Moves in Maternal Health Equity

May 23, 2023
There have been a multitude of actions taken by agencies, hospitals and health systems, and consortia to advance maternal health equity in the U.S.; president of Chartis Just Health Collective says the problem cannot be solved by one entity alone

There have been many moves toward improving maternal health equity in the past year. In August of 2022, we reported that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced an investment of over $20 million to improve maternal and infant health and implement the “White House Blueprint for Addressing the Maternal Health Crisis.” The funding will help reduce disparities in maternal and birth outcomes, grow and broaden the workforce caring for this population, increase access to care in rural communities, and support states’ efforts to decrease inequities in maternal and infant health.

“About 700 people die each year during pregnancy or in the year after,” we wrote. “Thousands of women each year have unexpected outcomes of labor and delivery with serious short- or long-term health consequences. Rural populations tend to have worse maternal health outcomes than individuals living in urban areas, and there are disparities experienced by racial and ethnic groups.”

Since then, there have been various efforts from agencies like HHS and health systems that focus on this dire issue. One example of these efforts is the University of Pennsylvania. Penn became home to the inaugural March of Dimes Research Center for Advancing Maternal Health Equity in January of this year.

We wrote in February, “Under the leadership of Elizabeth Howell, M.D., M.P.P., chair of the Department of Obstetrics and Gynecology in the Perelman School of Medicine, the center will leverage Penn’s research, technology, and partnerships to address racial disparities in maternal health outcomes—both deaths and serious medical complications—in the United States.

“In a story on the Penn website, Howell said one goal is for the center to develop a competitive process for maternal health equity research projects at Penn and elsewhere to receive pilot funding.”

Collaboration is the future

Duane Reynolds, president of the Chicago-based Chartis Just Health Collective, regarding racial disparities, says that “We know that there are disparities with Black birthing people in the United States that are three to four times greater than those of white birthing persons. We have a collective problem in the U.S. with this issue, in terms of our overall rates, but also then a problem with disparities that needs to be addressed. The timing of funding and policy change and healthcare change couldn't come sooner in order to really fix this challenge.”

As to whether or not more collaborations or consortiums focusing on maternal health equity will pop up in the future, he says, “The answer to that question is definitively yes. And, and the reason being is because this issue is very complex, and it's not going to be solved by one particular provider or entity. It is a really a community-based problem. There are four areas that I think require focus in order to get this right. The first is the administration of healthcare services. The second is intervention in upstream community level factors. The third is financing of maternal and infant care—the way in which we finance payments for services today needs to be revamped slightly in order to address the issue. And then the final category is state and federal policy interventions.”

When asked about influencing improving maternal health equity inside healthcare organizations, Reynolds comments, “When we're thinking about the administration of healthcare services, there are a few issues that I think are important for healthcare leaders to address first. One is improving access in areas that may have medical deserts—meaning a lack of providers that are able to care for maternal or infant childcare services. We need to make sure we understand where those deserts exist and come up with interventions that will help to solve that issue. The next is prenatal and postnatal planning and health education services. We need to ensure that moms and birthing people are well educated about the birthing process, knowing what they need to be doing in the prenatal stage and postnatal stage. The next thing is about new models of more culturally sensitive care, models that support additional ancillary providers. And what I mean by that is, we have seen that doulas and midwives have had a great impact on helping to reduce disparities. These individuals have been trained to communicate well and listen well to moms and birthing people during the birthing process.”

Using technology to move forward

“Additionally,” he adds, “as you think about these new models of care, consider things like 24/7 virtual triage to understand where there could be issues that would lead to potential challenges within the pregnancy process. Also, we need to make sure that we are automating and being proactive in our patient outreach so that we’re more tightly managing the birthing process, again, from prenatal to postnatal. Technology can be a great benefit in this area, making sure we have the platforms that support things like plan reminders, identification of resources for social needs that patients may have, and providing coaching services to moms or the people that may need a little bit more support through the birthing process.”

Reynolds concludes by saying that “Finally, as we think about technology, there is also the ability to incorporate data and analytics so that we are actually able to identify patients who may have risks associated with their pregnancy. Using things like predictive analytics to begin to evaluate and get ahead of any problems that could come down the pipe with a person’s first pregnancy.”

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