生育和生殖公正——通过加强护理、支持和预防改善孕产妇和婴儿健康结果
In New Jersey, while the infant mortality rate is lower than the national average, the maternal death rate is nearly twice the national average. New Jersey infants who are Black are more than three times as likely to die before their first birthday than White infants; mothers who are Black are more than seven times as likely as White mothers to die from pregnancy-related complications.
New Jersey has significantly invested in such initiatives as Nurture NJ and others with the goal of making New Jersey the safest state to deliver an infant. To be effective, policy implementation must reflect the lived experiences of Black women and pregnant people in New Jersey.
Policy Recommendations
1. Support and invest in a diverse workforce that is aware of bias and can provide appropriate care across the maternal and infant care and education continuum
- All healthcare providers should be trained to identify and acknowledge their implicit biases to counter their impact. Training should be patient-centered, with a focus on the lived experiences of Black women and pregnant people.
- Given the disproportionate impact of the maternal health crisis on Black women and pregnant people, New Jersey policymakers should take steps to support growth in the number of Black healthcare providers.
- More should be done to understand and support the career progression of doulas and community health workers. This would connect doulas and health workers with additional training and opportunities.
2. Implement new Medicaid policy to support racial equity
- Using all opportunities to advance equity within Medicaid program parameters, New Jersey officials should continue leading and implementing evidence-based services that help support enrollees’ health.
- Engagement and assistance should be given to diverse and new providers so administrative burdens in filing for payment or other technical aspects of program participation do not undermine the ability to provide services.
- Reimbursement should reflect fair rates for services that indicate the full, comprehensive time and care provided or the administrative time to bill. Doulas typically spend more time with clients than do other providers, so Medicaid reimbursement rates may not always amount to a living wage.
- Consider revising requirements that may create unintentional barriers to provider participation. Stateapproved programs through which doulas must be certified should be high quality and collaborate with community providers to ensure quality and participation requirements are not barriers to participation among qualified practitioners.
3. Enhance access to comprehensive reproductive health, including abortion care
- New Jersey should expand regulations to guarantee equal access to abortions, regardless of a person’s income, insurance coverage, or immigration status.
- The state should consider dropping the prescription requirement for over-the-counter contraceptive products by using state—not federal—funds for this coverage.
- The state should administratively expand the Department of Health Service’s Reproductive Health Care Fund to cover abortion care for those with no path to health insurance due to immigration status.
4. Enhance enforcement of paid leave benefits and increase participation
- The state Department of Labor & Workforce Development (DOL) should, as required, use $1.2 million appropriated annually to increase awareness of New Jersey’s Family Leave Insurance (FLI) program and uphold the requirement that half of the money to go to community-based organizations.
- The state should target outreach based on program data to groups underserved by FLI. If existing data is inadequate, DOL should create regular reports evaluating FLI to enhance efficacy.
- Enforcement of paid leave benefits for eligible workers should be enhanced. DOL could devise a monitoring mechanism or other enforcement activity to help workers—especially those who work for low pay and people of color—take leave without fear of retaliation.
We hold ourselves accountable to eliminating birth and reproductive justice barriers to health equity and their consequences on New Jersey’s women and pregnant people of color. Together, we can achieve a reality in which everyone experiences their best health and wellbeing.
" data-isabstract="false" class="cmp-text">我们都希望新泽西成为这样一个州:所有的婴儿都有平等的机会度过他们的第一个生日,母亲和孕妇可以安全地分娩和照顾婴儿,所有人都有公平的机会实现最健康的生活——没有基于种族、民族、性别、能力、性取向或阶级的障碍。
一个更健康、更公平的新泽西州的政策议程建议通过加强护理、支持和预防来改善孕产妇和婴儿健康结果。
在新泽西州,虽然婴儿死亡率低于全国平均水平,但产妇死亡率几乎是全国平均水平的两倍。新泽西州的黑人婴儿在一周岁前死亡的可能性是白人婴儿的三倍多;黑人母亲死于妊娠相关并发症的可能性是白人母亲的7倍多。
新泽西州在诸如“培育新泽西”和其他旨在使新泽西州成为分娩最安全的州的倡议上投入了大量资金。政策的实施必须反映新泽西州黑人妇女和孕妇的生活经历,才能发挥作用。
政策建议
1.支持和投资于一支多元化的劳动力队伍,使其能够意识到偏见,并能够在母婴护理和教育连续体中提供适当的护理
- 所有医疗保健提供者都应接受培训,以识别和承认他们的隐性偏见,以抵消其影响。培训应以病人为中心,重点关注黑人妇女和孕妇的生活经历。
- 鉴于孕产妇保健危机对黑人妇女和孕妇的不成比例的影响,新泽西州的决策者应采取措施,支持黑人医疗保健提供者数量的增长。
- 应该做更多的工作来理解和支持助产师和社区卫生工作者的职业发展。这将使助产师和卫生工作者获得更多的培训和机会。
2.实施新的医疗补助政策,支持种族平等
- 利用一切机会在医疗补助计划参数内推进公平,新泽西州官员应该继续领导和实施以证据为基础的服务,帮助支持参保者的健康。
- 应向各种新的提供者提供参与和援助,以便在申请付款或参与项目的其他技术方面的行政负担不会损害提供服务的能力。
- 补偿应反映服务的公平费率,表明所提供的充分、全面的时间和照顾或行政费用。助产师通常比其他服务提供者花更多的时间与客户在一起,因此医疗补助报销率可能并不总是相当于生活工资。
- 考虑修改可能对提供者参与造成无意障碍的要求。通过国家批准的项目,助产师必须获得认证,这些项目应该是高质量的,并与社区提供者合作,以确保质量和参与要求不会成为合格从业者参与的障碍。
3.增加获得全面生殖健康,包括堕胎护理的机会
- 新泽西州应该扩大法规,以保证无论个人收入、保险范围或移民身份如何,都有平等的堕胎机会。
- 州政府应该考虑取消对非处方避孕产品的处方要求,使用州政府而非联邦基金来覆盖这一范围。
- 国家应在行政上扩大卫生服务部门的生殖保健基金,为那些因移民身份而无法获得医疗保险的人提供堕胎护理。
4.加强执行带薪休假福利,并增加员工参与
- 根据要求,州劳动和劳动力发展部(DOL)应该使用每年120万美元的拨款来提高人们对新泽西州家庭休假保险(FLI)计划的认识,并坚持将一半的资金用于社区组织的要求。
- 州政府应根据项目数据,针对FLI服务不足的群体进行外展。如果现有数据不足,DOL应创建评估FLI的定期报告,以提高疗效。
- 应加强对符合条件的工人的带薪休假福利的执行。劳工部可以设计一种监督机制或其他执法活动,帮助工人——尤其是那些低薪工人和有色人种的工人——休假时不必担心遭到报复。
我们有责任消除妨碍健康公平的生育和生殖司法障碍,以及它们对新泽西州妇女和有色人种孕妇造成的影响。只要我们齐心协力,就能实现人人享有最佳健康和福祉的现实。
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