Youngkin Tackles Maternal Health Disparities the Right Way

by James A. Bacon

Governor Glenn Youngkin has launched an initiative to address disparities in maternal healthcare outcomes, and he’s doing it right. Rather than presupposing what the problem is and what the solutions are, he is resurrecting the Task Force on Maternal Health Data Quality Measures to do a deep dive into the data to find out how outcomes can be improved.

African-American, indigenous and Hispanic women, as well as women in rural and underserved communities, suffer higher mortality rates during pregnancy and in post-childbirth. The question is why. It is commonly said that “systemic racism” is to blame. If so, then part of the solution logically entails subjecting doctors and nurses to bias training, finding physicians for pregnant women who “look like them,” and pursuing other race-based remedies.

But what if the different outcomes are more closely tied to socioeconomic status, distance from medical offices, or the patients’ own behavior?

Youngkin’s Executive Order 32 does not pre-suppose that “systemic racism” either is or is not at the root of disparate health outcomes. The directive does not mention the concept at all. Rather, the goal is simply to ensure that all pregnant women receive “essential prenatal care, including medical and nutritional support, and information and education that improve birth outcomes.”

The task force builds on other maternal- and infant-health initiatives such as participation in the Improving Maternal and Child Health in Rural America Learning Collaborative of the National Governors Association.

The task force, says the executive order, will “monitor progress and evaluate all data from state-level stakeholders, including third-party payers, and all available electronic claims data to examine quality of care with regard to race, ethnicity, and other demographic and clinical outcomes data.” The Secretary of Health and Human Services shall provide a report by December.

There are many unknowns. Do disparities exist because of differential access to the healthcare system? If so, is the problem lack of Medicaid or other medical insurance coverage? Is it a shortage of gynecologists and obstetricians? Are physicians spurning poor patients because Medicaid reimbursements are too low? Are expectant mothers missing medical appointments? If so, why? Are their lives in chaos? Do they need reminders? Do they need transportation to the doctor’s office? To what degree are poor outcomes associated with obesity, diabetes, high blood pressure, substance abuse and other co-existing conditions? Are those conditions being treated?

A rational approach to dealing with disparities in outcomes will seek to identify concrete causes and address them. “Systemic racism” is a meaningless explanation. Doctors, nurses and hospital administrators don’t need bias training. They need to know exactly where the system is falling short so they can apply targeted remedies. Youngkin’s executive order will help them do that.

Update: The Virginia Mercury reports that Youngkin’s executive order is almost identical to a bill, House Bill 781, Del. Charniele Herring, D-Alexandria, and vetoed by Youngkin. The Virginia Mercury suggests that the executive order is somewhat longer than the bill and also deletes the word “birthing person.” Herring accused Youngkin of “politicizing” the bill.


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27 responses to “Youngkin Tackles Maternal Health Disparities the Right Way”

  1. Nancy Naive Avatar
    Nancy Naive

    let’s have a task force on gun ownership, or voting, or erectile dysfunction, or vaccines, or free speech. Healthcare is a right.

    1. Marty Chapman Avatar
      Marty Chapman

      Perhaps we could have an internal Bacon's Rebellion TF on obsessive-compulsive posting. The problem is real!

      1. Nancy Naive Avatar
        Nancy Naive

        Apparently.

        1. Marty Chapman Avatar
          Marty Chapman

          Nancy, I congratulate you on your hitherto undemonstrated self- awareness.

          1. Nancy Naive Avatar
            Nancy Naive

            You should try it. They tell me that occurs before mental age 2, and all you need is a mirror. Ask mommy for one.

          2. Marty Chapman Avatar
            Marty Chapman

            There you go! I knew you could focus if properly motivated!

    2. WayneS Avatar

      Unless one believes in slavery, health care cannot be a right. It may or may not be important enough to be an entitlement – that is open for discussion – but it is not a right.

      Rights can be acted on, engaged in, and/or exercised without requiring assistance or action from another person. Free speech, free press, right to life, right to pursue happiness, right to self defense, etc.

      1. Nancy Naive Avatar
        Nancy Naive

        We are all slaves on this boat; if but just to our appetites.

        1. LarrytheG Avatar
          LarrytheG

          is that a real quote? 😉

          1. Nancy Naive Avatar
            Nancy Naive

            It’s a quip. It’ll be a quote once someone repeats it.

          2. LarrytheG Avatar
            LarrytheG

            🙂

  2. Marty Chapman Avatar
    Marty Chapman

    A blank slate, go where the data leads, approach would be a refreshing change! It is hard to achieve in State Government.

  3. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    I agree that a study or analysis should not start out with a predetermined outcome in mind. But, I don't agree that Youngkin is going about this the right way. His executive order is more of a PR piece for the "accomplishments" of his administration than anything else. And he is certainly not asking the Task Force to do a "deep dive." To get the answers to the legitimate questions you raise would take years of work by persons trained to collect and analyze health care data. Youngkin wants a report by December 1, five months from now. And the report that he asks for sounds like it would mostly a compendium of resources that are now available.

    This is all for show. If he were serious, he would he would have commissioned a study by UVa. or VCU medical schools. By "commissioned," I mean provide funding to enable the assembling of a team of highly comptent analysts to look at existing data and generate new data. Sure, that would cost money, but if the Governor could spend $7.7 million to hire a consulting firm to study the Commonwealth's procurement process, he could have found the money needed to get at the causes of high mortality rates during pregnancy and post-partum among certain populations

    1. walter smith Avatar
      walter smith

      Well…can you trust UVA to do a dispassionate anaysis of actual data and not to apply its systemic racism filter to it? Or to cover up embarrassing stuff?
      Can you even get UVA to turn over the data in a meaningful way?
      I tried very hard – I think no one in Virginia tried harder – to get UVA not to do the mandate. As it turns out, my position was more in line with reality for students (besides the Nuremberg Code violations).
      IF you try to get data, UVA will hide behind HIPAA, FERPA, and say things like you can't force us to generate a report. But the data IS there – somewhere. Can we ever get an honest assessment?
      UVA did violate HIPAA during the Covid mania – team trainers would follow up with athletes on why haven't you gotten your shot yet…besides teachers learning about vaxed status or bribing the class to be 100% vaccinated for better grades. UVA did keep a Covid tracker, and, to its credit, because VT and JMU stopped keeping track when "breakthrough" cases began to appear in December 2022, UVA continued through Spring 2023. The UVA data showed that the evil unvaxed had "cases" at a 10% rate WITH WEEKLY TESTING REQUIRED.
      The "vaxed" students, WITHOUT WEEKLY TESTING REQUIRED, had cases at a 1 in 8 rate. Also, the "vaxed" students hesitated going to Student Health because they knew it meant isolation! The policy discouraged seeking help so the "case" "rate" may have even been worse.
      How many students or employees had adverse effects to the experimental shot? Is UVA Health still facing a staffing difficulty for (needlessly) dismissing unvaxed Docs and Nurses?

      1. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        Your comments are irrelevant to my proposal. If the administration provided funding to an institution or organization to conduct a specific study, the data and results certainly would be made available.

        1. walter smith Avatar
          walter smith

          In theory. Not my experience. And not the nature of govt to willingly comply with the FOIA laws if the applicable agency doesn’T like what it shows or it contradicts its narrative.
          You proposed UVA For a study. Maybe an outsider look would be better. Remember how UVA was going to release the outside counsel report on the shooting? And then twisted itself in a pretzel in collusion with the Commonwealth’s Attorney? The CA who won’t enforce the mask laws? Yeah, thatUVA. And the UVA that refuses to be transparent about its admissions statistics and processes, while claiming its support for free inquiry is “unequivocal.”

    2. James Wyatt Whitehead Avatar
      James Wyatt Whitehead

      Youngkin wants two reports. One to start off with Dec 1 this year. Another by Dec 1 next year. Unless Task Force 32 is headed by Bull Halsey I expect little action from the findings.

  4. Eric the half a troll Avatar
    Eric the half a troll

    “Youngkin’s Executive Order 32 does not pre-suppose that “systemic racism” either is or is not at the root of disparate health outcomes.”

    vs.

    “A rational approach to dealing with disparities in outcomes will seek to identify concrete causes and address them. “Systemic racism” is a meaningless explanation. Doctors, nurses and hospital administrators don’t need bias training.”

    180 degrees in just a few paragraphs. Fascinating… 🤨

  5. Teddy007 Avatar
    Teddy007

    Is there anyway for social conservatives who want to eventually ban abortion, most forms of birth control, IVF, and surrogacy can really claim to care about women?

    1. StarboardLift Avatar
      StarboardLift

      "…social conservatives who want to eventually ban abortion, most forms of birth control, IVF, and surrogacy…" anyone wanting this list is a religious zealot–it's completely irrational.

      1. Teddy007 Avatar
        Teddy007

        But look at what groups like the Southern Baptist Convention is voting in favor of.

        1. StarboardLift Avatar
          StarboardLift

          Southern Baptist Convention=shoe/fit

  6. Not Today Avatar
    Not Today

    Meanwhile, back on Earth One, we recognize that Younkin’s preferred policies would ‘help’ pregnant women and babies right into the grave, stretching resources already groaning and strained thin by pregnant refugees from neighboring states. Only Bacon is focused on ‘systemic racism’ when restoring the right to medical treatment that preserves female bodily functions is on the ballot.
    https://www.npr.org/sections/health-shots/2024/05/09/1250057657/medical-residents-starting-avoid-states-abortion-bans
    https://flatwaterfreepress….
    https://publichealth.jhu.ed

  7. LarrytheG Avatar
    LarrytheG

    So we already have a lot of data on this but it needs a "deep dive" as if it has not been studied before?

    It's not like we don't know – other countries with much better outcomes already know and already do.. and with success.

    The data itself is stark and one does wonder for the scale and scope of the disparities – how much more "deep dives" are necessary to decide what the causes are:

    https://uploads.disquscdn.com/images/d7c737d64a839cb4b3fa62995406ed52a9d6d10389c7058acd7b94481028249b.png
    https://tcf.org/content/com

    The link above to the site contains an abundance of information and data:

    They DO attribute to systemic racism – which JAB and Youngkin believe
    is not proven but assumed:

    "Black Women Face Three Times the Maternal Mortality Risk as White Women
    Even more concerning, however, is that the overall maternal mortality rate masks stark disparities by race and ethnicity. As illustrated by the below chart, Black women bear the brunt of this horrific burden. Due to systemic racism and discrimination at the individual level, Black women and birthing people face unnacceptable (and mostly preventable) risk during childbirth and throughout and after pregnancy. It must also be noted that Hispanic women saw the largest maternal mortality increase of any racial or ethnic demographic group in the study, rising by a staggering 44 percent in just one year."

    JAB says: " There are many unknowns." and ruminates:

    " Do disparities exist because of differential access to the healthcare system? If so, is the problem lack of Medicaid or other medical insurance coverage? Is it a shortage of gynecologists and obstetricians? Are physicians spurning poor patients because Medicaid reimbursements are too low?…."

    Is the US so different on the reasons why?

    "Differential access to the healthcare system? If so, is the problem lack of Medicaid or other medical insurance coverage? Is it a shortage of gynecologists and obstetricians? Are physicians spurning poor patients because Medicaid reimbursements are too low? Are expectant mothers missing medical appointments? If so, why? Are their lives in chaos? Do they need reminders? Do they need transportation to the doctor’s office? To what degree are poor outcomes associated with obesity, diabetes, high blood pressure, substance abuse and other co-existing conditions? Are those conditions being treated?"

    And here we are – apparently back at square one while other countries have apparently figured it out?

    I agree, we don't need to, should not, view this as caused by modern-day ongoing "racism" but at the same time, we seem unable or unwilling to confront why we do have such different outcomes than most other industrialized countries.

    Low-hanging race-neutral data could be something pretty simple like family/household income, perhaps the solution to that – harder?

  8. Marty Chapman Avatar
    Marty Chapman

    https://www.bbc.co.uk/sounds/play/p0j74zfs. BBC Radio 4 show "More or Less" Interesting examination of whether a change in reporting criteria resulted in the increase in US maternal fatalities.

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