A new study published in AJOG (March 2024) sparked a huge response in the maternal health field by suggesting that the maternal mortality rate may be much lower than previously estimated: 10.4 per 100K live births versus the CDC's most recent reported rate of 32.9/100K.
The many concerned responses centered around the wording of the study, which some considered to trivialize the issues facing pregnant women in the U.S.
But those responses missed something perhaps more concerning: regardless of aggregate changes in the maternal mortality rate, the reported disparity between White and Black deaths remained the same. In both estimates, Black women are calculated to die of pregnancy-related complications at 2-3X the rate of their White peers.
These racial disparities speak to a fundamental problem at the heart of maternity care delivery in the US: a problem that Black Maternal Health Week (April 11-17) was established to shed light on. Black mothers face different risks from their White peers, and we have to build care models to address those specific risks if we're going to close the gaps in outcomes and deliver equitable care.
What do those care models look like? We see lots of headlines that highlight the high rates of Black maternal mortality, but what lies beyond the headlines? Why do these disparities occur and what can be done to address them?
BLACK WOMEN HAVE HIGHER SOCIAL RISK
When compared with White women, Black women are far more likely to experience social risk that impacts their ability to access and receive care. Black maternal health outcomes and use of medical care show that in comparison to White women, Black women are
- More likely to be uninsured;
- More likely to fall in the coverage gap because a greater share live in states that have not implemented the Medicaid expansion; and
- More likely to face financial barriers in accessing care.
These barriers complicate access to care, contributing to lower rates of prenatal visit attendance in Black communities, which can lead to higher rates of preterm birth, low birthweight, and increased infant and maternal mortality.
SOCIAL NEEDS DON'T TELL THE WHOLE STORY
Black women have more biological risks than their peers, many of them related to blood pressure:
- Black women experience higher rates of preventable and chronic diseases including diabetes, hypertension and cardiovascular disease;
- Black women are three times more likely to have fibroids (benign tumors that grow in the uterus and can cause postpartum hemorrhaging) than White women; and
- Black women display signs of preeclampsia earlier than White women.
In addition to biological inequities, structural inequities and racial discrimination are sources of chronic stress among Black women, and partly responsible for the persistence of racial health inequities. One manifestation of this is the prevalence of white coat syndrome in Black women -- a condition where anxiety around a doctor manifests as abnormal spikes in blood pressure -- which complicates the ability to correctly assess risk for blood pressure related complications.
[Read: Babyscripts Eliminates Racial Disparities in Blood Pressure Capture]
TAILORING CARE TO RISK
To solve these disparities, we need to focus on delivering tools to Black women that are specific to their unique needs. To address the gaps that occur in traditional care spaces -- as well as prevalent distrust of the healthcare system in many Black communities -- we need to empower Black women with the education and tools to support a healthy pregnancy and postpartum alongside traditional clinical care.
Data-driven, digital tools can deliver objective solutions and reduce the opportunities for implicit bias. Solutions like remote patient monitoring, virtual doulas and mental health assistance can bridge the gaps in access to care; and technology can also connect women to aid for non-clinical risks tied to social determinants of health, such as stable housing, food and nutrition access, job security, transportation and others.
POLICIES TO DRIVE EQUITABLE CARE
Comprehensive policy changes are also necessary. The expansion of Medicaid in all states could reduce the coverage gaps that disproportionately affect Black women, providing broader access to essential prenatal and postnatal care. Additionally, policy-makers and healthcare providers must prioritize culturally competent care that addresses the unique needs of Black mothers. This includes recruiting and training more Black healthcare professionals and ensuring that all healthcare providers are educated on the impacts of racial bias and systemic discrimination.
Support for community-based programs should be a priority for policy-makers. These programs can offer support networks and resources tailored specifically to the needs of Black mothers. Initiatives like group prenatal care, which has been shown to improve birth outcomes by fostering a supportive environment and facilitating shared learning, are examples of how community-driven approaches can make a significant impact.
The commitment to addressing these deep-seated issues must also include ongoing research to better understand the many causes of maternal health disparities. Only through a multi-pronged approach that combines policy reform, community engagement, and rigorous research can we hope to see a significant reduction in disparities and healthier future for all mothers.
Interested in learning how Babyscripts improves health equity and access to equitable care? Schedule a call.
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