In February, the CDC published a new report revealing a startling uptick in the maternal mortality rate. In the first year of the pandemic, America’s rate of maternal mortality – already the worst of all developed nations – rose even higher, climbing 14% year over year into 2020. While the report cites possible causes as the pandemic and lapses in prenatal or postpartum care due to Covid-19 related disruptions, the data reveals stark inequities.
Of the 861 pregnant women and new mothers who died in 2020, one-third were Black. As the New York Times notes, Black Americans comprise just over 13% of the population, making their likelihood of fatality nearly 3x higher than that of White women. For Hispanic women, the rate shot up 44% year over year. While the report did not detail Asian American or Pacific Islander maternal mortality rates, their populations are also disproportionately impacted by maternal death.
This last point drives home just how devastating these maternal losses are: current estimates suggest that two-thirds of all maternal deaths are preventable. Within that context, the additional four deaths per 100,000 births from 2019 into 2020 becomes even more tragic. This year, we must reverse the trend. The following sections explore ways to improve the health and well-being of expecting and new moms by establishing a standardized continuum of care, enacting policy change, and aligning stakeholders on a path to increased advocacy to address inequity. These actions can drive systemic change to achieve healthier – and more equitable – outcomes for all.
Health equity begins with a true continuum of care
In America, the phrase “care continuum” is something of an oxymoron. The patient journey is winding, fraught with unpalatable economic decisions, and relatively unclear. In Denmark, where there are clearly defined standards of care, mothers and infants seemingly thrive. The entire pregnancy journey is predetermined, from regular visits with a midwife through to postpartum home visits, where mom and newborn are supported through the first few months post discharge. Community groups create a network of support through the complicated postpartum period and beyond.
In this context, it is not altogether surprising that the Danish maternal mortality rate is among the top ten lowest in the world, while the United States is ranked number 57. While the Danish welfare system and universal healthcare for all is not a near reality for Americans, elements of the system can be applied here to great effect. Evidence suggests that advocacy and support through the pregnancy journey results in fewer complications during delivery, a reduction in maternal mortality, higher rates of full-term natural birth, and lower rates of post-discharge ER visits and hospital readmissions.
In fact, in our experience over nearly two decades supporting women, infants and their families, we’ve found that establishing a thoughtful care management model can make an outsized impact. By investing in ongoing relationships throughout the maternal continuum of care, we are able to conduct health risk assessments, build long term case manager relationships that garner trust, coach women through their pregnancy or a NICU event, and identify and solve for social determinants of health that impact these women and their families. Developing a greater continuum of care, including community-based maternity care and support networks for women before and after birth, is our greatest chance to help counteract the woefully high maternal mortality rates of the last twenty years.
New policies act as a primer for true systemic change
Policy changes, outlined below, can help build toward standardization, a continuum of care, and a more equitable future.
Advocacy: Midwives, maternity case managers or maternal advocates help create a semblance of standardized care by promoting regular pre- and post-natal check-ups, healthy nutrition, emotional, and physical habits, and better communication with physicians at the time of delivery. States must invest in culturally relevant models that extend the continuum of care by offering subsidized home health visits, like those that Wyoming and North Carolina are piloting.
Paid family leave: While every Danish resident receives between four and six months fully paid family leave, only about 19% of Americans have access to any form of paid family leave at all. For many new mothers, returning to work two weeks after giving birth is the reality of their situation. Along with supporting new moms, paid family leave would help unlock an additional $28 trillion that could be added to the global GDP if we reach full gender equality.
Postpartum: 50% of maternal deaths occur after the day of birth, meaning that an equal amount of attention should be paid to new mothers after discharge. Experts agree that complications occur most often within six months postpartum; yet, many insurers only cover a limited period of time during the post-partum period, some as little as 6 weeks. To fully support new mothers and their newborns, the postpartum period of covered care and parenting coaching should be extended to twelve months.
To create change within our fragmented health system, we must unite policymakers, advocates, physicians, health systems, payers, midwives, doulas, and community organizations in order to develop a standardized continuum of care. Only then can we begin to address our maternal mortality rate and affect meaningful, long-lasting change that will improve the experience of motherhood in America for generations to come.
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