Massachusetts is facing a maternal health crisis marked by worsening outcomes and persistent racial disparities despite being one of the most insured states in the country. Experts and advocates point to a combination of systemic underinvestment, hospital and birth center closures, and deep-rooted inequities as key factors contributing to preventable harm among mothers and infants.

Recent analyses highlight that Massachusetts, with nearly 98 percent of its residents insured, continues to struggle with gaps in maternal care, particularly for people of color. A 2023 study estimated that racial health inequities cost the state approximately $5.9 billion annually, reflecting systemic barriers that encompass the entire spectrum of healthcare delivery and experience. These challenges have been exacerbated by reductions in hospital capacity for maternal care and threats to coverage for vulnerable populations, including potential losses of MassHealth benefits for up to 300,000 residents under new federal funding changes. Since MassHealth finances a significant proportion of births in the state, these coverage constraints risk further worsening outcomes and disparities.

Midwifery-led care and freestanding birth centers have been identified by health professionals as effective models for improving maternal and infant health. Studies have shown that birth center care for low-risk pregnancies results in fewer preterm births, lower rates of cesarean deliveries, and cost savings compared with traditional hospital-based care. Such models also promote continuity, shared decision-making, and culturally responsive support, elements many argue are lacking in Massachusetts’ fragmented healthcare system. Despite this evidence, the state currently operates with only one freestanding birth center, which itself faces possible closure. Plans exist to reopen or establish additional centers in the coming years, but advocates stress these steps are insufficient and overdue.

Legislators in both the Massachusetts House and Senate have introduced bills aimed at bolstering midwifery education and securing sustainable reimbursement mechanisms for birthing centers. Proponents contend that continued delays in addressing these policy gaps represent a conscious choice that adversely affects families.

Beyond expanding birth centers and midwifery programs, calls for broader systemic reforms have gained momentum. Advocates urge the state government, healthcare providers, and insurers to follow through on forthcoming recommendations from the Maternal Health Access and Birthing Patient Safety Task Force. Priorities include workforce investment, protecting healthcare coverage—especially for those at highest risk—and increasing access to professional doula care, which has been linked to improved maternal wellness and outcomes.

As Massachusetts grapples with the intersecting challenges of fiscal constraints, systemic inequities, and healthcare infrastructure decline, stakeholders agree that comprehensive and coordinated action is essential to improve maternal health and reduce disparities across the Commonwealth.