New Jersey lawmakers recently reviewed a pending bill that would require healthcare centers to screen pregnant individuals and those who have recently given birth for endometriosis. The bill, first proposed in January 2024, mandates screenings specifically for individuals with preeclampsia who show symptoms of endometriosis.

Endometriosis is a condition where tissue similar to the lining of the uterus grows in other areas of the body, causing painful symptoms. It has also been linked to maternal health complications: it can impact one’s ability to conceive, cause issues during early-stage pregnancy, or affect health post-pregnancy.

This bill is part of an effort to improve maternal outcomes and aligns with broader legislative initiatives in New Jersey aimed at enhancing women’s health services, including menstrual health programs.

“Menstrual health and maternal health are connected,” said Assemblywoman Shanique Speight, one of the proponents of Bill A1973. “I’ve worked on about 25 bills related to menstrual health, trying to understand the impact it has on women.”

As legislators discussed menstrual health, they began focusing on conditions like endometriosis and PCOS, recognizing their harmful effects. This led them to examine how endometriosis can affect pregnant women.

“Endometriosis can cause infertility, and it can create maternal health issues during delivery if it’s undiagnosed,” Speight explained. “When we started working on this legislation, my thought was to ensure patients are screened for endometriosis.”

New Jersey faces unique maternal health challenges. The state’s maternal mortality rate exceeds the national average, and it has one of the widest racial disparities in maternal and infant health. Black mothers in New Jersey are nearly seven times more likely than white mothers to die from maternal health complications, and Black babies are three times more likely to die before turning one.

While this bill could help address these challenges, overcoming systemic inequities requires ongoing work, supporters said.

Support Programs for Black Mothers

Enacting policy is only one way to improve outcomes. Several organizations across New Jersey are committed to reducing racial disparities in maternal and infant health through evidence-based education.

The Perinatal Health Equity Initiative, for example, offers programs for Black mothers to strengthen their support systems and deepen their understanding of best practices.

“The data in New Jersey shows that lack of continuity of care and insufficient patient-provider education are leading contributors to Black maternal deaths,” said Dr. Nastassia K. Harris, Founding Executive Director of the Perinatal Health Equity Initiative. “If we know where the gaps are, we need to focus on filling them.”

The initiative prioritizes breastfeeding education, therapy, community-building, and reducing preeclampsia risks.

Sistahs Who Breastfeed, one of the Initiative’s programs, provides a support group where Black mothers can connect with coaches and other mothers during their breastfeeding journeys.

“Seeing other Black women thrive in breastfeeding is empowering,” Dr. Harris said. “It helps you realize you can do it and provides a space for sharing stories you can’t tell others.”

Another program, D.O.P.E. Mamas, offers Black mothers access to therapists trained to help them navigate postpartum depression and anxiety.

“Black women often experience significant trauma during birth,” Dr. Harris said. “Becoming a new mother can be isolating, and we want to provide a safe space where Black moms can feel supported and loved.”

The Role of Doulas and Midwives

Doulas and midwives are also key to ensuring positive pregnancy experiences.

The New Jersey Breastfeeding Coalition (NJBC) works to improve breastfeeding outcomes by providing mentorship scholarships for underrepresented lactation professionals and collaborating with hospitals and community organizations.

Lorraine Mejias, President of NJBC, is also a doula who understands the vital role these professionals play in supporting mothers.

“The doula is the only professional present with the laboring person the entire time,” Mejias said. “In that first phase, we coach movement, breathing, and comfort. We make sure that if something’s off, the mother’s voice is amplified, and she is heard.”

Midwives also ensure mothers’ well-being during pregnancy and delivery.

“Midwives focus on helping women have natural births, seeing birth as a natural process,” Mejias said. “Their care model centers the mother, with everyone else as a support person.”

For Assemblywoman Speight, maternal mortality is a deeply personal issue. She has seen people in her community face hardships and stressed the importance of amplifying the work of doulas and midwives in underrepresented communities.

“I’m working on a public awareness campaign for doulas and midwives,” Speight said. “In communities like mine, doctors and hospitals often don’t inform patients that these services are available to them.”

Intersecting Policy and Community Engagement

To improve maternal health in New Jersey, particularly for Black mothers, both mothers and healthcare providers need to be informed. Doctors and nurses should not only be aware of racial disparities but also how these disparities impact Black women in their everyday lives, supporters said.

Dr. Harris argued that nurses should be “advocates” by staying up-to-date on best medical practices and examining their biases.

“As a health provider, I know that training can be outdated, and without continuing education, we may practice methods that are no longer relevant,” Dr. Harris said.

Engaging with the community is also crucial, health professionals said.

“There are many recommendations on improving our community, but who decided what the community needs?” Mejias said. “Are you actually working with the community to identify what they want, or are you assuming what’s best?”

After leaving clinical practice and working more closely with the community, Dr. Harris said she gained a broader understanding of where the issues lie.

“We need to work in ways that are culturally congruent—understanding the lived experiences of the community and using research from Black women who have said, ‘This is how we do this work,’” Dr. Harris said. “Until we make this a universal standard and invest in Black organizations doing this work, we will continue to be marginalized.”

By working directly with the community, policymakers and healthcare providers can improve maternal health outcomes. Communicating consistently with the people impacted by policies allows lawmakers to better understand the challenges people face and possibly prevent conditions like endometriosis and preeclampsia.

“We pass so many bills into law, but the most important part for me isn’t just crafting legislation—it’s making sure it’s implemented,” Speight said. “How do we get the data to know this is actually happening? I want to see the work being done.”

This story was produced as part of the Center for Cooperative Media at Montclair State University’s South Jersey Information Equity Project fellowship and supported with funding from the Independence Public Media Foundation and the New Jersey Civic Information Consortium.