Starting the next generation of thinkers, creators, and change-makers takes a lot of physical, emotional, and mental sacrifices. However, some of these sacrifices are made worse by the current culture around maternal health, perpetuated by both hospitals and society. Recent studies show that over the past several decades complications with maternal health have worsened based on recent events such as the COVID-19 pandemic and the overturning of Roe v. Wade. These have made preexisting racial differences in maternal and infant health worse, as women of color are often in areas where access to the resources they need becomes more difficult. For National Minority Health Month, I wrote this article to share research on the current culture surrounding maternal healthcare in America and some measures the federal government has in store to close the existing gaps in maternal healthcare.
Maternal Health Woes
Although advancements in medical technology have made breakthroughs in increasing life expectancy and reducing health complications, not all patients have benefitted from these changes, specifically pregnant women of color. The United States has the highest maternal mortality rate of any developed nation in the world, even though many of these deaths are preventable through equal access to healthcare throughout pregnancy and postpartum. Black women are more than three times more susceptible to death from pregnancy-related causes compared to white women. American Indian and Alaskan Native (AIAN) women are two times more likely to face such mortalities. Example conditions that increase the risk of pregnancy-related death include: cardiomyopathy, postpartum hemorrhage, infections, hypertension, preeclampsia, respiratory complications, and more. Black, A.I.A.N, and NHOPI (Native Hawaiian or Pacific Islander) women are more likely to experience pre-term birth, babies with birthweights under 5.5 pounds, late to no prenatal care, and higher rates of postpartum depression. Such issues cause these demographics to experience higher rates of infant mortality than white women, defined as infants passing before the age of 1 year old.
Figure 1 shows rates of pregnancy-related mortalities measured per 100,000 births based on race and/or ethnicity between 2016-2018.
Disparities in health care between pregnant women of different backgrounds stem from the severity of qualitative challenges such as struggles in finding quality healthcare providers, differences in health insurance coverage, underlying health conditions, living in environmentally unsafe areas, structural racism, and more. The more severe these conditions are, the higher the chance of risk for the mother and/or infant’s health and chance of survival.
Figure 2 shows multiple factors such as patient health, community environment, quality of health care, and structural amenities all contribute to the cycle of maternal morbidity and mortality
Advocacy for Maternal Health to Power the Next Generation
Despite all of these complications for women of color and their tumultuous journeys with maternal healthcare, more efforts are being made to reduce the health disparities surrounding prenatal and postnatal healthcare. One effort is the Biden Administration’s Blueprint for Addressing the Maternal Health Crisis. It outlines the current epidemic of maternal mortality while framing the priorities of federal agencies for improving healthcare access, increasing the quality and quantity of prenatal care, and increasing economic and psychological support for new mothers. A main part of the Blueprint includes efforts to diversify the workforce to include more midwives and doulas that are people of color, who can cater to the diverse needs of different populations. Doing so has proven to reduce severe outcomes of maternal mortality and morbidity.
Many federal agencies have carried out initiatives to reduce these gaps before and after the 2022 Biden Administration plan. Medicare and Medicaid coverage is increasing for new mothers due to the 2021 American Rescue Plan Act that extended postpartum healthcare coverage under Medicaid to last an entire year and expanded coverage for more people to access COVID-19 intensive care. The CDC has a program called Levels of Care Assessment Tool (LOCATe) to assist states with standardizing qualities of necessary maternal and neonatal care while raising awareness of urgent maternal warning signs during and after pregnancy through the Hear Her campaign.
Individual states have also made more efforts to reduce maternal and infant health care disparities. The Nurture NJ Strategic Plan aims to “outline challenges, action areas, and recommendations to achieve equity for all women with a focus on dismantling structural racism and addressing social determinants of health” in New Jersey. In New Mexico, the Changing Women Initiative is a non-profit that provides culturally centered midwifery care to Native American women who suffer higher rates of gestational diabetes, low birth weight deliveries, and other maternal health disparities.
It may take some time for gaps in maternal healthcare to be reduced and provide unbiased, quality care for all pregnant women. However, it is great that our nation has at least realized collectively that the current state of maternal healthcare in the United States is an epidemic of mostly preventative health conditions and mortalities. These issues can be easily solved with budget reallocations and standardized healthcare provisions at the grassroots, state, local, and national levels. With the teamwork of trained doctors and qualified health policy writers, we can change the outcomes for millions of future mothers and their infants nationwide.