SB 65 Seeks to Address Racial Inequities in Reproductive Care by Increasing the Number of Students in Licensed Midwife Training Programs

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By Tala Hughes

SB 65 (Skinner), as amended September 2, 2021, and as it applies to the Medical Board of California (MBC), adds Article 4 (commencing with section 128295) to the Health and Safety Code to require the Office of Statewide Health Planning and Development (OSHPD) to contract with programs that train licensed midwives to increase the number of students.

MBC oversees the regulation of licensed midwives, which is authorized by the Licensed Midwifery Practice Act of 1993. The Board has a Midwife Advisory Council (MAC), which assists the Board with regulatory, policy, and procedural issues impacting the midwifery program; and a midwifery task force, which acts as a liaison with MAC and reviews laws and regulations involving licensed midwives. According to the Board’s website, licensed midwives (LM) are authorized by the Board to attend pregnancy and childbirth, as well as provide care for family planning. LMs can also assist the mother and the newborn during the various stages of pregnancy, including prenatal, intrapartum, and postpartum. LMs are required to report data to OSDHPD, which then reports aggregate information to both the Board and Midwifery Advisory Council and is compiled into an annual report.

SB 65, or the California Momnibus Act, addresses the high rates of maternal and infant mortality attributed to racism and racial bias in health care. The COVID-19 pandemic made the racial and socioeconomic disparities in the health care system more apparent. California has one of the lowest maternal mortality rates in the country; however, Black and Native American pregnant and postpartum individuals in California die at higher rates than their white counterparts. The goal of the bill is to create better support for these individuals and uses Article 4, the Midwifery Workforce Training Act, as a method to do so.

Section 128296 of the bill explains that there is a low supply of maternity care providers and that they are maldistributed across the state. The shortage is predicted to become critical by 2025. People of color are significantly impacted by not having access to quality maternity care. The bill finds that “black women die from pregnancy-related causes at a rate of three to four times that of white women.” The bill also states that “black infants are more than twice as likely to die in their first year as white infants.”

To help address the inadequate access to reproductive care throughout California and the low supply of certified nurse-midwives (CNMs) and LMs, OSHPD will create a program that will contract with midwife training programs that include, or intend to include, a training component for underserved, lower socioeconomic, multicultural, or rural communities, or seek to recruit diverse students from such communities. According to section 128298, OSHPD may create regulations to implement SB 65 and may accept the educational standards set forth by the Board for programs that train licensed midwives. However, OSHPD shall not adopt educational standards beyond what the Board already requires so that no standards are created that could pose potential barriers for midwifery training programs to obtain funding.

The Midwifery Advisory Council will next meet on December 9, 2021, and will discuss, among other agenda topics, updates on midwifery-related legislation, updates on the midwifery program, and updates on the proposed regulatory language of the required annual report. The Board did not take a position on SB 65; however, the Board explained in its 2020 Sunset Review Report that they support licensed midwives establishing their own board and be regulated by a separate entity.

Governor Newsom signed SB 65 on October 4, 2021 (Chapter 449, Statutes of 2021).

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