The U.S. is facing a maternal care crisis
Improving maternal care is a critical priority for the U.S. healthcare system today – and rightfully so. According to a report from the Commonwealth Fund, the U.S. has the highest maternal mortality rates among 11 developed countries. In large part, this is due to a lack of maternal care providers and no guaranteed access to home visits or paid parental leave following birth.
“Despite all that we spend on health care and all the advancements in medicine, our rates in maternal morbidity and mortality are actually going up,” said Dr. Neema Stephens, National Medical Director for Health Equity at Cigna, in a previous podcast for Becker’s Hospital Review.
What’s more, about 36% of all US counties are considered “maternity care deserts,” meaning there are no obstetric hospitals, birth centers, or obstetric providers – and the number of counties where this is the reality seems to be growing, according to a new report. So, what does this amount to? Approximately 2.2 million women are living in maternity care deserts and 150,000 babies are being born there – all of whom face a higher risk of poor health outcomes, including death.
The numbers are staggering. While a system-wide approach will be critical in addressing the maternal health crisis, patient communication can help close such large maternal health care gaps.
Four in five maternal deaths are preventable
Another striking statistic is 84% of maternal deaths between 2017 and 2019 were due to preventable causes, according to a recent CDC report. Of the 1,018 reported deaths, 539 (53%) of them occurred well after women left the hospital, between seven days and a year after delivery. This highlights the “need for quality improvement initiatives in states, hospitals, and communities that ensure all people who are pregnant or postpartum get the right care at the right time,” said Wanda Barfield, M.D., M.P.H., Director of CDC’s Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion.
Mental health conditions – deaths by suicide or overdose – were the top underlying cause of postpartum death, followed by extreme bleeding, or hemorrhage. White and Hispanic women were most likely to die from suicide or drug overdose, while cardiac and coronary conditions were the leading cause of death for Black women. According to the CDC report, both conditions occur disproportionately later in the postpartum period.
According to the CDC, other leading factors in maternal deaths are clinician, facility, and systems factors. Some of these include inadequate training, missed or delayed complications diagnosis, poor communication, and a lack of clinician coordination.
Ultimately, the data underscores various weaknesses in the current maternal care system: policies that strip women of coverage shortly after giving birth, late postnatal checkups, lack of follow-up care or postpartum depression screenings, and much more. Those who face the brunt of such issues? Minority women.
Maternal care disparities: a grim reality in the U.S.
Politically, socially, and economically, the discussion around maternal care and poor outcomes for minority populations has been a growing concern. In fact, deep inequities across race, socioeconomic status, and geography are major factors when it comes to maternal mortality. Black mothers – who are three times more likely to die than white mothers from pregnancy complications – made up nearly a third of the deaths reported in the recent CDC analysis.
Researchers have found that access to care, access to comprehensive insurance coverage, and inequities in patient-provider relationships (such as structural racism or implicit bias) are widely believed to drive these disparities. Social determinants such as access to care, transportation, or technology, as well as employment or living environment, were also significantly heightened during the pandemic, exacerbating the effects even further. This resulted in unequal access to maternal care and an increase in maternal deaths for those in underserved communities.
To take it a step further, disparities can really boil down to timely patient access to maternal care, according to a 2022 survey from What To Expect, a pregnancy patient education company. Not only are black women more likely than white women to have delayed prenatal appointments, but they are also three times more likely to have their first appointment at 16 weeks or later and are getting their ultrasounds much later – both critical pieces of maternal care.
The next step to addressing maternal mortality and health disparities
While these stats are quite sobering, the data presents a real opportunity to address the underlying issues around maternal mortality and health disparities. Currently, there are some promising efforts and steps being taken, such as the Biden administration recently committing $470 million to address this issue with actionable steps. These include extended postpartum coverage, expanded social services, no more surprise bills, and more. They also cite the need for all industries touching healthcare to be involved in the maternal health conversation.
These are certainly positive advancements, however, a system-wide approach will be needed to tackle the many risk factors that impact maternal care. Health systems have the opportunity to address this further by prioritizing patient communication to enable accessible, high-quality, equitable care for all patients regardless of social factors.
ArteraTM is prepared to support organizations looking to improve maternal care by maximizing patient communication to better engage patients across their entire maternal health journey: from prenatal to postnatal and beyond.
How Artera can help improve maternal care outcomes
While there are no silver bullets when it comes to addressing the maternal care crisis, patient communication can significantly help to lessen the problem. The Artera platform can be an asset to close care gaps and increase pregnant patients’ access to services and information through automated recall messages, referrals, conversational messaging, and community outreach.
Recall messaging and referrals ensure patients receive additional outreach and timely touchpoints to continue their care pathway, following up at critical intervals for birthing patients to engage with routine care. Organizations using Artera, such as UNC Health, have seen referral conversion rates increase by over 40%, meaning more patients are able to connect with the follow-up care they need when they need it most.
Conversational messaging also gives these patients immediate and convenient connections with staff and providers for information when they need it, even after delivery. If they have any pressing questions, they are able to reach out directly to their provider for more information, making communication more accessible and efficient. Ideally, conversational messaging can help keep patients engaged throughout their entire maternal care journey – something that is frequently overlooked: “We tend to think about maternal mortality, or maternal issues, as a point in time or a moment in time for women…people need to understand more and more is that it is about the entire lifecycle of a woman, of her family, of everyone who touches that familial unit,” said Dr. Zenobia Brown, SVP of Population Health and Associate Chief Medical Officer at Northwell Health.
Artera’s workflows are just one type of tool that can enable the action needed to support maternal care long-term. Equipping organizations with effective patient outreach and making a change in other areas impacting care is how the healthcare system can collectively impact patient outcomes and help close gaps in maternal care. ♥
