closeup image of pregnant woman lying in hospital bed

American Indian, Alaska Native and Black women are two to three times more likely to die from pregnancy-related complications than white women—and this disparity increases with the mother’s age.

States Taking Steps to Address Health Disparities

By Ida Cossitt-Glesner | Jan. 15, 2021 | State Legislatures Magazine

Health disparities, particularly those highlighted by COVID-19, remain a priority for lawmakers, who have moved a variety of legislation through state capitols over the last two years. Improving maternal care, addressing health provider training requirements and strengthening workforce development surfaced as topics of interest.

American Indian, Alaska Native and Black women are two to three times more likely to die from pregnancy-related complications than white women—and this disparity increases with the mother’s age. Such disparities have persisted for decades across all 50 states, regardless of maternal education levels.

Racial disparities in maternal mortality may reflect differences in access to care, quality of care and prevalence of chronic disease, as well as racial bias or unequal treatment in health care. Some legislatures, including those in Delaware and Georgia, have formally recognized these racial disparities in maternal care through legislative resolutions.

Lawmakers have also established or modified institutions to study and address racial disparities in maternal health outcomes. Illinois created the Task Force on Infant and Maternal Mortality Among African Americans. Maryland adjusted membership requirements for the state’s maternal mortality review program so that the work group is more inclusive of the women affected by maternal death. New York established state and city maternal mortality review boards and a maternal mortality and morbidity advisory council to review the cause of each maternal death. The boards also provide recommendations to prevent maternal mortality and morbidity as they relate to racial disparities. Similarly, Vermont adjusted requirements for the state’s maternal mortality review panel, stipulating that reviews must consider health disparities and social determinants of health, including race and ethnicity.

Equity in Training

Several states have integrated health equity into training programs for health workers. California required implicit bias training for all perinatal health care providers, and Michigan established that community-based residency training programs should address health disparities and local maternal and child health issues. North Carolina initiated a study to assess the ability of its health care workforce to address the needs of minority populations experiencing health disparities.

Long-standing systemic health and social disparities have put some members of racial and ethnic minority groups at increased risk of getting COVID-19 or experiencing severe illness, regardless of age, according to the Centers for Disease Control and Prevention. States are addressing coronavirus-related health disparities in a variety of ways. Massachusetts created a task force to study and make policy recommendations that address disparities for underserved or underrepresented populations and for people with disabilities during the pandemic. Pennsylvania requires COVID-19 data collecting and reporting by race and ethnicity, and a Louisiana resolution requests that the Department of Health study and report on the matter of racial disparities in the state’s COVID-19 death rates.

Just as health disparities vary across the country, states are taking unique approaches to understanding and addressing the inequities.

Ida Cossitt-Glesner is an intern in NCSL’s Health Program.

Additional Resources

This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $853,466 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.