Prior to 2023……
One quarter into the new year, we are beginning to see more media coverage on maternal health disparities- highlighting the lack of progress that has been consistent with the previous decade. Defined as a person's death during pregnancy, labor, childbirth and the postpartum period, the broad mortality rate has continued to perplex clinicians and public health professionals. Recent national statistics further emphasize the stark inequality: 24 maternal deaths per 100,000 births, one in five mothers experiencing mental health concerns, and marginalized women still grappling with significant challenges due to a lack of proactive interventions. Black women have a two to three times higher risk of dying from pregnancy-related causes compared to white women. Black women are more likely to experience an unwanted prematurely decided cesarean delivery (Sperlich et al., 2019). Additionally, Black infants are two to three times more likely to be born preterm and are also twice as likely to die within the first year of life as white infants (Sperlich et al., 2019). In most cases, the deaths contributing to the above statistics are preventable, and are recognized by surveillance systems as a preventable maternal death (Review to Action 2023). In 2022, there was a 44% spike in maternal mortality for Hispanic/Latina women (AHA). Nationally, Hispanic/Latina women covered by Medicaid also experience a 28% higher risk of complications. Women facing social and economic inequities are more likely to face worse maternal health outcomes, due to systemic racism (KFF). Another crucial detail is that studies done have indicated that education level and economic status may not be a main contributor to this disparity. For instance, Black women, regardless of whether they hold high school diplomas or postgraduate degrees, still experience similar mortality rates. Comparably, Hispanic/Latina women with private insurance are still 22% more likely to have severe pregnancy complications compared to their white counterparts.Overall, the initiatives of 2024 prove to be a positive light in the journey of maternal health. Across the federal landscape, there is a notable surge in funding opportunities for organizations dedicated to tackling disparities.
Federal Initiatives
Federal funding is a priority in 2024. The highly respected non-profit organization, March of Dimes, highlighted funding opportunities to support and reduce instances of maternal mortality. One such initiative is the Center for Disease Control (CDC)'s Safe Motherhood Initiative,which is requesting a 56 million dollar increase to expand maternal mortality review committees around the country. A second initiative also from the CDC is a 448 million dollar increase for their immunization programs; improving access to immunizations for underserved communities is essential for both pregnant women and infants. Yet, another initiative forwarded by the CDC in 2024 is their national survey of Maternity Practices in Infant Nutrition and Care. The goals of this survey are to collect data to improve overall care practices in hospitals and other healthcare centers. Even more recently, the US Department of Health and Human Services launched their first Postpartum Maternal Health Collaborative. This collaboration, made possible with the 2022 White House Blueprint for Addressing the Maternal Health Crisis from the Biden-Harris Administration encompasses many important facets of maternal health, highlighting issues in postpartum care. This initiative seeks to find solutions for disparities in postpartum care while working towards the overall goal of discovering why the maternal mortality crisis is worsening in the United States. Federally, regarding rural health, the National Governors Association launched a supplementary initiative named Improving Maternal and Child Health in Rural America State and Territory Policy. In addition, the Centers for Medicare & Medicaid Services (CMS), announced their innovative Transforming Maternal Health (TMaH) model. This model has the overall goal of improving maternal health efforts for all perinatal people enrolled in Medicaid and Children's Health Insurance Program. This model also recognizes that the United States spends the most money on healthcare in the world, yet is still facing grave issues. The TMaH model has three important goals:focusing on infrastructure, quality improvement, and holistic care. Many organizations have yet to propose a review of infrastructure restructuring as a goal. Infrastructure, both physical and operational, should be revitalized to promote sustainability and adaptability. An example of a sustainable, physical infrastructure improvement could involve offering free or affordable parking at maternity wards in hospitals. Currently, many hospitals, whether public or private, mandate payment for parking, creating a financial obstacle for individuals who wish to accompany a loved one during childbirth but face financial constraints. In addition, a sustainable operational infrastructure improvement could entail establishing a proficient materials management team. This team would focus on procuring cost-effective materials necessary for childbirth while guaranteeing an adequate supply for every patient. Although this may sound trivial, budget constraints can lead to instances where surgical materials for cesarean deliveries can be limited, which can cause an unsafe environment if complications arise if material is not ready for immediate use. As a firm committed to caring for and seeing the whole-person, DHJ Services has shared their view of the importance of the entire care team, in blog postings that emphasize the effectiveness of doula services and midwives. The TMaH model also prioritizes holistic care, which will be highly beneficial for perinatal individuals receiving Medicaid services.
State Initiatives
Federal initiatives strongly advocate for individual states to expand any current initiatives in place. Since then, many states have further expanded their initiatives. New York and California have demonstrated their commitment to reducing the disparity, with many initiatives gaining momentum.
New York
The current state of New York’s maternal mortality crisis is amongst the worst in the nation, ranked at #30 (NYC GOV, Maternal mortality and disparate racial outcomes). New York City, where a majority of New York’s population resides, has two epicenters of severe maternal morbidity. These are located in The Bronx and Brooklyn. Within Brooklyn, Central Brooklyn has the highest rates of severe maternal mortality, with a majority of Central Brooklyn’s population being Black women from the Caribbean (New York City Department of Health and Mental Hygiene, Maternal Mortality Annual Report 2018). Within the Bronx, the South Bronx, has the highest concentration of maternal mortality, where a majority of the population is African American or Hispanic/Latino. These hotspots call for targeted interventions. In 2024, the grand proposal for New York City has a six-point plan aimed at improving maternal and infant health. This proposal involves removing co-pays for pregnancy services, extending access to doulas statewide, educating clinicians on maternal mental health, and furnishing free cribs to low-income parents. Additionally, and arguably the most profound, is the proposal to implement a system to monitor doctors who conduct cesarean sections that are not medically necessary.
California
California has also proposed legislation and initiatives to reduce this disparity, stating that the disparity cannot be caused from income alone, and must have roots in systemic racism and implicit bias. Thus, the introduction of implicit bias training for all providers in California. The rationale is to ensure that all facilities are compliant with updated initiatives. The California Department of Healthcare Services introduced Birth Equity as one of their populations of focus for 2024. In conjunction with CalAIM, the Population Health Management Program announced that birth equity must be a population focus, according to the latest data of the current disparities in California. The demographic groups facing unequal maternal morbidity and mortality include Black, American Indian, Alaska Native, and Pacific Islander individuals during pregnancy and postpartum periods (Enhanced Care Management (ECM) implementation timeline). Furthermore, In 2024, data will be analyzed at the state level, rather than the county level. This will assist by reforming the eligibility criteria for Enhanced Care Management (ECM) at both the MCP and Member levels.
What shows promise?
Despite the troubling maternal health disparities observed in 2023 and prior years, 2024 brings optimism. Federal and state initiatives are now demonstrating the administration’s commitment to tackling the systemic issues underlying these disparities. With increased funding, enhanced access to care, and targeted efforts addressing root causes such as systemic racism and implicit bias, there is a growing sense of optimism regarding the prospects for improving maternal health outcomes. As these initiatives gather momentum, there is a genuine belief that progress can be achieved in reducing maternal mortality rates throughout the country. DHJ Services is in full support of these efforts, and as we continue to navigate the landscape, we vow to continue to raise awareness, update our community and clients, and provide opportunities to engage best practices.
For further information on DHJ’s dedication to this effort, please feel free to contact us at info@dhjservices.com.
Comments