Haywood Brown, MD, on the current landscape of maternal mortality in the United States

Contemporary OB/GYN:

What is the current landscape of maternal mortality in the United States?

Haywood Brown, MD:

Maternal mortality has really been disappointing in the United States, for sure. Because over the last several years, we've seen our maternal mortality rate, and mortality ratios compared to other countries, actually go up. And sadly, in the United States it went up for all racial and ethnic groups, but more profoundly for African American women and Black women had a profound increase. At the highest, it's probably been since 2015. That clearly, some of that is related to COVID. There's no question about the fact that COVID was much more profound in women of color, but it also affected all populations. The other thing that we think has impacted Black maternal mortality, is there have been a significant rise of women with sickle cell disease dying. Now, why is that? Maybe because they live in rural communities where access to care is poor. Maybe it's because many of the programs that were dedicated towards sickle cell foundations and stuff for children and young adults have been impacted. But clearly, that's also been a factor that's impacted, you know, these individuals, for instance, have, you know, comorbidities as I imagine them getting COVID, as well. And so, I think those are the things that have been most concerning to us. People postponing care, in rural areas, cancer screenings, has also been impacted. The breast cancer disparity went up, cervical cancer disparity went up, colorectal cancer disparity went up. And I think the other challenge that we have is when people don't have any insurance and they have access issues, they're not able to even take advantage of most of the screenings. You can say you ought to be screen. But if you have no resources, and you have no ability to get there, how you're going to go about? So I think those are the biggest challenges that we're going to face going into the next, you know, 4 or 5 years that is correct in those types of health inequities, you know, particularly in rural America, even in urban America, where access issues a real challenge.

Contemporary OB/GYN:

Have you seen any kind of programs that have worked to try to fix this issue?

Brown:

One of the things that I'm working with right now is called a Community Care Initiative, which is a part of the Alliance for Innovation with Telehealth, but it's a postpartum community care Initiative. And with programs that have been expanding Medicaid, one of the things you heard this morning was especially Medicaid to 12 months postpartum. Well, the reality is, if we do that, we're going to do a better job of taking gestational diabetics and screening for diabetes. We're going to have better control of dealing with hypertension and heart disease. So, I really believe that if you expand things where people have the ability, and then you work with the community navigators, for instance, this is going to be very important when you begin to think about deaths that are not obstetric related suicide, depression, domestic violence, all of those impacted by the community. And so when we begin to engage the community, and our partners in this, I believe we can have an impact on maternal mortality.