CITY COUNCIL

The new majority

Women finally make up most of the New York City Council. How will that change the body’s priorities?

By Annie McDonough

WITH 31 WOMEN, the New York City Council has for the first time in its history a female majority. And with City Council Speaker Adrienne Adams, the body will be led by a woman too.

The women who are returning to the council or joining it for the first time have long lists of legislative priorities that cut across gender identities – from police accountability and education equity to affordable housing and transit accessibility.

But for some of the women who make up the council’s new female majority, the new session represents an opportunity to bring increased attention to issues such as the maternal mortality crisis and stubborn pay disparities – so-called women’s issues, even if the term is a bit of a misnomer. “They’re not solely our issues, they’re everyone’s issues,” said new Democratic Council Member Marjorie Velázquez.

As several council members pointed out, it’s not the case that these kinds of issues have been previously ignored by council members. The City Council has allocated money to an abortion access fund in the past, and both the state and city have introduced plans to confront maternal mortality – though follow-through on those plans has fallen short of health advocates’ hopes. But with more women in the City Council than ever, some members said there’s now a better chance of seeing action on these and other issues that primarily affect

The group 21 in ’21 hoped to elect 21 women to the City Council. They far exceeded that goal.

women. “We have more expecting and new young parents and mothers in the council. We have people who are the primary caregivers in their family,” said Democratic Council Member Carlina Rivera. “The issues that we take on will be very, very intersectional. Anti-racist, anti-poverty, focusing on supporting families.”

Maternal mortality is one area in which the City Council and New York City Mayor Eric Adams may have an opportunity to work together. Adams campaigned on a promise to increase access to doulas, particularly in parts of the city with low access to health care and higher risk factors. Research has shown that support from trained professionals like doulas during pregnancy and childbirth can help improve health outcomes and experiences for mothers.

Black women in particular have been found to have higher rates of maternal mortality. A 2020 study from the New York State Health Foundation found that Black women were more than twice as likely to experience potentially life-threatening complications during or after childbirth. The mortality gap is even higher.

The issue hits home for members including Velázquez, who represents Bronx neighborhoods including Pelham Bay and Throggs Neck, and Democratic City Council Member Rita Joseph, who represents parts of Central Brooklyn. In recent years, the Bronx and Brooklyn have had the highest rates of severe maternal morbidity, defined as experiencing life-threatening

conditions during pregnancy.

Joseph campaigned on advocating for universal access to doulas. “I’m a Black woman, I made it out, thank God, but there are so many others that do not,” said Joseph, who has four children. As Joseph points out, doula services are not currently covered by Medicaid in New York – though the state did experiment with a pilot program offering some reimbursement for doula care in Brooklyn and Buffalo. Adams has proposed his own city-funded pilot program to offer free doula services – potentially fully funded through the city’s budget if partial Medicaid reimbursement couldn’t come through.

Velázquez, meanwhile, said that one of her priorities is securing a women’s and children’s health center in the Bronx, a type of facility it currently lacks. “We can get there through talking to Health + Hospitals, but more importantly, looking at it as a capital project and just delivering those funds through there,” she said. A second step, Velázquez said, is ensuring birthing centers are fully staffed and fully funding public hospitals in order to do so.

During the pandemic, Rivera was among those who advocated for doulas to be classified as essential workers so that they were able to be present in maternity wards. “I’m not sure why we have to fight to make that classification necessary,” she told Gothamist last year. “But it’s certainly something that we’re proud of.” Rivera said she plans to reintroduce a bill in the council that would mandate hospitals develop and communicate clear guidelines regarding visitation in public health emergencies to ensure people in labor can have access to birth workers whenever possible.

The COVID-19 pandemic also made clear that caregiving work – both for children and the elderly – more often than not falls on women. The Centers for Disease Control and Prevention reported that 2 in 3 caregivers in the country are women. Women also left the workforce at higher rates than men during the pandemic, often to take care of children out of school and day care.

While New York City has made strides with universal pre-K, some council members said there’s still work to do

Council Member Rita Joseph has called for action on pay equity.

JOHN MCCARTEN/NYC COUNCIL MEDIA UNIT to provide accessible and affordable child and family care support across the city. “I know that for myself, we’re sort of in that sandwich generation, where we’re taking care of our kids as well as parents,” said Linda Lee, a new Democratic council member from Eastern Queens. Lee praised the previous administration’s work on universal pre-K, but said that support for people taking care of older relatives is lacking and she’s looking to beef up the city Department for the Aging’s budget. “I’m looking at this from a preventative measure, how can we put systems in place to take care of our elderly,” Lee said. Lee, who comes from the nonprofit sector, added that she went back to work three months after giving birth and found that few child care centers accepted children that young. “Those places that are willing to have child care for three months and up, how do we support them more?” Lee asked. “What are some of the barriers that they’re facing? … If you’re not looking for those services, you wouldn’t know.”

The three Republican women who are joining the council – Inna Vernikov, Vickie Paladino and Joann Ariola – did not respond to requests for comment for this story. But several other members who spoke to City & State said they anticipate working with those members to address issues that affect women. Lee said she has spoken with Paladino, whose neighboring Queens district resembles her own in having a large elderly population. “In that sense, we both share the same concern of what’s going to happen with the older population,” Lee said.

Sandra Ung, a new Democratic council member from Flushing, has said that a top legislative priority is expanding language

access for city services and programs. It’s a problem she has encountered in trying to help her own parents, who are immigrants, navigate city services. She said providing services to the elderly or child care programs doesn’t mean much if they’re not accessible to all New Yorkers. “Before they roll out a program, they think, ‘Oh, we’ll figure out the language access later,’” Ung said of the city’s current approach. “When you roll out a program without figuring out the language access part to it, people (for whom) English is not their first language, they’re not going to get the benefit of the resources.” Access to safe and affordable abortions “They’re is another issue lawmakers are hoping to shine a light on. While New York codified not solely our issues, protections of Roe v. Wade in state law in 2019 with the Reproductive Health Act, affordability and access barriers still rethey’re main. In 2019, the New York City Council everyone’s issues.” first allocated $250,000 to the New York Abortion Access Fund, which provides financial assistance to clinics who see patients who can’t cover the costs of abortions. Rivera said that that funding should continue. “I think it should be baselined – New York City in the city budget,” she said. “I think it’s

Council Member Marjorie Velázquez, on maternal mortality and gender not only proven to be helpful, it’s been a model for the rest of the nation.” Several council members also said that pay disparities addressing pay disparities across the city is crucial. Pew Research Center data showed in 2020 that women in the U.S. earned about 84% of what men earned. While the council has passed laws aimed at addressing these gaps – the council passed a bill at the end of the last session that requires salary ranges to be included in all job postings – one avenue city lawmakers might have to attack pay gaps is through their own workforce. A report mandated by a 2019 city law found that within the municipal workforce, the median salary for men is $21,600 higher than the median salary for women, while the median salary for a white employee is $27,800 higher than for a Black employee and $22,200 higher than for a Hispanic or Latino employee. “I don’t want it to be a hashtag,” Joseph said of pay equity, referring to the pithy calls for parity that tend to circulate on social media on Equal Pay Day, March 7. “I want it to become a reality.”■

This story is published in partnership with New York Focus.

Birth Rights

Gov. Kathy Hochul put advocates in a tough position on a licensing law for midwifeowned birth centers.

By Lee Harris

BUFFALO DOULA SERVICES L AST YEAR, the state Legislature unanimously passed a bill to clear regulatory hurdles midwives face when attempting to open a birth center.

The legislation passed by the state Senate and Assembly would have allowed midwives to rely largely on approval by a national accrediting body when seeking a license from the state Department of Health. The department had previously issued licensing requirements so onerous that not a single prospective midwife-led birth center had completed an application.

But before signing the bill, Gov. Kathy Hochul insisted on keeping licensing power with the health department, reintroducing complex criteria that the bill was meant to bypass. It was the latest instance of the new governor’s reliance on chapter amendments – late-stage tweaks or wholesale overhauls of bills – to negotiate with progressives behind closed doors, where she keeps most of the leverage.

The bill sponsors said the amended bill was still an improvement on the status quo. “We didn’t get everything we wanted. But I think the situation will be a lot better going forward,” Assembly Member Richard Gottfried, the Health Committee chair, told New York Focus and City & State. “In legislation, you take half a loaf.”

The issue split birth advocates, who said that at a last-minute meeting in December, sponsors gave them a choice between accepting the amendments or risking the governor’s veto.

One camp reasoned that the amended legislation would still give them a foothold to negotiate future regulations with the health department. Others favored letting the governor reject the bill and starting over with a public pressure campaign, rather than pursuing the insider strategy they said the bill’s sponsors urged.

MATERNAL MORTALITY

There are no birth centers in New York run by midwives, and fewer than five free-standing centers – facilities not located in hospitals – in the state.

It hasn’t always been this way, in a state that helped launch the natural birth movement of the 1960s and ’70s. There have been a spate of closings in the past two decades. Soho Midwives, the Elizabeth Seton Childbearing Center and Bellevue Birth Center all closed in the 2000s. Hospital closures followed: St Vincent’s in 2010 and Mount Sinai West Birthing Center in 2018.

Childbirth has also gotten riskier. New York City’s cesarean section rate soared by 36% between 2000 and 2007, according to the

state health department. While C-sections are the best approach for many pregnancies, the surgery comes with a higher risk of death, infection or complications like blood clots, compared to vaginal birth.

Alone among developed countries, the maternal mortality rate in the U.S. has increased in recent years. That rate, a key public health indicator, is dramatically higher for Black and Hispanic women. Between 2006 and 2010, Black women in New York City were 12 times more likely to die from pregnancy-related causes than white women. The disparity is multicausal: racism and medical discrimination, access to health care coverage and high blood pressure all play roles.

Midwives have been shown to improve outcomes for low-risk pregnancies. Birth centers are understudied in the U.S., but in the U.K., where the National Health Service offers midwives at home or in free-standing centers, a study found that healthy women who gave birth in birth centers were less likely to have a C-section, episiotomy, forceps or vacuum delivery, while mortality outcomes were roughly equal.

Why are birth centers so rare? One key reason is cost: Midwives are exposed to the same liabilities as obstetric units, but perform fewer billable services.

In New York, another top obstacle had been that midwives could not operate their own centers; they had to be supervised by medical doctors. The state passed legislation in 2016 to change that, but the state health department took years to issue new rules.

ONEROUS GUIDELINES

The pandemic spurred interest in births outside of hospitals. Under pressure, then-Gov. Andrew Cuomo put together a COVID-19 Maternity Task Force, which told the health department in April 2020 to finish the licensing process on an accelerated schedule. The department issued a new accreditation process in June 2020, but the regulations were so tough that not a single prospective birth center completed an application.

Advocates said that was because the rules were better suited to major hospitals than small birthing rooms. Birth centers fall under Article 28 facility requirements in New York, a condition for receiving Medicaid reimbursements. The licensing process requires midwives to win approval through the Certificate of Need (CON) application process run by the Public Health and Health Planning Council.

“The CON and licensure process in New York state is the most onerous and expensive in the U.S.,” said Jill Alliman, a director at the nonprofit American Association of Birth Centers. Other states exempted birth centers from the CON process. In New York it is so complex, she said, that most entities hire a consultant to complete it.

In a statement, the health department said that the CON is necessary to ensure applicants meet safety criteria.

“The intent is not to create a burden but rather to make sure that a proper standard of care is being met across New York state. This also helps to protect each of the provider groups to make sure standards are upheld by all entities,” the department said.

“The intent is not to create a burden but rather to make sure that a proper standard of care is being met across New York state.”

Instead of vetoes, Hochul tweaks legislation with chapter amendments.

Maura Winkler is a midwife who opened a birth center in Buffalo that has received national accreditation from the Commission for the Accreditation of Birth Centers, but is facing delays in the state CON process. She submitted her application, she said, but hasn’t heard back.

The financing requirements of the application are also overkill, Winkler said. Under current working capital guidelines, a birth center must estimate its third-year expenses and show that it has two months of that budget on hand before it has opened its doors to patients. Only half of that capital can be borrowed. Winkler said that’s burdensome and shouldn’t apply to small, low-overhead facilities like birth centers.

“I’m not building a facility from scratch that costs millions of dollars,” Winkler said. “It’s a remnant of (the Public Health and Health Planning Council) wanting to know that hospitals have the money to build new facilities so that they don’t get halfway into building it and then run out of money.”

Brooklyn-based midwife Trinisha Williams had been trying to open a birth center in New York City for years but doesn’t see the point in holding a signed commercial lease – another requirement for the application – while she waits for the state to review the application.

“We actually had found a commercial property, and we had started a conversation (about renting a space),” Williams said, a tricky feat in Brooklyn’s volatile rental market. “But when we tried to call the Department of Health to ask questions about the application, no one got back to us for two or three weeks. I was like, you want me to pay for a commercial lease, $9,000 a month, to just sit and wait? I don’t have money like that.”

The Public Health and Health Planning Council is also a source of frustration. The council has a broad array of advisory and decision-making responsibilities related to New York’s health care system, but midwives and advocates of natural birth are not represented on it.

“It goes back to this patriarchal view that doctors need to be in control,” Winkler said. Others see it as a conflict of interest: Birth centers must go up for review and approval from doctors representing the major hospital systems with which they would be direct business competitors.

CHAPTER AMENDMENTS

In May, after months of activism by midwives, legislation intended to streamline the licensing process passed the state Senate and Assembly.

As passed by the Legislature, the bill was meant to make the health department rely primarily on national standards from the Commission for the Accreditation of Birth Centers, which does not require, for example, proof of year three working capital. The state might have required additional basic information, like name and address, but the hope was that the department would rubber-stamp the approval of a national accrediting agency.

But after the bill passed, the governor did not sign it. Months went by, and advocates heard that there was pushback from the executive.

“We were under the mistaken impression that something having passed unanimously would hold a lot of weight for the governor’s office,” said midwife Whitney Hall, president of the New York State Birth Center Association. “Honestly, it never occurred to us that they wouldn’t sign it. It was bizarre.”

When she read the first round of proposed chapter amendments, Hall said, “I was heartbroken.”

That wasn’t the bill’s final form. The executive was pushing to add language specifying more application criteria, and explicitly mentioning Public Health and Health Planning Council’s role. Bill supporters pushed back, including Neelu Shruti, a doula and birth justice advocate studying midwifery, and doula Myla Flores. Bruce McIntyre, who set up a birth equity foundation after his partner Amber Rose Isaac died in childbirth, also emerged as a prominent voice for Black maternal health.

Activists involved with the legislation were at first advised by Gottfried’s office not to push the governor’s office on the issue, Shruti and Flores both said in in-

terviews. After Thanksgiving, they said, activists were getting impatient and were advised to apply public pressure – cautiously.

“By Thanksgiving, we were like, well, what’s happening? It’s almost the end of the year,” Shruti said. “They were like, ‘Yeah, I guess you can push. But also, they were saying, ‘Don’t go stand in front of her office.”

Hall said Gottfried and state Sen. Gustavo Rivera’s offices suggested advocates pursue a more conciliatory strategy, but stopped short of telling them what to do.

“They directly said what it would feel like to them if someone was advocating outside of their office. And they used the word aggressive – ‘That feels aggressive.’ So, they don’t tell us what to do, they just tell us what their perception of it is,” she said.

Asked about the claim that his office advised against protesting in front of Hochul’s office, Rivera said, “I did not discourage anyone from doing anything publicly like that.”

He added: “Sometimes there’s highstress moments in which there might have been some disagreements on the tactics. But ultimately, I will not discourage folks who want to advocate publicly for something, if they feel it is effective.”

HIGH-PRESSURE NEGOTIATIONS

A back and forth over the amendments carried on through the winter holidays. On the night of Dec. 30, Rivera’s office held a last-minute meeting with Hall, Shruti, McIntyre and Flores. At the high-pressure meeting, the office presented the amendments as a final offer.

“The deal was, take it or leave it. It’s a veto, or you accept these amendments,” Shruti said. “It was extremely secretive, because they were saying, you can’t share these documents with anyone, you can’t talk to anyone.”

Rivera’s office said that if they wanted the veto, they could try again. “But they were very discouraging of that option,” Shruti said, and suggested it might get “flagged” in the future, if it failed at this stage.

Staff also urged advocates to stay in close contact with their office as regulations were issued, which Flores found persuasive.

“At least it wasn’t terrible. It’s half decent,” Flores said. “When I saw the language saying that the goal is to harmonize what exists now, here in the state, with what exists nationally, to ultimately serve the intention of the bill, I was like, OK … let’s see what this can do.”

Shruti disagreed: “I personally was like, this is absolutely not what we want. Just get a veto and then really challenge her in an election year to do the right thing.”

“The birth world is not super politically savvy,” Shruti added. “Now, the governor gets a lot of credit for signing this bill. Both sponsors get a lot of credit for signing this bill. And advocates are now afraid to challenge them to say this bill wasn’t what we wanted because now they’re afraid that this regulatory process isn’t going to go as planned.”

The New York State Birth Center Association, of which Flores and Hall are both members, held an impromptu call shortly after the meeting, Hall said. Members who joined the call were split over whether moving ahead despite the amendments had been the right choice.

LEGISLATION SIGNED ON NEW YEAR’S EVE

“The Department of Health and the Certificate of Need process play a critical role in safeguarding patients and staff in healthcare facilities by requiring applicants to meet certain safety standards and criteria. I have secured an agreement with the Legislature that maintains the legislation’s intended streamlined licensing process for midwifery birth centers, while also balancing the need for adequate oversight from the Department,” Hochul wrote in an approval memo on Dec. 31.

The final version of the bill gave the health department power to use additional licensing criteria, including evidence of the capability to fund renovations and construction costs, as well as life, safety and building standards. It also stated explicitly that some of the standard requirements for an Article 28 license, like an assessment of an owner’s “character and competence,” will apply.

“The real debate was about life and safety criteria, because that concept can be used to impose onerous limitations that are really not necessary for something like a birthing center,” Gottfried said.

Birth center advocates – including several who ultimately supported the decision to forge ahead despite the amendments – now fear that codifying these criteria in the bill could replicate the lengthy and expensive process of the past. They also fear that delays in the review process could persist.

“It’s a fair concern,” Gottfried acknowledged. “The question is, does the bill, even with the chapter amendment, represent a

A baby is weighed at Buffalo’s only independent birth center, run by Fika Midwifery.

step in the right direction? And I think it clearly represents a big step.”

On the final outcome, he added, “I am glad we were able to negotiate with the governor to secure her signature rather than have the bill vetoed, which could kill any movement on a topic for years.”

In negotiations, bill sponsors pushed to add language requiring that health department regulations be developed in consultation with midwives. The final legislation required rules to be “harmonized” with accrediting bodies.

Hall supported moving ahead with the chapter amendments, but said she’s only cautiously optimistic. While she said the state’s new executive leadership should give midwives hope, she worries that the health department has historically misunderstood the obstacles.

“The lawyers that work for the department of health have an interpretation of the law that’s pretty restrictive,” she said. She’s waiting for the published regulations to see whether those attorneys’ interpretation wins out. “Do they really see the problem? I think the governor’s office does. I have faith that (Health Department Commissioner Dr.) Mary Bassett does.”

Winkler said she worries about the fuzzy language. “Are they going to truly ‘harmonize’ the requirements with (the Commission for the Accreditation of Birth Centers)? And if they don’t, how do we prove to them that they aren’t, how do we hold them accountable to the law?”

CHAPTER AMENDMENTS BECOME MORE COMPREHENSIVE

Democrats hold supermajorities in the Assembly and state Senate, and both chambers have been emboldened by a new governor reluctant to alienate her left flank. A closer relationship between elected officials and the governor could mean that advocates are asked to forgo outside pressure for a more inside baseball strategy.

Chapter amendments have been more sweeping under Hochul, said Blair Horner, executive director of the New York Public Interest Research Group, a nonprofit state policy organization.

“It seems to be, in some cases, complete overhauls of the bill. It’s unusual,” Horner said. He pointed to “dramatic” changes to other bills requiring health department involvement, including a bill for an antibiotic stewardship program in hospitals and nursing homes, and legislation on unregulated contaminants in drinking water.

When the governor threatens to veto a bill, legislators still have a last-ditch option: A veto override. But that alternative is almost never used – a fact that many attribute to the institutional bias in New York politics toward the executive.

The Legislature can only subtract or delete items from the executive budget. It could decline to approve the budget if the executive refuses to add key priorities, but that would be a risky step.

“If it were a legislative budget, the governor would exercise the veto, which puts the Legislature in the driver’s seat. This is the opposite,” said Phil Steck, an Assembly member representing Schenectady. “So when it comes to chapter amendments, the Legislature often fears there will not be cooperation in negotiating the budget if there’s not cooperation in doing the chapter amendments.” ■ Lee Harris is the editor-at-large at New York Focus.