Over 50,000 women are affected by maternal complications every year and about 700 die from them. Black women are 2-3x more likely to die than white women. Significantly, many maternal health outcomes are not determined by biological or genetic dispositions.
This system has been full of holes for a while – a mother giving birth to a child today is more likely to die in childbirth than her mother 30 years ago, and black women are more likely to suffer than white women. These racial disparities have existed since the 1940s.
Infant mortality rates have a been consistently lower – a positive sign, but also a symptom that our system disproportionately focuses on the health of the baby to the detriment of the mother’s heath.
MYTH: These rates are not about race but social class.
The maternal mortality rate for a college-educated black woman is 5.2 times that of a white woman without a high school diploma. Women of color are more likely to be on Medicaid, and the coverage for Medicaid is insufficient. Add cutbacks in private insurance and the lack of minority providers, who are more accessible to minority patients, and it’s impossible to deny the significance of race on maternal health statistics.
There is a critical need for support systems outside the hospital.
Pregnancy-related deaths often don’t happen in the hospital – only 17% of deaths occur on the day of delivery. About a 1/3 happen before birth, 19% in the week following, and the remainder occurs any time in the year following childbirth. Improving the hospital system is not enough.
There’s a variety of reasons that mothers die outside the hospital. Some of them are clinical, but many are related to other determinants of health, like depression, highlighting the importance of support outside the hospital system.
40% of women don’t even go to their postpartum visit, raising questions about what women really need in the way of postpartum support and indicating an area of opportunity for improving outcomes.
So what can we do?
● Expansion of Medicaid coverage is low-hanging fruit. Some motions have been made on the federal level to make it easier for states to extend coverage for postpartum mothers, but policy-makers need to take a more aggressive role.
● Focus on the community support system, not just the hospital. Establishing community-based doula and health worker programs to help support women prenatally and after birth is an important step to improving overall outcomes.
● Start talking in terms of women’s health, not just maternal health. Maternal mortality is not a problem of maternal health, but women’s health through a lifespan, yet 50% of women who come to the doctor for pregnancy don’t have a primary care provider. Their visit to the OB is often their first encounter with the healthcare system.
Covid-19 has challenged healthcare professionals to use tech in different ways. Innovative startups are helping leverage tech for maternal health to drive better outcomes.
Three innovators shared insights on their approaches to improve women’s health, identifying several important common threads:
“Mahmee has started to invest in an expanded content library that otherwise would have been handed to the patient at the in-person visit (around prenatal care, breast-feeding, mental health).” – Melissa Hanna of Mahmee
“Jollitot has made sure that women are empowered with culturally competent information that is accessible for everyone. That means providing content at multiple reading levels, and enhancing and simplifying written content with videos and visuals.” – Sean Usman of Jollitot
“A lot of young people spend time on the internet to figure out their symptoms — they don’t have experience with health systems, they might be embarrassed about asking for help — there are any number of reasons to prevent them from seeking out professional health. Kiira doesn’t provide clinical advice but a medium through which young people can be guided to the right resources and health professionals.” – Chrystal Evuleocha from Kiira
“Since Covid, Mahmee has been sensitive to changes in bandwidth and the need to accommodate different technologies. Translation services have also been a need as visit have transitioned from in-person to video.” – MH
“7 million birthing mothers live in an area with limited or no access to maternity care. And women in both rural and urban communities lack access. It’s not just a rural problem. Jollitot offers remote blood pressure monitoring to allow women to take their BP from wherever, with the knowledge that their provider can always see these data. This way of care is not limited to the provider’s office, but extended outside the office and accessible at all times.” – SU
“Kiira provides a platform through which a young person at a college or university can connect via phone, video and chat with health professionals. This serves as an extension of the school health center, especially important right now as schools are trying to keep students safe on campus.” – CE
“On the clinical end, Mahmee has partnered with people in the community to expand the referral base. If you’re seeing high screenings for mental health, the responsible clinical response is to connect that patient with resources in their community.” – MH
“Jollitot partners with healthcare providers and payers to improve care coordination. Women are given access to risk surveys that are communicated back to the provider and payer team, and they are immediately connected to the care team. The best way to empower women is to give them access to information and ensure that they are supported across the continuum.” – SU
From Hospital Providers:
Not every patient experiences the hospital system in the same way, so hospital providers need to use data to understand how patients are experiencing the system, and how patients can better be heard.
Covid especially brought racial disparities to the foreground. It’s incumbent on hospitals to be capturing the data around race, ethnicity, zip codes, etc., so that we can look at the data and figure out how to improve.
Covid has also encouraged hospitals to innovate and think outside the box.
For example, a pediatrician doesn’t automatically come to mind when considering maternal health. But pediatricians take care of families. The data shows that 60% of maternal mortality is tied to after birth — and pediatricians are set up to take care of mothers at those times. Early childhood mental health resources for women prepare them to head into their child’s adolescent stages.
Hospitals are setting up community supports to help build trust and security between patients and medical providers, and they rely on parent engagement and participation. Hospitals need partnerships with communities to understand and support maternal health, and health system programs need to be more collaborative to meet the needs of patients.
Are there ways to make sure that all hospitals are offering equitable care to mothers?
● Integrate and elevate the patient voice. It requires an investment of time and resources and finances, but it is the only way to move forward.
● Centers for health justice. So many of these things are not about the service line but the culture of the hospital system in general — we need global implicit bias training for everyone — from people at the front desk to the doctor. There needs to be a change in the culture itself.
● Take it upon ourselves to learn the inequities and disparities that exist in our health system. Learn through reading but also through talking to patients.
What are recommendations for young leaders coming into the medical field?
Maternal health and women’s health is one of the most critical areas to focus attention on — women make up 50% of the population and they also make most of the health decisions for the family. It’s an important lens through which hospitals should look at the problem.