America’s approach to childbirth care must change
Jhe maternal mortality crisis in the United States continues to worsen. After increasing steadily over time, annual death rates have skyrocketed by a 40% in 2021 alone, according to the Centers for Disease Control and Prevention. In addition, black women are 2.6 times more more likely die from maternity-related causes than white women. Such results transcend social class – in the highest income groups, twice as many black women die within a year of giving birth. The same which is true for their babies. In the richest country in the world, these appalling statistics reveal a crisis far worse than in any other high-income country.
As we honor Black Maternal Health Week 2023, we recognize the urgent need to overhaul the systems and structures that enable this to happen. Our experiences as former governors and former secretaries of the US Department of Health and Human Services tell us that transformation is possible. But it will take national commitments, targeted investments in culturally sensitive approaches, revamped reimbursement policies, and greater attention to women’s health as a whole to address this pressing issue.
As co-chairs of the Aspen Health Strategy Group representing both sides of the political aisle, we recently guided senior leaders from health, business, philanthropy, technology and other sectors in a search depth of solutions. The result is a 2020 report, Reverse the maternal mortality crisis in the United Stateswhich calls for multifaceted action to center maternity care outside of hospital settings.
Our work has convinced us that conversations about maternal mortality tend to downplay one of the most powerful tools at our disposal: community role models that respect the nuances of culture and language. These typically take a more personal approach to pregnancy, considering its social and emotional dimensions, as well as its health impacts, and drawing attention to the social determinants and structural inequalities that can undermine child care. maternity. The result is often to produce better maternal outcomes at lower cost, while increasing patient satisfaction. give birth to people.
Yet today’s center of childbirth care in the United States is made up of technology-laden hospitals, which approach each birth as if it required an intensive medical response. Childbirth is the most frequent reason for hospitalization. in this country. This focus on acute care is reflected in staffing and provider training that elevates the role of specialists, payment plans that do not cover a full continuum of ancillary services, and regulatory structures that prioritize needs. of the hospital rather than to the patients. The result is a system that lets parents and their babies down.
That said, there are evidence-based alternatives that actually work. Midwives, which are much more common outside the United States, can provide a multitude of prenatal and delivery services while remaining alert to the potential need for interventional obstetric care. Community health workers, doulas, and other providers skilled in integrating family and social supports with appropriate health care are also part of the prenatal to postpartum continuum. Often they have local roots, come from backgrounds similar to the populations they are reaching out to, and respect the need to provide ongoing, family-centered support.
Learn more: Elaine Welteroth: Going for midwifery care was the best decision I ever made
To take full advantage of their experience and skills, we believe the federal government should fund efforts to increase the number of licensed midwives and other local providers. States should develop accreditation and scope of practice standards so that community-based perinatal providers can use the full extent of their knowledge. Guided by a commitment to quality and equity, hospitals should refer to external resources and prioritize less acute services, even if this reduces their revenue. Employers and public and private insurers should also ensure coverage of appropriate maternal care outside of hospital.
None of this will adequately reduce the cost of maternal mortality unless it is accompanied by affordable insurance that covers community services, guarantees continuity of care and addresses the chronic medical and social conditions that often cause the greatest damage. Medicaid, especially in states that have expanded the program, provides significant coverage, but many women begin their pregnancy journey before becoming eligible and typically lose their benefits 60 days. after a birth.
While recent federal improvements allow, but do not require, states to expand postpartum coverage for one year, broader improvements to community care as a whole are essential. A huge deficit is the limited reimbursement of midwives, which means that many women have to pay out of pocket to access these services. And few models exist for paying for stable housing, adequate food, and other social interventions essential to good health.
The national maternal mortality emergency requires a response on multiple fronts, and health systems, third-party payers, regulators, accrediting bodies and employers can all help by shifting care to the community. Populations at risk of becoming pregnant should be included in any redesign effort and supported with adequate funding and training. Additionally, it is especially important to empower organizations that serve Black women to lead. Across all sectors, aggressive measures to address deep-rooted racism and racist practices are also essential for progress. A total effort to reverse this epidemic cannot wait any longer.
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