SACRAMENTO \u2014 Carolina Reyes, a Harvard-trained physician who specializes in high-risk pregnancies, got into medicine to help women obtain health care, especially underserved or marginalized people who face systemic racism. She\u2019s seen progress, albeit slow, over three decades, yet the number of maternal deaths each year continues to rise.<\/p>\n

Luckily, she\u2019s got the ear of President Joe Biden\u2019s health secretary.<\/p>\n

Reyes, 64, is married to Health and Human Services Secretary Xavier Becerra, who is championing the administration\u2019s initiative to require all states to provide<\/a> Medicaid coverage to mothers for a year after giving birth. In March, the Centers for Disease Control and Prevention released data showing a 40% increase in U.S. maternal deaths<\/a> from 2020 to 2021. The mortality rate among Black women was 2.6 times that of white women, no matter their economic status.<\/p>\n

Over the years, Becerra has spoken highly of his wife\u2019s expertise, but she downplays her influence, saying her husband of nearly 35 years \u201chad it in him to begin with\u201d to improve health care for women and to demand fewer pregnancy-related deaths. She, too, describes the nation\u2019s high maternal mortality rate as unacceptable and preventable.<\/p>\n

Reyes, a Latina who grew up as one of eight children in California\u2019s agricultural heartland, now practices perinatology at the University of California-Davis. She is a member of a California Department of Public Health panel<\/a> that reviews cases of maternal deaths and recommends improvements. And she chairs the board of the California Health Care Foundation<\/a>, a nonprofit that works to increase health care access. (California Healthline<\/a> is an editorially independent service of the California Health Care Foundation.)<\/p>\n

Her work has been a blend of medicine and advocacy, and she worries recent federal court rulings will erode hard-fought victories regarding the safety of pregnant women and their babies. She discussed the nation\u2019s maternal health crisis and health care disparities with California Healthline senior correspondent Samantha Young. The interview has been edited for length and clarity.<\/p>\n

\n\t\t
\n\t\t\tEmail Sign-Up\t\t<\/a>
\n\t<\/h4>\n
\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\n
Q: When did you first realize there are disparities in the health care system?<\/strong><\/p>\n
When I was in high school in the Fresno Unified School District, we were under a consent decree to desegregate. And I was, at the time, student body president at Roosevelt High School. I was asked to be on this unified school district desegregation task force, where the district had to come up with a plan.<\/p>\n
It was a time when I really had incredible exposure to how policies are made at a larger level, societal level, that really determine where people live, where they can seek health care, where they go to school. That experience had a tremendous impact on my life in terms of what I wanted to do in a career and how to give back.<\/p>\n
Q: The U.S. has one of the best health care systems in the world, yet the maternal mortality rate is high compared with other developed countries. Why do think that is?<\/strong><\/p>\n
What we know by the CDC and maternal mortality review committees is that about 60% of maternal deaths are considered preventable. And that\u2019s really been a lot of what I\u2019ve tried to focus on: What can we do to reduce the severity of disease? Or what can we do within the role that we play in maternal health that can reduce that?<\/p>\n
We know that there are societal issues absolutely that increase women\u2019s risks and there are public health issues. But there\u2019s a role that hospitals play in helping reduce that risk. Ten years ago, I was on the maternal mortality review committee for the state of California when we started reviewing cases of women who died within hospital systems to see, \u201cIs there a role that we can play in a hospital system to reduce that risk?\u201d<\/p>\n
We recognized that sometimes there were conditions that were not recognized early enough so that there was a delay in the care. Sometimes there was a misdiagnosis. Or in some hospital systems, especially rural systems where there aren\u2019t as many resources, sometimes there was the lack of specialists available. So, we\u2019ve identified these risks and said, \u201cWe can do something about them.\u201d<\/p>\n
Q: You served on a federal panel 20 years ago that <\/strong>published a groundbreaking report<\/strong><\/a> identifying racism in health care. It seems as if we could be much further along.<\/strong><\/p>\n
The purpose of that committee was to really answer the question: Do patients receive a different level of care based on race? Looking back, we knew there was something there, but we really didn\u2019t know. And it took months for the committee to come to that agreement, that there was a difference. I mean, that was honestly monumental, because we just didn\u2019t have that level of consensus before. And so just to say \u201cThat treatment is unequal and it\u2019s unacceptable\u201d was really profound.<\/p>\n
We thought that the 700-page report was going to be a time period where there was going to be tremendous movement, and I think I\u2019ve learned over 20 years that change doesn\u2019t happen quickly, especially when providers and health systems don\u2019t see that they play a role. It\u2019s like \u2026 \u201cOK, so maybe it exists, but not for me.\u201d<\/p>\n
We all saw George Floyd and how he was treated. And during covid we saw a tremendous difference in who was dying, right? Underrepresented minorities \u2014 certainly much higher. It was that culmination that made us realize the elephant in the room. We can\u2019t ignore that this does exist, that there is a difference in how people are treated, even in our health care system.<\/p>\n
Q: When addressing racism in health care, you talk about diversifying not just the health care workforce, but also the boardrooms of hospitals and health systems. Why is that important?<\/strong><\/p>\n
At the board level, change is hard. But we all play a role because leadership really helps determine much of what\u2019s carried out. So, to have a leadership that is understanding and representative of the communities they serve, I think it has been demonstrated that we do make a difference.<\/p>\n
Carolina Reyes blends medicine with advocacy, having worked on a groundbreaking report identifying racism in health care. She calls for more diversity in the boardrooms of hospitals and health systems.(Rich Pedroncelli for KFF Health News)<\/span><\/figcaption><\/figure>\n
Q: As a health care provider, do you have a wish list of policies you\u2019d like the government to take up?<\/strong><\/p>\n
There was tremendous effort around offering preventive health services as a part of what was covered under the Affordable Care Act. And individuals exhaled, finally thinking this is a tremendous win, especially for women in pregnancy. Because we fought for preventive health services to help them have access so they can prepare for their pregnancy. So, for women, this was huge. But now with the Texas federal court ruling<\/a> that the U.S. Preventive Services Task Force didn\u2019t have any authority, it is a tremendous step backward.<\/strong><\/p>\n
We have culturally, linguistically appropriate standards in place, but it\u2019s a matter in terms of how they\u2019re carried out by state and by individual hospital systems. My wish list is that we really do listen to our patients, speak to them in a language of their choice, and provide them written materials in the language of their choice. We don\u2019t fully do that.<\/p>\n
Q: You mentioned one Texas ruling on the ACA. What\u2019s your take on the ruling by another Texas judge <\/strong>suspending the abortion pill<\/strong><\/a>?<\/strong> And the U.S. Supreme Court\u2019s overturning of Roe v. Wade<\/em>?<\/strong><\/p>\n
As a maternal-fetal medicine specialist who tries to help women plan for pregnancies, those rulings are a tremendous setback.<\/p>\n
Q: And what about women of color? Will they find access to abortion services more difficult?<\/strong><\/p>\n
Oh, absolutely. When we speak of underrepresented minorities or those with less resources, they have less resources to then seek the appropriate care. Some women may have the opportunity to go to a different state or seek care elsewhere if their state doesn\u2019t provide it. Many women just don\u2019t have those resources to devote to them and don\u2019t have a choice. So, we will see that disparity widen.<\/p>\n
This article was produced by <\/em>KFF Health News<\/em><\/a>, which publishes <\/em>California Healthline<\/em><\/a>, an editorially independent service of the <\/em>California Health Care Foundation<\/em><\/a>.<\/em>\u00a0<\/p>\n
\n
\n\t\t\t\t\t\t\t\t\t\t\tSamantha Young: <\/span>
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t syoung@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t@youngsamantha<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n
\n
\n
\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n
\t\t\t\t
\n\t\t\tContact Us\t\t<\/a>
\n\t\t
\n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n