Particularly on the heels of the Dobbs v. Jackson Women's Health Organization decision, employers have addressed rekindled interest in reproductive health benefits and activism. Still, one element of the mainstream conversation that may be missing is intersectionality.
Research firm Mercer published a Dec. 1 report highlighting the U.S. maternal mortality rate — which is the highest “among high-income countries,” researchers noted — and how this phenomenon disproportionately affects Black and Native American people.
HR managers, benefits professionals and the C-suite can help by championing comprehensive reproductive health benefits. Mercer Senior Associates of Total Health Management Corina Leu and Brittany Bono recommended some key action items for employers. For one, employers can provide expecting workers and their families with financial reimbursement for the services of a doula.
HR managers can re-assess health insurance plans for coverage of various birth facilitators and pregnancy practitioners — think chiropractors, pelvic floor physical therapists, midwives and lactation consultants — and out-of-hospital or at-home births.
“The disparity in pregnancy outcomes for Black women compared to White women is substantial,” Bono and Leu told HR Dive via email. “The fact that those disparities hold regardless of socioeconomic status and education level tells us that this is not an issue of employed vs. unemployed people, but rather, it has the ability to impact anyone.”
The researchers then went on to tell HR Dive that it is possible to reduce racial inequities in the maternity space — and health care at large — but that lack of data is hindering progress.
“At this point, many vendors and employers are just beginning to collect and review the data needed to analyze outcomes and other metrics by race and ethnicity. The first step is for employers to have a method by which they can collect race and ethnicity data (e.g., through their [human resources information system]), and then encourage employees to voluntarily provide that information with explicit education about how that information will be used,” Bono and Leu said. “This information has to then be shared with other high-level demographic information to the organization’s vendor partners for use in program identification and reporting.”
Along with race and class, the intersection of LGBTQ identity with pregnancy and parenthood is often left out of mainstream reproductive health conversations. Throughout the Mercer report, for example, researchers incorporated the term “birthing people” to describe expectant workers who are assigned female at birth but may not necessarily be women.
Additionally, Bono and Leu brought up the need for “provider concordance,” a term that describes the phenomenon of a patient sharing a lived experience, cultural background or characteristics with their care provider. This has “well-documented positive impacts on historically underserved populations,” including Black people, Indigenous people, and other people of color, as well as queer people. “An example could be a provider who self-identifies as gay or who has specific experience and training working with transgender patients,” they told HR Dive.
“Employers can hold their health insurance and vendor partners accountable for not only having an inclusive provider network but especially having the capability for health plan members to select providers based on specific criteria,” Bono and Leu continued, adding that assessment of services that LGBTQ employees would need in family planning — including comprehensive gender affirmation treatment, egg or sperm freezing, egg or sperm donor purchase, and reciprocal IVF — would be helpful here.
Beyond the benefits component, employers can support maternal health by training managers to support expectant and new parents on their teams. The report added that training can be as straightforward as reducing stigma around discussions of pregnancy and lactation.