Lashana Gilmore was just 34 years old when, in 2019, she died giving birth to her second baby. Her death sent a shock through her West Philadelphia community — and through her State Representative, Democrat Morgan Cephas. Cephas was also just 34 at the time and was grief-stricken over the — totally preventable — loss of one of her constituents.
The young mother’s passing strengthened Cephas’s commitment to using policy to save women’s lives, a journey she’d begun the year prior when a citizen at an event asked her what the Commonwealth was doing to address maternal mortality and morbidity. Maternal mortality, of course, refers to the death of a mother during childbirth; less attention is given to maternal morbidity, which refers to health issues — preeclampsia, for example — that arise during pregnancy or childbirth, and can have a staggering effect on a woman’s health and well-being.
Cephas was honest: She wasn’t sure. So she promised to look into it and get back to the woman.
What she learned alternately shocked, horrified and uplifted her. The number of women who have died each year after giving birth in America has nearly doubled in the last two decades. The U.S. is the only industrialized nation to boast such an awful statistic. There are many reasons for this, including lack of obstetrics care, chronic health conditions, outdated practices — and race. Black women, as Cephas learned, are three times more likely to die after childbirth than White women.
There should be no reason, no reason, when we have institutions like the University of Pennsylvania and Temple University, when we have institutions that are leading in technology, leading in innovation, leading in education, that we cannot tackle this issue here in the Commonwealth of Pennsylvania.
This led Cephas to form close working relationships with equally passionate legislators across the state, and across the aisle. It also led her to introduce House Bill 1362, which called for more rigorous data collection around maternal mortality and morbidity; the language from HB136 was ultimately signed into law this past October by Governor Josh Shapiro. (As a law, it is called Act 5.)
Also this October, Cephas, along with State Reps Gina H. Curry and La’Tasha D. Mayes, launched the Black Maternal Health Caucus. Its focus: to bring attention, funding, and legislation to the issues surrounding pregnancy and childbirth for Black women.
Now, Cephas and the Black Maternal Health Caucus are in the process of building a Pennsylvania MOMNIBUS, which will be a package of bills aimed specifically at addressing maternal health in Pennsylvania. While that package has not been finalized as of yet, Cephas has a series of additional bills addressing coverage for doulas and resolving bias in healthcare.
The Democratic legislator from West Philadelphia sat down with The Citizen to talk about what the Commonwealth is doing to help birthing people, and how we can all be part of saving women’s lives.
Jessica Blatt Press: Many people think of healthcare as a clinical or scientific field, but you’re transforming the sector through policy. How did you become interested in the intersection of the two?
Rep. Morgan Cephas: I actually stumbled upon my interest in doing policy in this space. In 2018, we were having a roundtable conversation with Senator Bob Casey that focused on policy, broadly, as it relates to Black women in the Commonwealth of Pennsylvania. It was a discussion with a series of stakeholders from different industries — healthcare, government, medicine, and so on. After a young woman asked me about maternal health and mortality, I took a deeper dive.
My research led me to the issues of health equity, and how healthcare can have a significant impact on your life in general: Your healthcare and health dictate your ability to move across the economic spectrum, your ability to obtain educational opportunities, your ability to have a family, to raise a family, to live, work and play in your community. The pandemic highlighted this — how much of our lived life experiences are impacted by our access to quality healthcare.
It led me to believe that policy can have a direct impact on healthcare and, in turn, so many other aspects of your life.
And here’s the thing: We definitely can turn this issue around. And we can really transform communities. It always goes back to the data, and the data from the CDC says that 90 percent of the deaths that are occurring nationally are preventable. In Pennsylvania, 92 percent of the deaths are preventable. When we have numbers like that, we know that this is an issue that we can tackle.
I appreciate that you haven’t shied away from acknowledging that racism — more than poverty or education — is largely fueling these truly horrific numbers.
Absolutely. [Tennis superstar] Serena Williams had the best healthcare access you can get, and she’s healthier than anyone that I know — but she still wasn’t listened to about the challenges that she was having with her body after she gave birth. And the data and numbers don’t lie.
When you control for educational attainment, income, neighborhood, zip code, it does not matter: Black women are still three times as likely to die because of childbirth. The only difference is our skin complexion. So if we’re not calling it out and shining a light on it, then we’re never gonna move the needle in the right direction.
You recently attended Governor Josh Shapiro’s signing of Act 5. Can you explain what it will do, and why it’s so significant?
In 2018, a bill by my Republican colleague Ryan Mackenzie was signed into law mandating that Pennsylvania would track our maternal mortality rate every three years. There would be a report produced on what’s happening from a demographic perspective, an age perspective, with private insurers versus public insurers — really capturing and aggregating that data. It would tell a story and allow us to look for trends, and a maternal mortality review committee could then make policy recommendations about what legislation our chamber needs in order to address some of the challenges. But, also and just as significant, what investments can we make during budget season to help tackle this issue?
So similar to that bill, the maternal morbidity bill will essentially do the same thing, but for morbidity. [Editor’s note: Both will now also be reported annually, instead of just every three years.] For every one maternal mortality, there are at least 70 morbidity challenges. Morbidity, of course, is not as drastic as losing someone’s life. But if a birthing person has complications during pregnancy or childbirth, they can live with those complications until perpetuity, and it can impact their ability to get gainfully employed or acquire education or to live a quality life. We have to make sure that we’re tackling those challenges.
I want to believe that women’s health is a bipartisan, or nonpartisan, issue. Have you found that to be the case?
This is very much a bipartisan issue. I was talking to a Republican colleague of mine and he explained that his wife had challenges during her birthing process — thankfully both the mother and the child survived, but she had complications afterwards. And because of that experience, he’s more than willing and very eager to join the Black Maternal Health Caucus that we just launched. He recognizes it’s a challenge not just in urban communities but in rural and in suburban communities. In Philadelphia and Pittsburgh, we have large hospital systems — but when you go into the collar counties or the rural counties, they’re sometimes having to travel up to an hour to access care. So it’s very much a Pennsylvania problem that we all can collectively come together and tackle.
When you control for educational attainment, income, neighborhood, zip code, it does not matter: Black women are still three times as likely to die because of childbirth. The only difference is our skin complexion.
At a time of so much political division, you seem to excel at working across the aisle, as with Republican Representative Ryan Mackenzie. To what do you attribute this success?
Ryan Mackenzie and I spent a week in Taiwan, on a trip that was organized to help better understand our [trade and investment] partnership with Taiwan. And during that trip we got an opportunity to better understand what our policy perspectives are, what issues we care about, what’s happening in each other’s respective districts, and where there are opportunities for alignment.
That’s really how I’ve been able to navigate this work with my colleagues across the aisle. Yes, there are things that we adamantly do not agree on. We also recognize that each of us have our own, individual lived experiences: I’m a Black woman, born and raised in the urban setting of Philadelphia. Some of my colleagues on the other side of the aisle don’t have that lived experience. But the goal is always to find where we can reach common ground. What’s happening in your area that’s also happening in my area that we can collectively address? I’ve been relatively successful, particularly in the maternal health space, because of that.
I’m also working with my colleague, Republican Representative Mike Jones, on a bill called Dignity for Incarcerated Women. There’s a piece in the bill that speaks specifically to pregnant birthing people who are incarcerated, and how to ensure that our system creates an environment where that individual is rehabilitated, and also is able to thrive as they’re navigating a challenging birthing experience. And I’ve been able to work with Mike Jones from York County, who’s otherwise the polar opposite of what my policy perspective is. You just find what can you work on and leave the other politics out of it.
Tell me more about the investments the Commonwealth has made to bolster support for and awareness of maternal mortality and morbidity.
I definitely want to shine a light on the work that Governor Tom Wolf did prior to Governor Shapiro. He was a humongous champion when it came to this issue. When there was an opportunity to extend Medicaid up to a year postpartum — which was a part of a legislation done by the Biden administration — I assumed that we would have to make the case, rally the advocates, present research and data, explain that this is an opportunity for us to take this in the right direction. But to the credit of former Acting Secretary of the Pennsylvania Department of Human Services, Meg Snead, it was a no-brainer for them: They immediately latched on! So under Wolf’s leadership, Pennsylvania extended Medicaid up to a year postpartum.
The second piece he did was dedicate $25 million of his American Rescue Plan funding to the issue of maternal health. Some of the things that we have been able to fund with those dollars included creating a Pennsylvania doula commission, whose role is to help identify and train new doulas; and to create a maternal health innovation fund to be invested in new, innovative ideas. One project, based on a program out of the University of Pennsylvania, was Heartsafe Motherhood, which allows patients to go home with a blood pressure cuff to help monitor vitals and get data to their doctors faster, so that clinicians can communicate with the mother. And then the next step is going to insurers to insure that they reimburse for these innovations.
Now Governor Shapiro has taken the baton and in his very first budget, there was a dedicated $2.3 million fund specifically for maternal health. We have ideas about what that money can be spent on: extending that innovation fund, potentially creating a perinatal hotline, creating funds that provide a monthly basic income for mothers [like Philly Joy Bank], to remove some of the financial burden that families have with a newborn. In his press conference, Governor Shapiro said that $2.3 million is “a down payment,” which is great. As we go into discussions for the next budget season, we want to ensure that that fund stays and is also expanded.
What can we do to keep the momentum on solving this issue going?
My ultimate vision is for all birthing people in Pennsylvania and in our nation to have a safe, and healthy birth experience. There should be no reason, no reason, when we have institutions like the University of Pennsylvania and Temple University, when we have institutions that are leading in technology, leading in innovation, leading in education, that we cannot tackle this issue here in the Commonwealth of Pennsylvania. And when you have the government, advocacy groups, and practitioners all on the same page that we collectively need to address this issue, you have a once in a lifetime thing happening.
Citizens can help with this: Call on your representative and senator to join the Pennsylvania Black Maternal Health Caucus, and to sign on in support of legislation on this topic. Get involved with local organizations that are trying to tackle the issue — that could be by way of donating, volunteering, or just learning more about their information and the things that they do and elevating it on your social media platforms or any platforms that you have. Write op-eds about what Pennsylvania is doing, what we should be doing, and urge people to get involved in the fight. But definitely start by learning more about the issue, because I’m sure that everybody has someone in their family who has given birth — learn their birth story. The more that we talk about this issue, the more it will become a priority for each legislative branch.
This piece is part of a year-long editorial series looking at innovations to address inequities in women’s healthcare, sponsored by Independence Blue Cross.
