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The pandemic continues to shed light on health disparities in the U.S., including the stark gaps in maternal and infant mortality and morbidity rates. Despite advances in technology and research, maternal health disparities are worsening.
In this article, we’ll cover:
What are maternal health disparities?
Maternal health disparities, preventable differences in health during pregnancy, childbirth, and the postpartum period, occur when birthing people don’t have access to the same care as someone else. CDC research shows that disparities in maternal health, which can be based on a variety of factors including race, ethnicity and socioeconomic status, are rising. Maternal mortality is the death of a pregnant person from complications during or within six weeks after the pregnancy, and maternal morbidity includes short or long-term health issues caused by or related to pregnancy like cardiovascular problems, infections, and diabetes.
The rates of maternal mortality and morbidity are disproportionately rising among Black and Indigenous People of Color. In the U.S., Black women are three to four times more likely to die due to pregnancy-related complications than white women. This issue similarly affects Indigenous people: Indigenous women are twice as likely to die giving birth as white women. But race isn’t the only factor that affects maternal disparities. People with lower incomes also have a higher risk of maternal death, as do people in rural and underserved areas with less access to care.
The history of maternal health disparities in America
The first data collection on the maternal mortality rate in the U.S. occurred in 1933 when 619 deaths per 100,000 pregnancies were reported. Throughout the 20th century, the introduction of antibiotics and improved maternity services, living conditions, and surgical procedures caused maternal mortality rates to plummet. In the late 1990s, maternal mortality further declined to nine deaths per 100,000, but began rising again after 1997 due to reduced access to healthcare services and the compounding effects of underfunding the healthcare system. Since then, the maternal mortality rate has doubled—but it has been only relatively recently that this crisis has made headlines or been taught in medical schools.
Currently, in the U.S., about 50,000 to 60,000 people are severely injured while giving birth, and 700 die during and after childbirth per year. Although deaths during delivery are a large part of the problem, slightly more than half of all maternal mortalities occur after the day of delivery. In 2021, the maternal mortality rate was 23.8 deaths per 100,000 pregnancies, making the United States one of the most dangerous places in the developed world to give birth today.
The five main causes of pregnancy-related mortality are:
Since the country began tracking this data, there have been notable disparities across races in maternal mortality. Maternal mortality rates have risen for every segment of the population, but the most recent maternal mortality rate for Black people was 55.3 deaths per 100,000 births—more than two times the rate for white people. In other words, if you’re a Black birthing person, you’re twice as likely to die during childbirth as a white person.
Understanding racial disparities in maternal health
Although health equity has been a focus for healthcare professionals and institutions in recent years, inequities in maternal healthcare are still disturbingly common. Maternal health disparities are an intersectional problem, meaning gaps in care are even more significant when people live at the intersections of multiple oppressed groups.
The social determinants of health and access to care
To improve how people receive support, it’s important to create equitable circumstances where every person has the opportunity to achieve their full health potential without being marginalized by socially determined factors.
Health equity takes into account the social determinants of health (how we live, work and play and how those conditions affect our health), which may also impact how someone is able to receive care and communicate with providers. These factors can be organized into five distinct categories: social environment, biology and genetics, physical environment, individual behavior, and health services.
Research shows that identity, physical environment, and location can also have a significant impact on access to care. Five million women live in maternity care deserts—counties that do not have a hospital offering obstetric care and no access to OB providers. An additional ten million women live in counties with limited access to maternity care, including high-quality hospitals and providers, as well as affordable insurance. This can exacerbate issues for people already facing other barriers to a healthy pregnancy, compounding their disadvantages.
“There are many factors. You may have issues with people being denied care, or people may not have access to the same treatments and medications due to insurance or Medicaid coverage,” explains Susana Vega, a medical-surgical nurse and midwife. “They may have limited transportation so consistency in terms of appointments and care is a challenge, and there may also be an issue accessing healthy food.”
Bias in healthcare
These inequities may be in part because some providers overlook the pain of Black patients and spend less time with them during appointments. Their pain and needs are undervalued and go unheard, and as a result, warning signs and chronic conditions go untreated, leading to further complications. Further, structural racism in maternal healthcare is biased against the needs of Black birthing people, which can manifest in bias in the day-to-day interactions between patients and providers.
The physical impact of racism
The maternal health crisis is affected by more than just provider bias and social determinants of health—the experience of racism also has an impact. Research shows that the stress pregnant people feel when experiencing racism can actually impact the health of their pregnancy. The experience of racism and sexism can trigger weathering, the decline in physical health outcomes as a result of chronic exposure to social and economic disadvantage.
This idea of weathering has since been applied to Black people generally but is especially true in maternal healthcare—there is a physical cost to the psychological stress of racism. “Studies have shown that for Black women, even women of different socioeconomic status, disparities can be attributed partially to racism and stress in the body,” explains Vega. “That’s another piece of the maternal health crisis that we don’t largely address. The stress, people’s mental and emotional health, and how much that affects our health overall and our wellbeing.”
How employers can improve maternal healthcare disparities
Most pregnancy-related deaths are preventable—meaning that filling in gaps in the traditional healthcare system can save lives.
What does filling the gaps in care look like?
Providing culturally-humble care
It’s more important than ever for employers to support employees as they navigate the ingrained racism of the healthcare system. To combat the maternal health crisis, companies can offer virtual care and expand the pool of available providers to ensure culturally-humble care and enable care matching. Care matching allows patients to see providers who share a similar background and cultural experience. Research shows that providers from a similar background promote greater trust and communication with patients, reducing healthcare disparities for historically marginalized groups.
Supporting the mental health of parents
Companies need to ensure that all employees have access to mental health support throughout their journey. “We need more mental health coverage across the board,” says Vega. While up to 20% of birthing people suffer from mental health challenges like depression and anxiety during pregnancy, studies show that they often do not receive adequate treatment. Birthing people need greater access to mental health resources and support and more conversations normalizing mental health struggles in the family-building journey.
Offering postpartum support
When considering how to supplement traditional healthcare benefits, employers should prioritize solutions that offer continuous support into the postpartum period. For new parents, the postpartum period is an important time of change, cheer, and challenges, but it’s often neglected. “We need more postpartum support,” Vega affirms. “After a person has a baby, it can feel like they don’t matter anymore. They have a single check-up afterward, which often leaves a lot that is left unattended.” To thrive in the postpartum period, new parents need access to a variety of specialty providers including sleep coaches, lactation consultants, and career coaches.
The importance of community and resources
Offering community support and up-to-date resources can have a huge impact during the family-building journey. Especially because many expecting and new parents may be reading misinformed content online, it is important to have trusted resources to help inform decisions and feel a sense of community. “I love group care and prenatal education,” says Vega. “We know birthing people who are able to connect to people like them is a huge factor in providing the social support they need for a healthy pregnancy, birth, and life in general.”
Offering virtual care to remove barriers
Virtual care can create greater access to healthcare for people who are unable to miss work or disrupt childcare to meet with providers. “I have people who struggled to be physically there for an appointment, and then they would just miss that appointment,” says Vega. “Now they can just talk to their provider on video or on their phone. I think virtual care opened up a lot of time for them and made it accessible for them to address urgent concerns or questions.” Providing employees with 24/7 virtual care, like free virtual support groups or access to digital solutions with clinically-vetted resources, can empower them to take charge of their health on their schedule, no matter their location.
Maven’s approach to addressing maternal health disparities
Reducing the maternal mortality and morbidity rates in the U.S. starts with supplementing the existing healthcare system with increased support for reproductive healthcare and education. Maven is dedicated to filling in gaps in the traditional healthcare system by increasing access for all birthing people.
As the world’s largest digital health benefit for starting, growing, and caring for healthy families, Maven is designed to provide culturally-humble, inclusive care. Over 8% of providers on Maven identify as LBGTQIA+, 40% have strong clinical experience working with the LBGTQIA+ community, and almost 40% of Maven providers identify as BIPOC. Through Maven, members have 24/7 access to specialized, personalized providers, support, and resources to improve health outcomes.
As your company looks to provide better care for every member of your team, Maven is here to help. Reach out today to see how Maven supports birthing people and their families.
This content was originally published here.