Traci Dancy got pregnant with her first daughter at age 30. She didn’t have diabetes, high cholesterol or any other conditions that added extra danger to her pregnancy. 

Still, she worried.

“As a person of color, I am very aware of the dangers and risks,” said Dancy, who lives in Lee’s Summit with her husband and two daughters.

Black people who give birth in the United States have a maternal mortality rate that is 2.6 times higher than white and Hispanic people. Black infants are twice as likely to die. And babies who survive are about 50% more likely to be born dangerously early.

Those are just some of the grim statistics that have rallied policy makers from the White House on down to push for changes to improve maternal mortality rates among Black Americans.

In December, Kansas City spent $250,000 on a program to improve maternal and infant health outcomes by providing free doulas to pregnant people in the city’s high-need ZIP codes. 

Both Missouri and Kansas have extended postpartum Medicaid coverage from 60 days to a full year. And Missouri’s Department of Social Services just rolled out an outreach campaign called Healthy Moms, Healthy Babies and announced that Missouri Medicaid, known as MO HealthNet, is now covering group prenatal care, a version of care that has been shown to lower the risks associated with pregnancy for Black patients.

“It doesn’t matter which side of the political aisle you’re on, people are really interested in improving maternal health,” said Ann Borders, a Chicago-area maternal health doctor who helped write a report about group prenatal care for the American College of Obstetricians and Gynecologists. “Everyone knows this is an important issue.” 

When Missouri expanded Medicaid coverage to a year after pregnancy, it became the 40th state to make the change. The American Rescue Plan included a temporary option for states to extend postpartum coverage, and federal legislation last year made the option permanent.

Traci Johnson, a maternal and fetal medicine doctor at University Health, said lives have already been saved in the four months since the state’s extension.

“I feel it,” she said, “every day.”

Before Missouri extended coverage, patients with high blood pressure, diabetes, obesity or other health concerns would have been on their own. Without insurance coverage, they would have little chance of affording follow-up visits with Johnson or another doctor. That, in turn, could jeopardize their health. 

The consequences were hard to miss. Missouri’s Pregnancy-Associated Mortality Review board, which Johnson chairs, published a report last year that found between 2018 and 2020, 210 people in the state died while pregnant or within a year of pregnancy. That included about 70 deaths each year, but a spike to 85 deaths in 2020. The ratio of Black people who died of pregnancy-related causes during the period was three times that of white people.

Maternal mortality was highest among overweight patients. The report states that 16% of people who died of pregnancy-related issues had some form of high blood pressure and 6% had gestational diabetes.

With the extension of postpartum coverage, Johnson can make sure patients get the ongoing care they need.

“I wouldn’t have been able to do that before,” she said. “I see the motivation is different when (patients) know that it’s going to be covered. Patients are keeping their appointments and making their appointments. They are taking their medications. That used to not happen.”

MO HealthNet’s recent decision to reimburse providers an additional $40 for group prenatal appointments is also a hopeful sign, Johnson said, because group programs also have real potential to help shrink the state’s maternal mortality rate. She would like to see group care like the program University Health offers in the Kansas City area as an option for every patient.

“It gets us closer to where we want to be,” Johnson said.

EleVATE, University Health’s program, started at Washington University in St. Louis and expanded to Kansas City in 2021. The program, which is part of an ongoing research study into the effectiveness of group prenatal care, couples traditional prenatal care with education and social support to help patients confront racial inequities and overcome trauma and toxic stress.

Groups of about eight participants — all at roughly the same point in their pregnancies — gather at regular intervals during their second and third trimesters. During 90-minute appointments they have individual checkups with the health care provider and then participate in group education and discussions.

Dancy, who enrolled in the 10-week program at University Health Lakewood Medical Center for her second pregnancy last year, said it was a game changer for her.

The birth of her first child — during the height of COVID — included a long, difficult labor and a failed vacuum extraction, leading to an emergency cesarean section. Although her daughter was fine, the birth experience became very stressful for Dancy and her husband.

“All of the things that you just don’t want to happen to a first-time person with no experience,” she said, “happened.” 

Thanks to the EleVATE program, her second daughter’s birth the day after Christmas was a very different story. Dancy still had a C-section, but the group prenatal care program prepared her much better to advocate for herself and her baby. 

As a Black woman, she said, that’s something she hasn’t always felt comfortable doing in a health care setting.

The midwife who led Dancy’s group taught her to ask three questions of the doctor who showed up at her delivery: Am I safe? Is my baby safe? Do we have time to discuss the options?

“Just those simple questions change your mind (to think) I’m in control of the situation and I’m on the doctor’s team,” Dancy said. By asking the questions “I’m not going against the doctor. I’m not going against the nurse. I just want to understand what’s going on.”

Aja Greer, the nurse midwife who facilitates the EleVATE program at University Health, said she wants all of her patients to have a chance to go through the group prenatal care program. Although official outcomes haven’t been released, she knows the program is making a difference. 

Of the 30 patients who have participated so far, Greer can point to only two unfavorable outcomes. One patient with a history of preterm births had an early delivery. Another, who had to miss much of the EleVATE program, was diagnosed with postpartum depression after she gave birth. 

Those aren’t results Greer would have expected from her patients in traditional prenatal care. She credits the group program with the improved outcomes, and so do her patients.

“They’re saying that they felt like they had more support,” Greer said. “They learned more about how to navigate how they felt during pregnancy, how to communicate with their partner, and how to advocate for themselves in the hospital.” 

States also look to improve Black maternal mortality rates by increasing access to doulas, the caregivers who guide and support people before, during and after childbirth. Studies show  doulas can help reduce cesarean births, preterm births and the number of underweight newborns. Some insurers already cover these services. 

Kirk Mathews, chief transformation officer with MO Healthnet, said Missouri is hoping to include doulas as enrolled Medicaid providers by the end of the year. Legislation that would clear the way has been introduced in both Missouri and Kansas.

Hakima Payne, who founded Uzazi Village, a Kansas City nonprofit working to improve birth outcomes for Black people, said she has been working for years to make doulas more available.

“The crux of my research my entire career is how do we get doulas to people who can’t afford to pay for them?” Payne said. “The research is clear that doulas improve birth outcomes.”

Sandra Thornhill, a doula who co-founded the MO KAN BIPOC Reproductive Justice Coalition, is happy to see interest in finding solutions to the maternal mortality crisis facing Black people. But she worries legislators would impose regulations on doulas that could make it harder for them to do the work they’ve been doing in the Black community for hundreds of years.

“If legislators want to be a part of valuing the work that doulas and birth workers do, I would love to see them help facilitate conversations with these insurance companies, and then say, ‘Take it away. We don’t want to try to govern or legislate the process that has been thriving on its own already,’” Thornhill said.