CANTON, Mass – The 25,000-member Massachusetts Nurses Association (MNA) applauds the lawmakers and key stakeholders that have succeeded in bringing important maternal health legislation to the desk of Gov. Maura Healey. MNA nurses and healthcare professionals have long fought for solutions to inequities in the state’s maternal healthcare system that have limited patient care access and led to negative outcomes for vulnerable populations.
Legislators passed a maternal health bill on August 15. The bill expands access to midwives – licensing, regulating, and offering Medicaid coverage to certified professional midwives – and addresses an array of health concerns both during and after a child’s birth. It mandates MassHealth coverage for doulas, who provide nonmedical emotional and physical support before and after childbirth, up through a year after pregnancy, and provides certified nurse midwives with MassHealth reimbursement rates equivalent to those for physicians who provide birthing care. The bill also establishes a task force to study the availability of and access to maternal health services as well as essential service closures of inpatient maternity units and acute level birthing centers.
“MNA nurses and healthcare professionals have been advocating for solutions to our maternal health crisis for many years,” said MNA President and practicing ICU nurse Katie Murphy. “We would like to thank all of those involved for their hard work, with special gratitude to the Joint Committee on Public Health Chair, Representative Marjorie Decker, the Joint Committee on Health Care Financing Chair, Senator Cindy Friedman, Senator Liz Miranda, and so many others who have worked tirelessly on this issue.
“We look forward to building upon this foundation to ensure access to essential services like maternity care for all communities,” Murphy said. “In response to the closure of dozens of maternal and other hospital services across the state, MNA nurses and healthcare professionals have filed legislation to strengthen the state’s essential healthcare services closure law and have performed independent research on the impact of maternal healthcare deserts.”
In 2021, the MNA published a white paper titled “Massachusetts: Maternal Health Services are Central to Racial and Social Justice” identifying access to “reproductive care, including maternity and birth-related services, as essential to racial and social justice. Unfortunately, due to the state’s lack of any viable regulatory authority to protect these and other public health services, and a privatized health care system that values a market-based health care model over its mandate of ensuring the communities it serves the full spectrum of health services, including maternity care, too many families are seeing their access to these services curtailed, placing both mother and newborns at unnecessary risk, particularly those living in poorer communities and communities of color.”
The paper called for the following actions:
- A moratorium on any further closure or reduction in maternity services including midwifery services in the Commonwealth.
- Those geographic areas now suffering inadequate maternal care services need to be made whole again.
- Trial projects including birth centers, nurse midwifery programs, and doula care with funding provided by the Commonwealth. In areas approaching maternity desert status, such as North Adams and southeastern Massachusetts, a cooperative maternity hospital should be considered an option, designed with both community and provider input.
- Programs targeted to increase the diversity and cultural competency of healthcare providers.
- Updating of state laws and regulations to allow for the imposition of fines or other penalties on facilities that close services deemed “necessary for preserving and health status in a particular service area.”
- The Commonwealth should undertake a comprehensive evaluation of what maternal/child services are needed in each geographic area in order to serve the citizens of Massachusetts.
“Access to essential services has declined across the Commonwealth because our healthcare system follows a corporate, profit-driven Wall Street model and our state has limited powers to ensure patients can receive necessary care,” Murphy said. “We need to re-center patients as the most important part of our healthcare system rather than profits. We must ensure mothers and babies, people suffering from mental health or substance use issues, and all our most vulnerable residents are able to access the care they need.”
Hospital closures have become an intensive area of focus this summer due to the Steward Health Care bankruptcy and resulting fallout on patients and communities. Prior to Steward’s proposed closures, a long history of shuttered services reducing or eliminating access to essential healthcare despite DPH hearings and findings had prompted the MNA to work with its legislative partners to propose a bill that would give the DPH, Attorney General, and the public more tools to hold hospitals accountable for closures.
Maternity services have been a specific target for these closures, creating what the March of Dimes has characterized as “maternity deserts,” meaning regions where residents lack appropriate access to needed maternity care, particularly for those serving poorer communities and people of color. In 2022, a Special Legislative Commission on Racial Inequalities in Maternal Health in Massachusetts issued a report showing how racial minorities are negatively impacted by inequitable policies and practices, including lack of access to appropriate maternal care.
In the last decade, Massachusetts has seen the loss of at least 10 maternity units – including most recently Leominster Hospital maternity and the North Shore Birth Center – each of which was evaluated by DPH and deemed essential to preserving the health of those communities. Below is a map detailing those closures.
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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.
