A new report found care provided in community birth settings, whether at home or in what are known as birth centers, can improve maternal health outcomes, especially for Black, brown and Indigenous women.

The U.S. has a far higher maternal mortality rate than other high-income nations, and Black and Indigenous women are two to three times more likely to die from pregnancy-related causes than their white peers.

Carol Sakala, director for maternal health at the National Partnership for Women and Families and co-author of the report, said community births often lead to better outcomes around preterm birth, Caesarean birth and breastfeeding.

"These models are especially powerful when they are community based and led," Sakala contended. "And they have the potential to do an incredible job of meeting the needs of birthing people of color, and mitigating effects of racism and trauma."

She noted a bill before the General Court would create a system for licensing Certified Professional Midwives (CPMs), who can attend to out-of-hospital births. It also would reimburse CPMs through MassHealth, the state's Medicaid program.

Currently, many families who opt for community births have to pay for care out-of-pocket.

Sakala added hospital care has received a lot of publicity for its shortcomings during the pandemic, which has increased demand for community births.

"That was greatly magnified when the pandemic set in," Sakala asserted. "We're asking healthy people to go into hospitals and potentially be exposed to the virus, and also to be separated from their loved ones and their support networks and often from their newborns as well if there were certain issues or concerns. "

The report added community births are cost-effective, and there are a number of steps to help increase access, from ensuring midwives and birth centers are covered by insurance, to supporting schools and programs trying to get more midwives into the workforce and expanding into underserved areas.

It also recommended increasing funding for community birth care and including midwifery as an eligible profession for loan forgiveness.

The U.S. Supreme Court will hear oral arguments this week on Idaho's near-total abortion ban.

Idaho v. United States is on the docket for Wednesday.

At issue is whether the ban violates the Emergency Medical Treatment and Labor Act, which prohibits hospitals from denying patients medical care because of financial or insurance issues.

The Idaho law has restricted access to reproductive care. Rory Cole is a fourth-year medical student at the University of Washington who is from Idaho and plans to practice in the state.

"A lot of these patients that we've been seeing don't really have a choice anymore, in that sense of it's not about if they want to be pregnant or not," said Cole. "It's about saving their life or their health, and we can't help them in Idaho."

Other states will be watching Idaho's Supreme Court case, and it could have an outsize impact on rural states that ban abortion, leaving patients with few options for care.

Cole said the Idaho law puts doctors in a tough place.

"The wording is so vague in the legislation here, that it makes it just extraordinarily challenging for doctors to kind of know what is legal and what is not legal here now," said Cole, "which is a place that no physician wants to exist in."

Idaho has seen an exodus of medical providers. The state has lost 22% of its practicing obstetricians since its abortion ban took effect, according to a recent report.

"Ultimately," said Cole, "that place of needing to help the people in Idaho and the people here deserving wonderful care was what brought me to basically try and stay in Idaho for residency."




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Vending machines commonly found in workplace break rooms generally contain soft drinks or snacks but one machine in Indianapolis dispenses unconventional items at the turn of a knob.

The Plan B morning-after pill, pregnancy tests and condoms are displayed in a clear glass case inside a colorful blue and orange dispenser. The items provide easy access to protection against an unwanted pregnancy and are free of charge.

Melissa Gruver, organizing director of the feminist organization Indiana Task FORCE, said it operates like a traditional vending machine.

"You just push whenever you want and it falls down, and you reach your hand through the little door and you pull it out, take it with you," Gruver explained.

A 2022 Indiana Department of Health Termination Report indicated 9,600 pregnancies were aborted, with Marion County recording the highest number of unwanted pregnancies. The report also noted the average age of a woman in Indiana who sought an abortion was 27, and 67% of all terminated pregnancies occurred within four to eight weeks of conception.

The state's contentious near-total abortion ban, which was upheld by the Indiana Supreme Court last year, has stoked fears lawmakers may begin restricting a woman's choice of birth control.

Indiana Task FORCE and reproductive health groups All-Options and the Midwest Access Coalition want the emergency contraceptive vending machine to serve as a gathering spot for community conversations on reproductive rights and sexual health.

"We've long been organizing our communities to bring about reproductive justice, which we didn't have before and we definitely don't have it now," Gruver pointed out. "But what we know to be true is that there are more of us that want access to reproductive care than those that try to stop it. We're excited to continue to work to meet this need now, and to organize for a better community."

Gruver hopes to have one dispenser in every Indiana region in the future to add to the single machine currently in an eastside Indianapolis grocery store. She added some universities in the state already have vending machines offering similar contraception products but users have to purchase the items.

This story is based on original reporting by Mary Claire Molloy for Mirror Indy.


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