Government has important role in reducing racial maternal health disparities

The newly released US Commission on Civil Rights report, Racial Disparities in Maternal Health, analyzes the federal government’s responsibility to act in reducing racial maternal health disparities, including reducing maternal death and poor pregnancy-related health outcomes.

A public virtual briefing was held in November 2020 by the Commission to gather information from experts such as health care providers, advocates, government officials, academics, and impacted persons.

“Testimony received by the Commission shows the federal government can play an influential role in reducing racial disparities in maternal health outcomes. Improving access to quality maternity care for women is critical, including preconception and inter-conception care to manage chronic illness and optimize health; prenatal care; delivery care; and postpartum care for 12 months post-delivery, all of which is necessary for improving pregnancy-outcomes,” Norma V. Cantú, chair of the U.S. Commission on Civil Rights, told Contemporary OB/GYN® via email interview.

According to the report, Black women are 3 to 4 times more likely to die than White women from pregnancy-related complications. Pregnancy-related complications are over 2 times more likely to kill Native American women.

The Commission’s research found that in 2004, 45% of US rural counties did not have obstetrics services in hospitals. It reported that services grew by 9% in 10 years, totaling 54% by 2014, but this growth is inadequate. The most severe impacts for maternal racial health disparities were in states with the strictest Medicaid eligibility requirements, and in largely Black counties. “Black women were found to be 10 times as likely as White women to live in a county that had no in-hospital obstetric services and 4 times as likely to live in a county where hospital obstetric services had recently closed,” the Commission reported. Reductions in care maintain and increase racial health care disparities, according to the Commission, “as many obstetrics services are being cut from hospitals that serve Black women in rural America, who experience some of the worst birth outcomes in the US.”

The Commission reported that Blacks and Latinos make up almost 1/3 of the US population, “yet Black and Latino health care professionals each make up only 3% to 6% of the total, and only about 9% of physicians identify as Black, Latino, or Native American.”

"At the federal level, efforts can be made to improve hospital quality, particularly for women of color if maternal health disparities are to be eliminated.” Cantú said in a press release. She noted that safety culture improvements are correlated with better maternal health outcomes. “One recommendation for improving safety in maternal health care is to implement standardized care practices across hospitals and health systems and to standardize data collection systems,” she said.

As a call to action, the Commission recommended the following to reduce racial maternal health outcomes as a distillation of the report in the email interview with Contemporary OB/GYN®:

Provider Actions:

Increase cultural competency training, including implicit bias training, among health care workforces.

Improve the quality of maternal health care through the development of a plan for collaborative partnerships with hospitals and their ambulatory providers to implement evidence-based, culturally sensitive training, education, and best practices.

Endorse the best practice of having a maternal ‘check-up’ prior to the standard 6-week infant check-up and continuing ‘maternal-focused’ checkups for at least 1 year postpartum.

Encourage health care providers to screen for postpartum depression in the first visit.

Provide physicians with objective checklists to screen for common postpartum complications such as cardiomyopathy, embolism, and infection.

Ensure that rural and Native-servicing health care centers have adequate resources to provide this more robust care.

A program in North Carolina is being hailed for promoting evidence-based quality maternity care and should be scaled and replicated nationwide, according to the Commission. The program is known as Pregnancy Medical Home, which improves the quality of perinatal care among Medicaid customers and provides increased access to comprehensive care for women receiving Medicaid.

Community-based programs and services:

Develop a statewide framework for scaling home visiting programs. Home visiting has been shown to improve both maternal and infant health outcomes.

Invest in community-based programs to hire women from the community to provide doula support, home visiting, care navigation, breastfeeding, postpartum classes, and childcare assistance.

Reference

US Commission on Civil Rights. Racial disparities in maternal health, 2021. https://www.usccr.gov/files/2021/09-15-Racial-Disparities-in-Maternal-Health.pdf. Published 2021. Accessed September 17, 2021.