The data is in and it's alarming: with the pandemic putting increased pressure on health systems and complicating access to care, the number of women who died during pregnancy or shortly after rose 40%, increasing the country’s already unpardonable rates to 33 deaths per 100,000 live births.
One of the most shocking things to come out of this report is continuing trends of higher mortality rates for BIPOC and low-income mothers, despite concentrated efforts over the past several years to close disparities in maternal health.
It points to the need for solutions outside of the clinical sphere. Though there are pockets of the country where quality of care is lacking, for the most part, women are receiving the same care regardless of their healthcare provider.
To get to the root cause of the disparities, we need to look outside the clinical experience. We need to be delivering holistic care that addresses the whole person, including social determinants of health before, during and after nine months of pregnancy.
With the goal of addressing food insecurity, one of the most urgent of these social risks, Medstar Health partnered with Babyscripts to understand patient barriers to utilizing WIC.
WIC is a Special Supplemental Nutrition Program for Women Infant and Children that provides nutritious foods to low-income women, infants and children up to age 5. According to the most recent data, only 57% of eligible recipients are enrolled in WIC nationally.
Medstar Health obtained first-hand patient perspectives of the WIC enrollment process and utilization of benefits using both focus groups and survey data collected through Babyscripts. The goal was to fill the gap in patient-centered research on this topic, and increase ultimately increase patients’ understanding of and utilization of the resources available to them.
Babyscripts created a needs assessment for MedStar Health, based on research completed via provider surveys and family focus groups, to understand barriers and opportunities for education and enrollment in WIC. Babyscripts also facilitated recruitment for the event, with over 200 interested participants.
An additional survey launched through a collaboration between Babyscripts, WIC, and MedStar Health focused on barriers to enrolling in WIC and retaining WIC benefits. The survey was sent out to DC mothers enrolled in Babyscripts.
The collaborators found that patients encounter misinformation about eligibility, difficulties applying for coverage, and confusion about WIC approved foods. In focus groups they heard the following:
Remote options during the pandemic made the enrollment process easier:
“I called the WIC center and basically told them I was confirmed pregnant, so they scheduled an appointment for me to have someone call me and go over everything. So it was pretty easy for me.”
Sources of information on DC WIC were gained largely from family and friends:
“I heard about it from my mom; she had WIC with me and my siblings when we were younger so now I use it for my two daughters.”
“My mom said they’ll help you out…cause I was going to pay for it when I first had my son. She was saying I don’t have to pay…And people inside the hospital helped me sign up for WIC.”
Stigma, and the difficulty of matching allowable grocery items with store availability, decreased the likelihood of utilizing WIC resources:
“When I get to the counter it’ll just be like WIC doesn’t cover this…it don’t approve it. And I never understand how they don’t approve something they are saying I’m supposed to get.”
A desire to be heard better by pediatric providers and WIC staff and for improved communication between the two:
“I feel like some nutritionists be trying to gaslight people, because my son…his body was not taking the Simulac…He was losing weight…I was like this was something that [the nutritionist] told me to use.”
“I got so fed up with it. I just started buying it myself, because it’s like, I’m not about to keep trying to convince a doctor that I’m going to try my son on whole milk.”
Thirty-one participants completed the survey conducted through Babyscripts, with the following results:
- 71% were not enrolled in DC WIC; 29% were enrolled
- 55.6% of individuals learned about DC WIC through their doctor’s office
- 69.6% stated the best way to learn about WIC would be to have educational resources online of those who did not have WIC, while 60.9% preferred to have providers educate
- 43.4% of participants stated a helpful way Babyscripts could help improve the DC WIC process would be to allow a method of communication to their healthcare providers
Though there is still a lot of work to be done to remove challenges to WIC utilization, these results show that there is a tremendous opportunity for digital health to improve access to food education resources.
In response to the results and needs from Medstar Health and our customers working with the underserved, Babyscripts created a survey that identifies WIC eligibility, educates patients about the importance of proper nutrition and the availability of resources, and connects them to the right support services.
Reaching mothers in the spaces where they already turn for information — their phone and their provider — represents the best opportunity to improve barriers of food insecurity.
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