The maternal health crisis requires data-driven, thoughtful, and strategic approaches at the national and local level. Health plans, medical professionals, academia, and nonprofits must lean in together, because no single group can solve it alone.
In pursuit of advancing maternal health equity and improving maternal health outcomes, Darrell Gray, II, president of Elevance Health's affiliate health plan in Maryland, recently brought together several experts for a conversation on maternal health and steps needed to address maternal health disparities. The hour-long discussion included academic researchers in maternal health, pediatrics, and health equity as well as maternal and OB/GYN healthcare providers.
Highlights of the discussion:
- A big picture approach is needed to make progress in the face of some daunting data about maternal health. The United States has one of the worst records for maternal health outcomes, and the COVID-19 pandemic has worsened the situation.
- Dr. Adam Myers, senior vice president and chief clinical transformation officer, Blue Cross Blue Shield Association, set the stage: “Severe maternal morbidity rates are consistently higher in black, Latina and Asian women, compared with white women, regardless of age or type of insurance. And these rates have risen by 9% for all racial and ethnic groups in both Blue Cross and Blue Shield commercially insured and Medicaid populations between 2018 and 2020. The reality is stark. It’s somewhat overwhelming to think about how to impact the complexity of this given the reality that only about 20% of health outcomes are directly associated with traditional healthcare that we provide and support. And 80% are structural issues and outside of the healthcare system … If we want to mitigate these disparities, we have to think broadly and comprehensively.”
- Maternal health is about more than physically delivering a baby, and it’s not just a timeline-based consideration, said Dr. Tiffany Inglis, Carelon national medical director for maternal-child and women’s health.
- Inglis said it’s important to consider the family makeup of the person giving birth. “Postpartum isn’t just a few weeks,” Inglis said. “We know it’s really that whole year after the birth of a child, and what that does to mental health, physical health, social needs, the family dynamic. The family unit is different for everyone.”
- Dr. Kiwita Phillips, associate professor of clinical medicine and residency program director at Morehouse School of Medicine in Obstetrics and Gynecology, went on to describe that all of what happens—and the larger social structure—before someone gets to pregnancy matters. “If you were not well before the pregnancy, you’re not going to be more well during it,” she said. “Some groups of people are experiencing different levels of stressors. It may be more difficult for them to access care, or get quality care. Those small pieces every day affect their ability to have a stress-free maternal experience.”
- There are geographic access and workforce diversity challenges.
- Some areas of the country have no maternity care at all. The March of Dimes reports that 2 million women of childbearing age live in maternity care deserts, according to Sherenne Simon, MPH, senior director of health equity, March of Dimes. “The level of systemic change needed to address these inequities is critical, but first we need to know where the challenges lie. That’s what the maternity care desert report” comes in, Simon said.
- “We want to make sure we are training diverse groups of people,” Phillips said. “There are many ways to diversify the workforce … we need more Black obstetricians, but we also need people who are not MDs … we need certified nurse midwives” and other practitioners. Phillips said we all have implicit bias because of the social constructs that surround us. Research suggests that provider bias and diversity influence outcomes for birthing parents and babies.
- Data is a crucial component of health equity; there’s no single approach that’s going to work for every person.
- “Clinical trials haven’t always included every population,” said Dr. Karriem S. Watson, chief clinical engagement officer, All of Us Research Program, with the National Institutes of Health. This is why the All of Us program is key to informing work now that will create a different future and better informing research in the future.
- “We have made a big commitment to understanding who our pregnant people are, where do they live, what do they need from a clinical and social perspective,” Inglis said. Elevance Health looks at the data to find out which way is the right path and sees it as a continuous cycle of improvement.
The panelists agreed that the need is urgent, but the struggles are complex, and so they offered a few suggestions on how to move forward.
- Phillips: “Set the expectation that this is not work that gets done quickly; it’s generational.”
- Simon: “Celebrate small wins” and recognize that we don’t have to do everything, but we can choose to do something.
- Watson: “Research has to move at the speed of trust.”
- Inglis: “Be thoughtful and mindful and know that none of us can do this alone.”
Follow Elevance Health on LinkedIn for more conversations like this. Comments have been edited for length and clarity.