Health Care News

Addressing America’s Maternal Health Crisis

Today’s guest blog post is by NACHC intern Eskedar Girmash.

We asked NACHC staff to describe their mothers. Responses included: brave, strong, kind, funny, selfless, young spirited, and loving. Mothers are an integral part of our lives and we’re excited to celebrate them this coming Sunday. Along with the observance of Mother’s Day, we would like to highlight the increased focus among the media and health experts about the issue of maternal mortality rates. 

Elsewhere in world maternal mortality rates are dropping, but America is facing a maternal health crisis. Earlier this week the Centers for Disease Control and Prevention reported that for every five mothers dying in the United States from pregnancy and childbirth, three could have been saved if they had received better medical care. 

Maternal mortality rates in the U.S. have more than doubled since 2000  at 700 deaths a year. Minority women are disproportionately affected. Black women are 3 to 4 times more likely to die during childbirth compared to Non-Hispanic White women. Surprisingly, these trends hold true regardless of education level and socioeconomic status.  Studies have indicated that racism may be a pivotal factor.  

Weathering” is an important concept that highlights the link between racism and high maternal mortality rates among black woman. Public health researcher Arline Geronimus, Sc.D coined the term to describe how the intersectionality of racism and sexism corrodes the health of black women. Geronimus told NPR, “What I’ve seen over the years of my research is that the stressors that impact people of color are chronic and repeated through their whole life course, and in fact may be at their height in the young adult-through-middle-adult ages rather than in early life. And that increases a general health vulnerability — which is what weathering is.” Geronimus’s study finds that this accelerated aging increases the risk of pregnancy for black woman.

A report from The Foundation for Black Women’s Wellness also noted, “To truly make progress on improving the birth outcomes of black women and babies, we must move upstream to intentionally address root causes. If we don’t, we will continue to swim against the current and recycle the same patterns of disparity at the ultimate cost of losing the lives of black mothers and babies.” Many health centers are addressing racism and other forms of implicit bias. Some have adopted models, such as trauma informed care to provide the most respectful and culturally competent care for their patients. 

A case in point is Southern Jamaica Plain Health Center in Boston.  They created a Liberation in the Exam Room toolkit to educate and train providers on racism and its effects on patients. The developers of the toolkit note, “Committing to health equity requires us to deepen our understanding of structural racism in all the spaces we occupy.” The toolkit encourages providers to ask directed questions related to identity, experiences in the health care system, and life experiences. Asking questions like, “Many of my patients’ experience racism in their health care. Are there any experiences you would like to share with me?” can foster relationships between provider and patient that are rooted in trust and respect.  Moreover, these questions allow providers to specify their care to meet the intersectional needs of their patients.

To address maternal health inequities, Representative Robin Kelly (D-IL-02) introduced the MOMMA Act, H.R. 1897. This legislation will standardize maternal health data collection; establish and enforce national emergency obstetric protocols; expand Medicaid and CHIP to one year after childbirth; and fund regional training programs to improve access to culturally competent care. Physicians are also addressing maternal health inequities. Last week, the American College of Obstetricians and Gynecologists (ACOG) released guidelines on how to treat pregnant women with heart disease. Dr. Hollier, president of ACOG, stated, “Most of maternal deaths are preventable, but we are missing opportunities to identify risk factors prior to pregnancy, particularly for black women.” The new maternal health guideline distinguishes between common signs and symptoms of normal pregnancy versus those that are abnormal and associated with cardiovascular disease. Hollier highlights, “As clinicians, we need to be adept at distinguishing between the two if we’re going to improve maternal outcomes.”

NACHC’s Chief Medical Officer, Ron Yee, MD, recently spoke to Repertoire Magazine on the issue of maternal mortality. NACHC is closely following these new legislative and organizational developments. We are excited to delve deeper into the issue of maternal health and welcome any thoughts, ideas, or feedback you may have.