How one Connecticut bill aims to address maternal health disparities — from report cards to doulas

CT Insider – Saturday, April 5, 2025
By Cris Villalonga-Vivoni

As a medical power couple, Dr. Andy Beltrán and his wife anticipated some challenges when she went into labor with their first child. Some issues, like going into labor at 2 a.m. on a random Saturday, were expected.

Others, however, carried more serious health risks and they said they were lucky things turned out fine.

Throughout her labor and delivery, Beltrán said the hospital’s on-site staff dismissed his wife’s concerns, chalking up her pain to dehydration. The staff performed an exam and timed her contractions, he said, but her symptoms initially didn’t meet the specific clinical threshold and they recommended discharging her.

His wife, who preferred not to share her name, insisted she stay, even after Beltrán said staff became more visibly frustrated during the exams. Four hours later, Beltrán’s wife was in full-active labor and staff started the process to provide an epidural for the pain. It took two attempts during the confusion of a shift change before the medicine could be safely administered and 20 minutes later, their new baby was born.

Beltrán, who is Guatemalan and the chief medical officer at the Hispanic Health Council, and his wife, a half-Jamaican, half-Haitian registered nurse, never disclosed their medical backgrounds to the staff. He said mom and baby, now 7-months-old, are doing well, but it was only after reflecting at home that they recognized their experience was part of a more significant national issue — one contributing to the maternal health crisis and disparities faced by women of color in Connecticut and across the country.

“The cultural nuances that mattered to her were dismissed, leaving her feeling powerless in a system she had spent over a decade working within. If an experienced nurse and a physician face these barriers, what happens to those without the knowledge, language, resources or confidence to advocate for themselves?” Beltrán said during a late March public hearing in support of a new maternal health bill meant to study the disparity. “This is not an isolated experience — it is systemic. Health care systems have been built without fully accounting for the cultural preferences and lived experiences of people of color.”

Bill calls for maternity report card

The proposed bill before the legislature’s Public Health Committee aims to continue studying the layers of the maternal health crisis and potential solutions they could implement. From a maternity ward report card to the work of doulas in hospitals, the proposed bill builds on years-long efforts from advocates, providers and lawmakers alike to address a long-reported crisis.

Tiffany Donelson, president and CEO of the Connecticut Health Foundation, said Black birthing people are overrepresented in the state’s maternal mortality and morbidity rates considering they only make up about 10.7% of the total population.

Of the 31 pregnancy-related deaths between 2015 and 2020, six were Black women, equating to about 19% of the total, according to a December 2022 report, the most recent data available from the state Maternal Mortality Review Committee. At the same time, Black women accounted for only 12.8% of all live births, the data shows. In comparison, Hispanic and white women have higher birth rates than death rates.

Moreover, an estimated 90% of the pregnancy-related deaths in Connecticut were preventable, with more than half occurring a week or up to a year after giving birth, according to the committee’s report.

The maternal health crisis is also a unique disparity “where we cannot account for income alone,” said Donelson, noting that discrimination may have contributed to 70% of the pregnancy-related deaths from 2018 to 2020 in Connecticut.

If adopted, the proposed bill — which was voted out of committee on March 27 with minimal changes and awaits debate on the floor of the General Assembly — would establish three prongs of research and reporting focused on different aspects of maternal health.

The first is to create a state task force to study the available perinatal mental health care services, best practices and identify gaps in care that impact the “diverse perinatal experiences of unique populations,” according to the bill.

The public health commissioner would also form an advisory committee to study doula-friendly practices in hospitals. Doulas are state-certified non-medical professionals who can provide support to individuals throughout their pregnancy, birth, and early parenting. They aren’t often on staff or associated with hospital maternity units, but provide significant reported benefits, especially for mothers of color.

The bill calls for an assessment of current policies, identify challenges that keep doulas out of hospital care, study the impact to services, and develop legislative recommendations to promote their inclusion in the field.

The last section of the bill, which received the most back-and-forth discussion during the public hearing looks to establish an annual maternity care report card for birth centers and hospitals based on patient experiences. It’d also include an equity score, giving each center a grade of A to F in assessing fairness in treatment.

The idea for the report cards was born after hearing about the systemic issues Connecticut mothers of color faced at a forum in late October, said Megan Scharrer, policy advocacy manager at the Hispanic Health Council. She said the council has advocated for the scorecard’s creation, especially after seeing Maryland legislators create a similar system in 2024.

How it would work

According to proposed bill, both the report and equity score would be based on quantitative, qualitative measures that reflect “disparities in obstetric care and outcomes across patient demographics,” including income, set by an advisory committee through the state public health department. After the findings are published, the board would meet to develop recommendations to centers to improve their performance.

Scharrer said some of the questions in the report card could include the patient’s access to language interpreters and other support services, overall treatment from staff, and any issues or complications. She said the goal is not to shame hospitals with the scorecards but to establish a tool that identifies gaps and finds ways to improve the care facility staff provides.

“We’re one of the richest states. We have some of the best health insurance, but we do see black women and Latino women and other women of color dying because of poor treatment and historically racist systems that exist in the health care setting,” Scharrer said.

Connecticut Hospital Association representatives said that while they largely favor the overall bill, they had concerns and testified against creating a reporting card system.

Dr. Selina Osei, the association’s director of health equity and community engagement, said using a manufactured scorecard report system with “arbitrary” measures could lead to worsened inequities and add to the already large pile of maternal health reporting. Osei said that a report card focused solely on the labor and delivery event would only see one part of the pregnancy experience.

She said it could also lead to patient privacy violations, especially if the providers are asked to collect and publish specific data, making it easier to identify the patient since the report is publicly available by facility name.

Beltrán agreed with the association that the equity score isn’t based on a pre-set national criteria. But “we have to start somewhere,” he added.

Beltrán said the health report card would hold institutions accountable and highlight disparities while promoting improvement.

“It could have been really bad luck that we became a part of those statistics that people are saying is happening, or it could be just, this is what happens. This is what’s been happening,” he said.

The only way to know for sure is to document events.

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