Vice President Kamala Harris visited UCSF April 21 to draw attention to the critical need for addressing disparities nationwide in health care for Black people during pregnancy.
In an afternoon event at the UCSF Rutter Center, Harris met with leaders of EMBRACE, a nearly four-year-old clinical program that was developed to provide perinatal care for Black mothers, Black pregnant individuals, and their families from an intentional angle of racial consciousness.
Her visit included four segments: a personal interaction with an EMBRACE participant during an ultrasound; a group meeting with the current EMBRACE cohort of six expecting or postpartum participants and their partners; a roundtable discussion with physicians, doulas, midwives, and other Black care providers to discuss the challenges and joys of their work; and a press conference with other public leaders.
Maternal mortality is not only a health care issue, Harris said: it is also a housing issue, a transportation issue, and an environmental issue.
“We are here today, to lift up the tremendous work that is being done by this group of extraordinary leaders,” she said. “Here at UCSF, at EMBRACE, you have helped build a model of culturally competent care. You include partners and family members in perinatal care…You have brought together extraordinary staff. In being a national model, this is lifting up exactly the design that is necessary to see [across] the planet outcomes that you all have been producing here.”
University of California President Michael Drake, MD, opened the public event, which included comments from Senator Dianne Feinstein; California Lieutenant Governor and UC Regent Eleni Kounalakis; San Francisco Mayor London Breed; EMBRACE Co-Director Andrea Jackson, MD; and an EMBRACE participant, Adrienne Gorrell, who introduced the Vice President. Congresswoman Barbara Lee and Oakland Mayor Libby Schaaf also attended, along with other dignitaries.
Inequities Throughout Pregnancy and Postpartum Spectrum
For Black women, pregnancy and postnatal care are widely linked to inequities in access, outcomes and patient experiences, across all backgrounds and socioeconomic levels. While approximately 700 women die each year in the United States due to pregnancy or delivery complications – the highest maternal mortality rate of any developed country – Black women bear a disproportionate share of those deaths. They are 3 to 5 times more likely to die during or after pregnancy than white women nationwide, are more likely to suffer from disorders like postpartum depression without clinical intervention, and are subject to more discrimination within the medical field.
The Harris visit brought visibility to those stark inequities by showcasing EMBRACE for the enhanced care and support it provides. With a commitment to a pregnancy and postnatal experience grounded in dignity and respect, EMBRACE engages participants from the 12th week of gestation and continues to support them through the infant’s first year of life. EMBRACE has reached 45 families since it was founded in August 2018.
“Our program is (about) more than just surviving, it’s about thriving,” said Dr. Jackson, a UCSF obstetrician and gynecologist who co-founded EMBRACE. “We celebrate life, we celebrate family, we celebrate joy, Black joy…So when you think to yourself what is their secret sauce, why does EMBRACE work? It’s us.”
Creating a New Model of Care
The program incorporates yoga, individual and group discussions, wellness activities, blood pressure readings, and “tummy time,” when partners listen through ultrasound to the heartbeat of the fetus.
Embodying elements that sets it apart from traditional prenatal care, the program highlights racial responsiveness that addresses racism at the core of Black lives. Social and economic factors that affect participants’ health are identified and acknowledged. All the program’s facilitators are Black, and through their individual experiences, provide support and knowledge inherent to the Black experience. The program integrates mental health and wellness services, and creates prenatal care plans, espousing a true collaboration with patients and integrating patient’s family into prenatal care.
Women are the pillars of so many families and so many communities, and when women then see the care they need, by extension it makes families and communities stronger…and it makes our nation stronger.
At the Rutter Center event, UC President Drake described EMBRACE as a “wonderful example of how we at the University of California are seeking innovative ways to close health equity gaps and improve the care we provide to patients of all backgrounds.”
“Everyone deserves to experience pregnancy, childbirth, and early motherhood with support, dignity, respect, and the best medical care we have to offer,” he said. “Today, we tell pregnant people and mothers: your health, your lives, your families – they matter, and we are here to take care of you.”
EMBRACE is housed within the Black Women’s Health and Livelihood Initiative, which was launched two years ago under the co-leadership of Dr. Jackson and Judy Young, MPH executive director of the National Center of Excellence in Women’s Health (CoE) at UCSF. The center was among the first to receive the CoE designation in 1996 and is renowned for advancing women’s health through its sex and gender focus, support of rigorous research, innovative clinical care, education content, inclusive leadership development, and community partnerships.
The program is one of numerous initiatives through the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences that aim to address these disparities. Among them is a community health Pregnancy Pop-Up Village in San Francisco that provides pregnancy-related clinical care, government services and support, such as lactation services, within high-need areas. The department is also affiliated with the California Preterm Birth Initiative, a nonprofit whose mission is to create positive change through research, community partnerships and education, as well as with the Zuckerberg San Francisco General Hospital (ZSFG).
The ZSFG Family Birth Center was the first Western site to offer CenteringPregnancy, a patient-centered group prenatal model led by ZSFG’s certified nurse-midwifery faculty. ZSFG midwives have offered a racially concordant care program for more than two decades for San Francisco’s LatinX community and have launched a Black Centering Pregnancy to offer the same evidence-based care for Black, African-American and African-identifying patients, as well. They also have created the BIPOC Aspiring Midwives Program, offering shadowing, mentorship and community building to diversify the midwifery profession.
National Champion for Maternal Health
In her quest for a nation with health equity, Harris championed maternal health as a U.S. Senator, bringing racial disparities in maternal mortality to the forefront legislatively, particularly among Black women. In addition to her support for community projects, she introduced bills including the Black Maternal Health Momnibus Act and the Maternal CARE Act. As Vice President, she held a Maternal Health Day of Action Summit in December 2021, as well as the first-ever Cabinet-level meeting on maternal health.
At the UCSF event, Harris said the direct or indirect cost of poor maternal health care has been estimated at upwards of $30 billion per year and she called upon all 50 states to expand Medicaid coverage for postpartum care from two months to 12 months. Currently, 11 states are working to expand coverage.
“Women are the pillars of so many families and so many communities,” she said. “And when women then see the care they need, by extension it makes families and communities stronger…and it makes our nation stronger.”