Melissa Harris-Perry: I'm Melissa Harris-Perry, good to have you with us. The Women's Health Protection Act passed by the House of Representatives late last week has little chance of becoming law, but there is significant legislative action winding its way through Congress, which addresses women's health, and just might find its way into the law. The Black Maternal Health Momnibus package.

Now, Momnibus is big, really big. For a thorough explanation, I'm turning to Dr. Monica McLemore. She's an Associate Professor of Family Healthcare Nursing at the University of California, San Francisco. An affiliated scientist with Advancing New Standards in Reproductive Health, and a member of the Bixby Center for Global Reproductive Health. Monica, what exactly is the Momnibus?

Dr. Monica McLemore: The Momnibus was originally introduced by Representative Alma Adams, who is a Democrat from North Carolina, and Representative Lauren Underwood, who is a Democrat from Chicago. It was originally a package of nine bills that were put together to really address the Black maternal health crisis here in the United States, and unfortunately got released the Monday before the entire nation went on lockdown for COVID-19.

Early on in the 117th Congress, Rep Adams, and Rep Underwood, along with the 200+ signatories with the Black Maternal Caucus within the House of Representatives, re-introduced the Momnibus. Instead of it being 9 bills, it's now 12, and it included things like paid family leave, and perinatal mental health for veterans. It included three new bills that had COVID-19 provisions for individuals.

Basically, what it is, is it is a set of bills and legislation that would really transform reproductive health across multiple spectrums. It has reform in it for [unintelligible 00:01:57] for people who provide pregnancy related services. It has provisions to look at workforce. It has provisions to look at State Maternal Child Health programs. It is one of the most comprehensive packages of bills for us to really provide comprehensive reproductive health care for pregnant capable people in the United States. We are so lucky that mid-September, it was included as part of the mark-up to the Build Back Better Initiative.

It looks like two of the bills, particularly one that was specific to maternal morbidity or mortality review committees. Those committees that look at every maternal death. The Kira Johnson Act named for Charles Johnson's wife, Kira, were earmarked. Those funds were allocated under the Build Back Better markup process in the Energy and Commerce Committee.

This is the first time it will allow us to really help to address the Black maternal health crisis in the United States, and it is a comprehensive set of legislation that we really, really want to be able to see be passed, including some low-hanging fruit like expanding Medicaid for the postpartum period up to a year, instead of what it currently is under Medicaid, which is 60 days.

Melissa Harris-Perry: You've referenced a couple times the Black maternal health crisis. What exactly is that?

Dr. Monica McLemore: In the United States, we've tried to bring awareness to the fact that Black moms are three to four times more likely to die from pregnancy related issues, according to data from the Centers for Disease Control and Prevention. It is estimated that of those between 700 and 900 deaths, that between 50% and 60% of them are preventable.

The burden is really born in Black communities, and in some geographies in native and indigenous communities as well. The Momnibus really seeks to address many of those upstream and preventable causes.

Melissa Harris-Perry: I want you to talk to me a little bit about nurses, and particularly the ways that nursing education may or may not, at least, particularly right now, be serving the very communities, the Black mama communities, in the broadest sense, that the Momnibus bill is seeking to uplift.

Dr. Monica McLemore: Nursing has both this long history of service, and this long history of Black and queer folk as participants in the workforce. Yet, unfortunately, at the higher echelons of power in nursing, it remains unbearably white, and it does not reflect the communities that we serve. There have been multiple pathways to nursing education, but we have one national license as registered nurses.

When I tell people I have three degrees from public institutions and I maintain my RN licensure, I always say, "Yes, I'm a doctorally prepared nurse," but when I think about the entry to practice that I obtained, which was the Baccalaureate of Science in Nursing, I have worked with associate degree nurses. I have worked with community college nurses. I have worked with masters nurses.

When you further complicate this around pregnant capable people, I would be remiss if I didn't say anything about the midwives and the discrediting of the grand midwives. Those of which who were mostly Black. When you think about nursing midwifery, and professional midwifery, it's no different. There are multiple pathways to become midwives. One of the things that the Momnibus does address is this idea that we want to reinvest in the Black midwifery workforce, because we know that the midwives doulas, in partnership with communities and patients, give superior outcomes when we're talking about pregnant capable people.

That said, we have not been able to structurally diversify the nursing workforce. This was further highlighted and born-out by the recent future of nursing report, and that there are direct instructions for schools of nursing, for professional organizations in nursing, for the National Institutes of Nursing Research, which is under the National Institutes of Health, to diversify our workforce as a potential path to improve health outcomes.

The story of nursing is both one of needing a reckoning, but also one of opportunity. One of excitement l, and one of, if we can really get beyond our shameful history, then I think we actually have a prime opportunity to do some really good work.

If we wanted to be able to diversify midwifery, could easily be built now. There are no midwifery programs at any historic Black college or university. We wanted to rapidly diversify the midwifery workforce. We would build paths to historically Black colleges and universities who already have health sciences on the campus.

Melissa Harris-Perry: Okay, Monica. My next question is, how does abortion and the access to safely terminate pregnancies fit into this broader understanding of maternal healthcare?

Dr. Monica McLemore: We know from national polling that Americans have been supportive of abortion rights, and are supportive of people being able to have timely and safe and community-based abortion care. For the first time ever in a Supreme Court case that potentially could overturn Roe versus Wade and has implications for Casey and [unintelligible 00:07:41] the gay marriage decision, there is a Black Maternal Health Amicus brief, that was led by the National Birth Equity Collaborative, and our good friend and colleague, Dr. Joia Crear-Perry and her team, was really happy to sign on to this, to make the argument that's grounded in reproductive justice, that the state's rights, and this is specific to the case of Mississippi, does not trump human rights or bodily autonomy of individuals.

This issue around abortion, this issue around fetal rights, this issue around viability, is being couched incorrectly, because the state's interest in termination of pregnancy does not trump the human right to bodily autonomy in life and in death that we all currently have as a human. No one can go dig up your corpse when you're dead and take your organs without your consent.

If we have bodily autonomy in life and death, and these are human rights that we are afforded, then the state's right in Mississippi does not trump that human [unintelligible 00:09:01] When we look at the SBA in Texas, virtually banning abortion at 6 weeks, and deputizing citizens and private individuals to be able to bring lawsuits against people who aid and abet, people seeking essential abortion care and exercising their right to bodily autonomy, we are looking at a step backwards, in terms of how we think about operationalizing reproductive justice and human rights in the United States.

I was very glad to see corporate individuals, I was very glad to see people step up to want to defend the right of individuals to access abortion care in the State of Texas, in the State of Mississippi. We also saw a similar law to the state in Texas be introduced in Florida last week. We need to be very clear with people that[00:07:56] states' rights do not trump human rights and that the human right to bodily autonomy is consistent with reproductive justice. That is the way that we will end the Black maternal health crisis in the United States, is to respect the bodily autonomy and to trust Black women, Black birthing people and other pregnant capable individuals.

Melissa Harris-Perry: Can you expand for me just a little bit, the phrase women's health or our assumption that reproductive health is always about women, where women is pretty narrowly defined as CIS gendered folks. What happens when we expand that definition?

Dr. Monica McLemore: What we are trying to achieve is gender inclusive language to recognize that not all people who birth or have capacity to do so identify as women, that not all people who have capacity to birth are actually ever going to birth, and that we really are trying to get at a better taxonomy to talk about a variety of issues that impact people, regardless of what their reproductive capacity is. That's why reproductive justice is so important because it really allows us to have that precision that we're seeking in our language.

Women's health is a component, but not comprehensive of reproductive health and reproductive well-being. We don't want to be exclusionary at all, we want to make sure that LGBTQIA folks and non-binary folks and people who don't necessarily even believe in gender, understand that there are health services that we all should expect and have a right to, under human rights. One of the things that I think is really, really important that we think about is the language that we use when we're talking about services across the reproductive spectrum and to have some precision in that language.

Melissa Harris-Perry: Dr. Monica McLemore is the Associate Professor of Family Healthcare Nursing at the University of California, San Francisco. Thank you so much for joining us today.

Dr. Monica McLemore: Thank you for having me.

Melissa Harris-Perry: Okay, y'all, we wanted to hear from you on this as well. What has been your experience with reproductive healthcare? Have you felt seen and heard by your healthcare providers?

Emily: Hi, this is Emily from Alexandria, Virginia. I have been on some form of birth control with the exception of two pregnancies for about 20 years. I am thoroughly pro-choice, but my husband is not. He is [unintelligible 00:12:49] Catholic. It's something I try and respect. We just agree to disagree, at which point in a pregnancy life begins.

Evans: Hi, this [unintelligible 00:12:59] I'm calling from Las Vegas, Nevada. About 15 years ago, my then wife was pregnant and the pregnancy threatened to compromise her health, that it might have killed her. I had to go with her and she actually had to have a medical abortion performed. It was a very solemn worst moment for us, at the same time I'm glad that we did have the resources to be able to keep her alive and she's still alive today.

Jasmine: Hi, this is Jasmine from San Diego. It took me two years and three OBGYNs to get an IUD. The first two refused because I "had not used my uterus yet." I was 25 and can't imagine having a child at that time in my life. Instead of an IUD, I was prescribed multiple types of birth control that made me very ill. I finally found a good OB who listened and immediately scheduled my IUD. I'm now 31 and I still don't have any kids. I'm very thankful.

June: I'm June from Corning, New York. I want to say that planned parenthood was very important to me when I was in college. It gave me safe, secure exams and provide birth control responsibly.

Speaker 7: I've been able to take my reproductive healthcare for granted. Growing up with [unintelligible 00:14:10] I used planned parenthood for birth control, yearly exams and a termination of an unwanted pregnancy when I was 18, as well as the morning after pill in my 40s. I've used them before having health insurance and after having private insurance. I had private insurance before having my child and now into menopause.

I've used planned parenthood in and out of my care when I wanted privacy. I can't imagine not being able to make choices about what I want to do with my body based on my current situation in life. I've had so much freedom to choose and I worry for the future fertile aged woman who won't have the freedoms I did. It's wrong.

Melissa Harris-Perry: Thank you so much for sharing your stories with us and you can continue telling us about your experiences with reproductive health care at 877-869-8253 or send us a voice memo at takeawaycallers@gmail.com. We always love to hear from you.

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