An urban maternity care desert, Washington DC is ground zero for transportation insecurity for maternity care patients and has some of the worst maternal health outcomes in the US.
DC reports 30.7/100K maternal deaths compared to national average of 23.5/100K, and while Black mothers make up half of births, they represent 90% of birth-related deaths in DC. Forty-nine percent of DC’s Black residents live in medically underserved areas compared to 21% across neighboring Maryland and Virginia, with the only hospital serving Wards 7 & 8 closing its obstetric ward in 2017.
Twenty-three percent of DC mothers receive inadequate prenatal care compared to national average of 15.5%, and 80% of the city’s health outcomes are related to social health determinants, versus 20% related to clinical care.
There is no quick solution to addressing the institutional factors driving negative maternal health outcomes in the DC area, particularly maternity ward closures or lack of options, but there are immediate opportunities to improve the circumstances and enhance the chances of safe and healthy deliveries for women in this region.
One of these opportunities is existing infrastructure. Babyscripts partnered with Lyft Healthcare to connect patients to ride-share services through the Babyscripts myJourney app, which patients are already using every day to support their pregnancy.
The program, a limited pilot that was founded by Lyft Healthcare, served expectant and new mothers receiving care through MedStar Health and GW-MFA, both DC-based. The primary concern for women in these underserved areas is not the process of childbirth itself, but the potential for emergency complications.
Frances Thomas, pregnant with twins, was especially focused on keeping her stress to a minimum during her high risk pregnancy, so as not to put any increased strain on her babies. Before Babyscripts and Lyft, she relied on a mix of insurance-provided rides and public transit to get to the doctor. When asked what her typical plan for transportation was, she said "Hope and pray that the Metro cooperates - it's sometimes...always...hit or miss.”
If a woman is relying on public transportation, friends, or family to get to her appointments, there is greater potential that she’s going to be late for those appointments or miss them altogether. Aleyah Johnson was in a car accident early on in her pregnancy, which took her car out of commission. She typically relies on family members for rides to prenatal appointments, but in her words, "You know how that is." Aleyah shared that she had less anxiety since having access to the Babyscripts-Lyft benefit: "I have not missed any appointments since I've had the free Lyft pass from Babyscripts. My rides have been great and peaceful.”
Public transportation is especially unreliable, and in the periods of extreme heat that often hit DC in the summer can be uncomfortable if not dangerous for pregnant users -- not to mention that emergencies rarely cooperate with the time tables of public transit. Using a ride-sharing service is more reliable, but can be prohibitively expensive for some, especially during surge periods. "Having a growing family in this economy can put a burden but this helped," one mother told us. Another shared, "I no longer have to worry about money when I'm planning my appointments. This Lyft pass has definitely made life so much easier."
A survey of those patients who have made use of rides through Babyscripts and Lyft Healthcare shows that more than half rely on a combination of public transportation and ride sharing services to get to doctor appointments. Over 40% supplement with rides from friends and family, with a quarter walking or biking to appointments.
Without easy access to the doctor, women may opt to forgo prenatal care, which can significantly contribute to pregnancy-related emergencies. For many who are working hourly jobs, it's simply not an option to take off for hours to attend a 20 minute appointment. With the Babyscripts-Lyft benefit, however, patients had to allocate less time for transportation to and from their appointments, which made it easier for them to attend. As one patient shared, "I no longer have to allow more for walking or biking so I can get there and back from the hospital in no time. Works really great for my busy schedule and make it easier to schedule appointments during the weekdays."
Many women in underserved areas fail to attend their postpartum appointment, missing opportunities for monitoring, screening and treating complications related to childbirth like postpartum hypertension. More than 50% of maternal deaths occur in the postpartum period, and postpartum visit attendance is a significant indicator of outcomes.
Through the collaboration between Babyscripts and Lyft Healthcare, Babyscripts users have an easily accessible transportation option for getting to their appointments, and have demonstrated high levels of engagement with the benefit.
Lakia Thomas suffers from sciatica, so getting a ride to the front door of the hospital was a godsend. After her c-section, the Babyscripts-Lyft benefit was even more helpful, since she was unable to drive herself to her postpartum appointments. She really appreciated her husband not having to take off from work to drive her: in her words, this benefit "helps you keep your independence."
While some providers and payers have ride sharing benefits available to their patients and members, engagement rates are typically low. This collaboration leveraged Babyscripts myJourney, an app that patients are already engaging with on a daily basis for information about their pregnancy and postpartum, to let users know about the Lyft Healthcare benefit. In the app, they fill out an assessment to find out their eligibility, get access to the benefit, and learn about the crucial importance of attending prenatal and postpartum visits.
To date, 148 patients have used the Babyscripts-Lyft benefit, citing cost savings and timeliness as two of the greatest benefits to using Lyft rides. At an average of 7.5 rides per user and $30 per ride, users are saving an average of $227 total — money that can now go to other necessities like groceries or diapers. "As a low income family it does help," one patient shared. "I have no drivers license and so it's been a hardship lately." Another said, "Rides are super expensive. So having free ones really helped me save some extra cash. I had two last week. And both days totaled almost $60. So great option to have. Super appreciative."
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