Maternal Health is (rightfully) widely discussed in today's healthcare system, and even transcends our industry in legislative and larger societal conversations. Despite the aim of my newsletter to simplify some of the more complex topics in healthcare, maternal health and maternal health equity are not "simplify-able" issues with immediate solutions. Here's what you need to know:  

Maternal health outcomes in the United States are generally not where they need to be, to say the least. All individuals should have access to a safe and happy birthing process, but that is not a reality for many, especially for people of color (POC) and those living in rural areas.  

A 2023 study found the median state maternal mortality ratio (aka the number of maternal deaths per 100,000 births) at minimum doubled across all ethnic groups between 1999 and 2019, with the American Indian or Alaska Native population in Western states and the Black population in Southern states most affected. Additionally, while in-hospital maternal mortality rates have decreased, severe maternal morbidity---conditions and complications like infections, high blood pressure, cardiovascular problems, etc.---is on the rise, underscoring the urgent need for improved perinatal and postpartum care. These disparities also stem from a few of the many care issues impacting maternal health, like access to care, rural hospital closures, and a general lack of trust from POC towards the healthcare system.

In addition to solutions like bias training and other on-the-ground steps to improve the clinical experience and patient-provider interaction, the path toward maternal health equity starts with a broader view---looking at and understanding the scale of disparities through data, policy and culturally informed interventional care measures.

Legislation and Systemic Action

Before we dive into what that looks like in practice, let's review a few of the pieces of legislation, policy and models that are currently driving maternal care reform:

• White House Maternal Health Blueprint --- In June 2022, the Biden administration introduced their plan to reduce mortality and morbidity rates and improve maternal health outcomes through increased access to services and coverage, better collection of and transparency around data, better workforce protections, and strengthened social and economic support programs during all points of care.
• U.S. Department of Health and Human Services' initiatives --- During this year's Maternal Health Week in April, HHS announced their agency's efforts and funding as part of the Biden-Harris Administration's goal to advance maternal and pediatric health equity. Approximately $468 million was made available across several programs that improve outcomes at the community-, state- and federal-levels: Maternal, Infant, and Early Childhood Home Visiting Program, State Maternal Health Innovation Program, and Maternal Health Research Collaborative for Minority-Serving Institutions.
• The California Model --- Founded in 2006 at Stanford University School of Medicine, the California Maternal Quality Care Collaborative (CMQCC) partners with member hospitals and uses research, outreach, toolkits and their Maternal Data Center to improve outcomes for parents and children alike. As an interesting result, California has seen maternal mortality decline by 65% between 2006 and 2016 while the national rate rose.
• CMMI's new behavioral maternal health models --- The Center for Medicare and Medicaid Innovation (CMMI) was founded as part of the Affordable Care Act to shift our system to pay for quality over quantity in healthcare (think: Value-based Care!). Pending Congress agreement on funding, the agency is expected to announce two models to address both the mental health and maternal health crises in the U.S., ultimately looking to integrate specialty care into primary care and provide better data to accountable organizations to help facilitate this integration.

These are all encouraging steps forward in improving care outcomes, especially the power of data in demonstrating tangible, impactful results. However, we cannot solely legislate or "policymake" our way out of a problem in healthcare --- for this to be sustainable long-term, it requires the environment (read: the system and players within it) to acknowledge the issue's importance and work to combat the issue alongside legislation changes and funding improvements.

Ensuring basic access to coverage across populations is the first step in improving maternal care --- in addition, we should be looking at parental care holistically from a physical and mental health standpoint, and ensuring individuals have access to quality perinatal and postnatal care that supports positive health outcomes.  

"African American mothers with a college degree have worse birth outcomes than White mothers without a high school education."

"Researchers work with averages, not individuals. And with thousands of examples -- the evidence pointing to the impact of racism and stress on pregnancy outcomes is becoming hard to ignore."

Looking at improving maternal care outcomes in practice, the Providence Health Women's and Children's Clinical Institute has been promoting the adoption of best practices in maternal health for over eight years.  Multidisciplinary teams that are clinician-led and professionally managed design and implement protocols across various states and the many ministries of Providence Health & Services to improve maternal health outcomes. Hardwiring the OB Hemorrhage Protocol in our Electronic Health Record (EHR) system-wide has resulted in overall outcome improvements including reduced ICU days, blood transfusions and hysterectomies. The Institute is also standardizing the Team Birth communication technique whiteboard rounding and non-medical terminology to be inclusive of all persons involved in the birthing process and promoting shared decision-making.

Providence Health is committed to addressing health disparities and has partnered to implement programs across our ministries. Understanding that trust is a necessary element in engaging our communities and patients, especially those of color, Providence has identified community organizations to collaborate with to address maternal health disparities.

To shout out a few, Denise Colomé, MCM, Director of Health Equity, Providence Health South Division is excited for the opportunity to work with iDREAM for Racial Health Equity, a Project of Community Partners to address health disparities in birthing mothers. In LA County, the Providence Women's and Children's institute has partnered with iDREAM to launch Black Mamas Glowing, a pregnancy peer support experience to improve the birthing experience for women of color.

The Black Mama Glowing experience provides access to a care team of experts who will provide wholistic education and engagement around developing a sacred birthing plan, myths and truths about mental health and emotional wellness, tapping into social support and self-advocacy from prenatal care to delivery while monitoring and measuring outcomes.

Organizational Spotlight: MyLÚA Heath

As we move into the increasingly digital, AI-powered age, I would be remiss not to mention the role digital health tools and data may have in addressing disparities across the care continuum. We can leverage technology and the tools at our disposal to advance care models in all spaces -- models that are culturally sensitive and community-focused to address the needs of a particular population. Informed education, data collection and patient engagement should align with lived experiences; that's how digital health platform MyLÚA Health was developed.

I came to know MyLÚA Health through an introduction by a colleague who was aware of their vision and passion for addressing health disparities in women of color.  They are a virtual maternal care startup and platform doing important work to reduce maternal morbidity and advance health equity through increased care access, health literacy, and data-informed care outcomes.  

Based on one of the founder's own family care experiences, MyLÚA aims to support and empower throughout pregnancy and post-partum, specifically seeking to close care gaps often experienced by BIPOC communities. Their solution is built entirely around that vision and not solely focused on optimizing administrative functions (which is often the lens through which we look at AI and other technology in healthcare).

MyLÚA is a real-life example of how tools and solutions developed with specific individuals and populations' lived experiences in mind can materially affect health outcomes.

Looking Ahead + Final Thoughts

As I stated at the start of this edition, improving maternal health overall and eliminating maternal health disparities does not have an immediate or one-time solution -- our system will need ongoing data-informed and people-centric interventional measures to get us on the true path to better outcomes and equity. In addition, we must create an environment that allows legislation and policy changes to effectively deliver on its intended purpose. From necessary action at the federal level all the way down to individuals in our communities, it's powerful to see examples of the latter leading the charge for change having a positive impact based on their own lived experiences.

In this edition, we covered the landscape of maternal health, recent legislative and systemic action in the space, and the role of digital solutions in improving care outcomes. As a follow-up in October's newsletter, I'll share takeaways from my conversation with MyLÚA co-founders J'Vanay Santos-Fabian, MBA and Aish Ravindran on the Maternal Health Blueprint, meeting Vice President Kamala Harris and their vision on how to improve care for all.

Until next month.  

Ruth 🌸

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