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The White Paper highlights:
• The alarming racial disparities in maternal and infant morbidity and mortality that exist in the U.S. and Nebraska,
including the significant contributing factors and economic burden.
• Potential solutions including the provision of doula care (with a focus on culturally congruent doulas for Black,
Indigenous, and People of Color (BIPOC) communities), implicit bias training for providers, improved access to
prenatal care, and addressing social determinants of health through policy changes.
• Establishing Medicaid reimbursement for doula services in Nebraska is proposed as a key intervention involving
a doula-led workgroup to develop implementation guidelines, training, credentialing, and quality assurance
measures.
• The need for collaborative, multifaceted, and community-driven efforts involving doulas and affected
communities is crucial to implement meaningful, holistic changes and ultimately improve maternal and infant
health outcomes while ending racial disparities.

We encourage you to review the White Paper to understand Nebraska's maternal health landscape better and, most importantly, identify opportunities for policy, systems, and environmental changes that could significantly improve outcomes for ALL Nebraska mothers, babies, and their families.

The Nebraska Department of Health and Services released the Maternal Mortality Review Committee Report for 2017-2021 this month. From 2017-2021, 50 Nebraska women died while pregnant or within one year after the end of pregnancy. Non-Hispanic Black women in Nebraska experienced the highest pregnancy-associated mortality ratio (PAMR), with 110.2 deaths per 100,000 live births, representing 7.5% of total live births but 20% of pregnancy-associated deaths. Twenty-eight percent of maternal deaths were due to a pregnancy complication, 93% of which were found to be preventable.

This month, the Nebraska Department of Health and Services released the Child Death Review Annual Report for 2021. In 2021, at least 122 children died before turning one, an infant mortality rate (IMR) of 5.2 deaths per 1,000 live births. Significant disparities exist in IMR for African American infants compared to White infants, 11.6 vs 5 per 1,000 live births. The top three causes of infant deaths in 2021 were Perinatal Conditions, Congenital Anomalies, and Sudden Unexplained Infant Death (SUID).

On November 16th, the March of Dimes released the 2023 Prematurity Report Card for the United States and Nebraska. The U.S. received a D+ and Nebraska fell to a D- (D). The preterm birth rate in Nebraska climbed to 11.3% (10.8), the highest it has been in the last 10 years. Significant disparities continue to exist for Black and Indigenous Groups.