for itself.” Georgia Gov. Brian Kemp’s office also declined to comment, referring questions to the health department.

Under Georgia law, the work of the maternal mortality review committee is confidential, and members must sign confidentiality agreements. Those members see only summaries of medical records stripped of personal details, and their findings on individual cases are not supposed to be shared with the public — not even with hospitals or with family members of women who died.

The health department’s letter states that there could be new steps to keep the board’s deliberations from public view. The letter said officials might change “other procedures for on-boarding committee members better ensuring confidentiality, committee oversight and MMRC organizational structure.”

Maternal mortality review committees exist in every state. They are tasked with examining deaths of women during a pregnancy or up to a year after and determining whether they could have been prevented.

Georgia’s had 32 standing members from a variety of backgrounds, including OB-GYNs, cardiologists, mental health care providers, a medical examiner, health policy experts, and community advocates. They are volunteer positions that pay a small honorarium.

Their job is to collect data and make recommendations aimed at combatting systemic issues that could help reduce deaths and publish them in reports. The Georgia committee’s most recent report found that of 113 pregnancy-related deaths from 2018 through 2020, 101 had at least some chance of being prevented. Its recommendations have led to changes in hospital care to improve the response to emergencies during labor and delivery and to new programs to increase access to psychiatric treatment.

The health department’s letter states that the “change to the current committee will not result in a delay in the MMRC’s responsibilities.” But at least one other state has experienced a lag as a result of reshaping its committee. Idaho let its maternal mortality review committee legislation expire in July 2023, effectively disbanding the committee after lobbyist groups attacked members for recommending that the state expand Medicaid for postpartum women. Earlier this year, Idaho’s Legislature re-established the committee, but new members weren’t announced until Nov. 15. There is now more than a yearlong delay in the review process.

Reproductive rights advocates say Georgia’s decision to dismiss and restructure its committee also could have a chilling effect on the committee’s work, potentially dissuading its members from delving as deeply as they have into the circumstances of pregnant women’s deaths if it could be politically sensitive.

“They did what they were supposed to do. This is why we need them,” said Monica Simpson, executive director of SisterSong, one of the groups challenging Georgia’s abortion ban in court. “To have this abrupt disbandment, my concern is what we are going to lose in the process, in terms of time and data?”

Committee considered details of Candi Miller’s death

One objective of any maternal mortality review committee is to look at the circumstances of a death holistically to identify root causes that may be able to help other women in the future.

In the case of Candi Miller, the most prominent detail in a state medical examiner’s report of her death was that she had a lethal combination of painkillers in her system, including fentanyl. It attributed the cause of death to drug intoxication.

But the Georgia committee looked at the facts of the death with a different objective: to consider the broader context. A summary of Miller’s case prepared for the committee, drawn from hospital records and the medical examiner’s report, included that Miller had multiple health conditions that can be exacerbated by pregnancy, that she had ordered abortion pills from overseas, and that she had unexpelled fetal tissue, which showed the abortion had not fully completed. It also stated that her family had told the coroner she didn’t visit a doctor “due to the current legislation on pregnancies and abortions.”

The committee found her death was “preventable” and blamed the state’s abortion ban.

“The fact that she felt that she had to make these decisions, that she didn’t have adequate choices here in Georgia, we felt that definitely influenced her case,” one committee member told ProPublica in September. “She’s absolutely responding to this legislation.”

For Miller’s family, the committee’s findings were painful but wanted. “It seems like that is essential information that you would share with the family,” said Miller’s sister, Turiya Tomlin-Randall, who was not aware of the committee’s work until ProPublica contacted her.

She also said it’s upsetting to hear that the committee’s members were dismissed partly as a result of her sister’s case being disclosed to the public. “I don’t understand how this is even possible,” she said.

The committee also investigated the case of Amber Thurman, who died just one month after Georgia’s six-week abortion law went into effect. The medical examiner’s report stated that Thurman died of “sepsis” and “retained products of conception” and that she had received a dilation and curettage, or D&C, and a hysterectomy after an at-home abortion.

When the committee members received a summary of her hospital stay, they saw a timeline with additional factors: The hospital had delayed providing a D&C — a routine procedure to clear fetal tissue from the uterus — for 20 hours, which Thurman needed for rare complications she’d developed after taking abortion medication. The state had recently attached criminal penalties to performing a D&C, with few exceptions. The summary showed doctors discussed providing the D&C twice, but by the time they performed the procedure it was too late. Committee members found that there was a “good chance” Thurman’s death could have been prevented if she had received the D&C sooner.

Doctors and a nurse involved in Thurman’s care did not answer questions from ProPublica for its September story. The hospital also did not respond to multiple requests for comment.

Thurman’s family also told ProPublica they had wanted the information about her death disclosed.

Idaho and Texas shift policies

Some experts say that keeping the reports of maternal mortality review committees confidential is important for a committee to serve its purpose. They are set up not to assign blame but instead to create a space for clinicians to investigate broad causes of maternal health failures. But others say the lack of transparency can serve to obscure the biggest disruption to maternal health care in half a century.

“We know that the reports that have come out of that committee are anonymized and synthesized in order to provide a 50,000-foot view,” said Kwajelyn Jackson, executive director of Feminist Women’s Health Center in Atlanta, which provides abortion care. “But my worry is that in an effort to protect the state, there will be less information that will be available to people who could shift their actions, shift their protocols, shift their strategies, shift their behaviors in order to make a difference in maternal health outcomes.”

Two states did make shifts to their committees — Idaho, after members made a recommendation to expand Medicaid that Republicans opposed, and Texas, after a member publicly criticized the state.

In 2022, Texas committee member Nakeenya Wilson, a community advocate, spoke out against the state’s decision to delay the release of its report during an election year. The following year, the Legislature passed a law that created a second community advocate position on the committee, redefined the position and had Wilson reapply. She was not reappointed. The state instead filled one of the slots with a prominent anti-abortion activist.

Wilson said Georgia’s decision to dismiss its committee could cause greater harm.

“What message is being said to the families who lost their loved ones?” she said. “There’s going to be even less accountability for this to not happen again.”

Ziva Branstetter, Kavitha Surana, Cassandra Jaramillo and Anna Barry-Jester contributed reporting. Doris Burke contributed research.

Report on Georgia Latinos: Legal status and language among barriers to health

2024-11-20T01:19:25+00:00

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Latinos, who make up at least 11% of the state’s population, face serious barriers to health care, especially mental health services, according to the State of the Latino Community in Georgia report released Tuesday.

“Immigration is a social determinant of health,” according to the report, which cited immigration status, transportation, and language among the challenges in gaining access to care.

In 2022, 58% of the about 1 million Latinos in Georgia were born in the United States, and that share is increasing.

Community leaders discussed the report at the 10th annual Latino Summit in Norcross. The report was sponsored by a group of community organizations led by the Latino Community Foundation of Georgia and Ser Familia, a nonprofit organization that provides social services.

The report combines quantitative data from the U.S. Census Bureau and the Georgia Department of Public Health with individual stories and insights from Latinos in the state. Data in the report is limited with a lack of statistics disaggregated by race and the difficulty of counting undocumented immigrants.

The report covers a host of issues, from economic development to the arts. Here are five takeaways related to public health.

1. Immigration fears affect access to health system

About 350,000 of Georgia’s 1 million Latinos are undocumented immigrants, according to the report, but concerns about immigration status and deportation are widespread, said Belisa Urbina, CEO of Ser Familia.

Latinos often live in “mixed status” families or are otherwise fearful of being tracked. That prevents them from applying for government services, said Nikolai Elneser, the community impact officer at nonprofit Neighborhood Nexus.

Close to 15% of Latino children lack health insurance, more than double the 7% of Georgia children across all groups.

At Tuesday’s summit, Gilda Pedraza, executive director of the Latino Community Fund of Georgia, called on the state government to expand Medicaid to include all people, even if they are undocumented.

Not having a driver’s license makes it harder for some to get to and from doctor’s appointments in Atlanta, which has limited public transit.

2. Mental health system lacks Spanish-speaking providers

Intentional self-harm is the seventh leading cause of death among Latinos in Georgia. Latinos are the only group for which self-harm is in the top 10 causes of death, according to the report.

“We see about 1,500 minors a year in services, group and individual therapy, and two-thirds of them present [with] suicidal ideation. … This is very alarming,” Urbina said at the summit.

Some Latinos are reluctant to turn to psychiatric medications for cultural reasons, according to the report, but may trust a provider who takes the time to thoroughly discuss medication.

Parents are especially eager to get services for their children, but have trouble finding Spanish-speaking providers and getting appointments when they are not working, Elneser said.

“We have a tremendous disparity between the people that need the services and the available services that are linguistically relevant,” Urbina said.

Georgia’s certification requirements for foreign health professionals, including mental health workers, are too cumbersome, she said.

She estimates there are 100 fully licensed mental health providers who speak Spanish in the state and maybe only one Spanish-speaking psychiatrist. Her organization will soon hire a Spanish-speaking psychiatric nurse practitioner.

While many Latinos are proficient in English, people want to access services in their own languages, Urbina said. It’s especially important when discussing traumatic or sensitive topics.

Children face particular stresses, including the need to serve as interpreters for their family while dealing with weighty issues. And Latinos in general feel a great deal of anxiety about immigration, leaders said during Tuesday’s summit.

3. Latinas getting inadequate maternal health care

Pregnant Latinas get adequate maternal care at lower rates than the general population in Georgia.

About 22% of the state’s live births are born to Latina mothers who had inadequate prenatal care, higher than the 16% rate for non-Latina mothers.

The inability to get insurance and pay for services is one major barrier, said Roxana Chicas, a professor of nursing at Emory University. They also may have difficulty taking time off work to get care during the day and not be able to get rides to clinics.

“We know that more and more Latinos are moving out into Gwinnett, Cobb and further out, and [there’s] no transportation,” Chicas said.

Women who need to change their diets – because of gestational diabetes, for example – may not get culturally competent guidance about what to eat, Elneser said.

“The healthcare system is lacking cultural competency, and sometimes it’s not a warm environment for some women,” Chicas said.

4. Heat is a public health issue

The report calls on the governments and businesses to expand protections for workers exposed to heat.

Latinos are over-represented in hazardous occupations like construction, hospitality, and farmwork, according to the report, and heat is a particular problem.

Farmworkers are far more likely to die from heatstroke than other types of workers, according to one study cited in the report. The report notes that most H-2A (temporary agricultural visa) workers in Georgia are Latino.

“Many of these workers are workers of color … that don’t have the option of not working outdoors,” said Chicas, who specializes in studying the impact of heat on worker health.

“We have a responsibility to protect these workers while they’re building our homes, while they are harvesting our foods, so that they don’t die on the job from heat stroke, which is preventable,” she said.

It’s hard to know exactly how many people have died due to heat in Georgia because no surveillance system exists, although national numbers can help indicate local trends, Chicas said. It’s hard to identify when heat causes a death. She gave the example of someone who falls due to heat stroke – that death would be counted as death due to a fall and not heat.

Protecting workers from heat is not only the right thing to do, it’s also good business, the report said.

“Safe working conditions (including heat protections) benefit both workers (less injuries and illness) and employers (less absenteeism, lower turnover rates, and disruptions of operations),” the report said.

Six states have enacted worker heat protections, according to the Natural Resources Defense Council.

Pedraza called on U.S. Sen. Jon Ossoff to support legislation providing federal heat protections.

5. Trust is key to Latino public health

Leaders emphasized that trusted health workers are key to helping Latino Georgians access health services.

While more Spanish-speaking providers are needed, that’s not the only solution. Urbina would like to see more funding for community health workers.

Her organization has one who works within the Wellstar Health System to help people access and navigate services.

Ser Familia provides group therapy, and there are other evidence-backed, culturally competent programs that social service groups can provide that require a trained, but not necessarily professionally certified, health worker.

“There’s fear of being tracked as a mixed-status family,” Elneser said. “Latino communities have a very strong preference to engage with community organizations,” rather than governmental social services.

The personal touch is key for a community skittish about accessing help, said Dianne Román. As the coordinator of the Latino Community Fund’s Ventanillas de Salud program, she helps Latinos find free, Spanish-language services.

Román makes it clear that the events she organizes are “a safe space” to try to lessen people’s concerns about being deported over their immigration status.

And she serves as a constant point of contact for people in need of help.

“It [is] something more personal, and that’s how I like to work with the community: They know who is providing the services. They can trust you,” Román said.

This story has been updated to correct Roxana Chica’s first name.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.