Zaza Cristina Robles had been a pregnancy coach in Peru, so upon arriving in the U.S. at 16 weeks pregnant, her first priority was seeking medical care.
The cost for just one doctor’s visit shocked her and her husband, prompting worries about the impending delivery expenses.
“When they showed us the bill, it was so expensive, my husband and I thought, ‘If this is just for the doctor’s visit, imagine what the delivery will be?’ It scared us,” she said.
Her sister-in-law connected her with the Hispanic Health Council, a nonprofit in Hartford, Connecticut.
There, she found solace through their Comadrona program, designed to assist Latina immigrants and low-income pregnant women in going through the complexities of the U.S. healthcare system.
“They really helped clear up a lot of my fears,” Robles said.
Through the program, Robles secured healthcare coverage as she and her husband pursued asylum in the United States.
Her comadrona guided her to a doctor who serves low-income patients and connected her with other essential services.
“One of the things that we do here at Hispanic Council is provide birthing classes, in their own language,” said Bianca Noroñas, the Comadrona program manager.
Noroñas emphasized that coaching and social services have been instrumental in helping mothers in their program avoid childbirth complications.
“If you don’t receive education and support, that is going to affect you directly in your life,” Noroñas said.
In the United States, the rate of maternal morbidity — medical complications during childbirth — and maternal mortality is nearly double that of other developed nations.
“We’ve been paying a lot more attention to try to understand why these differences persist and why our numbers are so high,” said Marie Thoma, a professor at the University of Maryland School of Public Health.
“A lot of investment has been going into addressing some of these factors around the health before, during and after pregnancy that we can improve on in the U.S.”
During the pandemic, maternal mortality rates worsened significantly, particularly among Latinas.
According to the Centers for Disease Control and Prevention, there was a notable increase in maternal deaths in 2020, with Hispanic women experiencing a 44% surge.
While the reasons behind these disproportionately higher mortality rates among Latinas during 2020 aren’t fully understood, the broader trend in the U.S. indicates that women of color often face poorer childbirth outcomes.
A study by the Blue Cross Blue Shield Association revealed that Latinas with private insurance plans have a 22% higher rate of severe pregnancy complications compared to non-Hispanic white women, while low-income Hispanic women covered by Medicaid have a 28% higher rate.
Factors such as higher rates of obesity and chronic conditions like diabetes among women of color, along with financial and cultural barriers in healthcare, contribute significantly to maternal morbidity, noted Dr. Yvette Martas, a board member at the Hispanic Health Council.
“It is the issue of being listened to,” Martas emphasized. She stressed the need for the healthcare system to support mothers well beyond the delivery room, fostering a culture where pregnancy is viewed as a natural process rather than a medical condition.
The costs associated with maternal and child morbidity in the U.S. are substantial, amounting to $32.3 billion for births in 2019 alone, according to the Commonwealth Fund.
Health insurers and major employers like Walmart have taken notice and are implementing measures to address the problem.
Walmart, for instance, expanded its pregnancy-support programs to workers in four states, offering up to $1,000 for doula services.
Blue Cross Blue Shield of South Carolina has seen significant reductions in maternal and infant morbidity rates through its Centering Pregnancy program, cutting the need for neonatal intensive care unit admissions from 13.9% to 3.5% and saving an average of $67,000 per NICU case.
“I think offering doula programs and offering paid leave — there’s a lot of things that I think our companies can do … that could really support moms during and then just as they return to work,” Thoma said. “It will give back to the company as well.”
Beyond pregnancy, the Comadrona program at the Hispanic Health Council continues to offer postpartum support, providing assistance with diapers and lactation coaching to new mothers like Robles.
“Thank God … It turned out well for us and they cared for us so well,” said Robles, grateful that her delivery went smoothly without any complications.
