Harnessing Innovation to Improve Maternal Health

US maternal health is at a crossroads. Hundreds of women in the United States die each year from complications related to pregnancy and childbirth—a crisis exacerbated by the COVID-19 pandemic and the growing maternity care deserts nationwide.

The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics’ most recent report put the US maternal mortality rate at a whopping 32.9 deaths per 100,000 births, which is more than 10 times the estimated rates of some other high-income countries.

While another recent study suggests the national US maternal mortality rate is 10.4 deaths per 100,000 births, even with that lower overall rate, US maternal mortality still exceeds that of other developed nations. Furthermore, there are significant and persistent racial and ethnic disparities in pregnancy-related deaths, which are three times more likely for Black women than white women.

Black women also have the highest risk for progression from gestational diabetes to type II diabetes after birth, higher rates of self-reported depression, and, among Black women ages 20–44, more than twice the hypertension prevalence of other racial and ethnic groups.

Research shows that coverage before, during, and after pregnancy facilitates access to care that supports healthy pregnancies, and positive maternal and infant outcomes after childbirth. However, people of color are more likely to be uninsured and face other barriers to care, such as limited access to providers and hospitals and lack of access to culturally and linguistically appropriate care. Medicaid covers over 40% of all births in the US, and roughly 64% of those are to Black women.

These challenges may be particularly pronounced in rural and medically underserved areas: A March of Dimes report found that more than 5.6 million women in the US live in counties with limited or no access to maternity care services.

Although studies have shown that primary care benefits the health of mothers, newborns, and children, all too often, the US health care system fails women of reproductive age in a variety of ways. Without access to primary care providers, maternal care can be episodic and fragmented for women from underserved populations—a contributing factor to the high rate of maternal mortality.

Preventing Maternal Mortality

Simply put: It’s unacceptable that maternal mortality has been rising in our country, especially when 84% of pregnancy-related deaths are considered preventable.

The leading underlying causes of pregnancy-related death include mental health conditions (23%); excessive bleeding (14%); cardiac and coronary conditions (13%); infection, thrombotic embolism and cardiomyopathy (all 9%); and, hypertensive disorders of pregnancy (7%), although the leading underlying cause of death varied by race and ethnicity.

Changes are needed at an institutional level to help reduce maternal mortality. Health care systems, communities, families, and other support systems need to be aware of the serious pregnancy-related complications that can happen during and after pregnancy.

To that end, the US Department of Health and Human Services (HHS) and the Biden-Harris administration have initiated efforts to combat maternal mortality and improve maternal and infant health, particularly in underserved communities.

In June 2022, the White House also released a “blueprint” for addressing the maternal health crisis. It identifies key maternal health efforts, such as the CDC’s Perinatal Quality Collaborative program, which supports multidisciplinary teams implementing maternal health quality improvement initiatives for addressing the maternal health crisis.

To help implement initiatives outlined in the blueprint, the HHS Office on Women’s Health (OWH) and the Centers for Medicare & Medicaid Services (CMS) launched a national challenge in 2021 to identify programs that can effectively address the inequity of postpartum care for Black and African American and American Indian and Alaska Native women enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).

The first phase of this competition identified programs that could successfully increase access to, attendance of, and quality of care for postpartum visits for the target populations. Examples of some of the programs that are helping to address these inequities include:

• A digital health app that provides pregnant and postpartum women with remote access to psychotherapy;
• A program that uses technology and collaboration to identify, track and connect providers to health data, including indicators for several mental and physical medical conditions; and
• A diabetes navigation system.

Some of these programs were also recently recognized by HHS as winners of the second and final phase of the $1.8 million competition, which builds upon the work completed by programs during phase 1.

Additionally, with so many births financed by Medicaid—and more than one-half of pregnancy-related mortality occurring in the 12-month postpartum period—43 states, the District of Columbia and the US Virgin Islands have extended Medicaid coverage for 12 months after pregnancy. Postpartum care provides necessary follow-up care for conditions associated with morbidity and mortality during and after pregnancy.

How Providers Can Help

With more than half (53%) of pregnancy-related deaths happening up to one year after delivery, it’s critical for all health care professionals to ask whether their patient is currently pregnant or has been pregnant in the last year to inform diagnosis and treatment decisions.

Women with pregnancy-related health complications may not always recognize the early warning signs of an illness. That’s why early and consistent prenatal care improves the chances of a healthy pregnancy.

A single, networked approach to sharing patient information and implementing evidence-based strategies for providers to collaborate and coordinate care for these patients and help them realize positive, healthy outcomes.

Support throughout pregnancy and postpartum is critical for creating lifelong physical and mental health and well-being for mother and infant, and these leading-edge programs funded through the national challenge are a solid start—though far from an end—to addressing the significant and persistent racial and ethnic disparities in pregnancy-related illness and death that plague our country. We can, and must, do more.

About the Authors

Britteny Matero is a partner and senior vice president, Market Access for Innsena, a health tech consultancy focused on improving care outcomes for underserved communities. With a diverse background that includes a role leading government relations, public policy and social impact at PointClickCare, as well as nearly 12 years in state and local government, Matero brings a wealth of experience to Innsena. During her tenure with Oregon Health Authority’s Office of Health Information Technology, she played a key role in establishing public-private partnerships, overseeing health information exchange and interoperability programs, and managing Medicaid EHR incentives. An accomplished leader with a proven track record in health care program development and systems change, Matero excels at crafting smart, solutions-oriented strategies that enhance service delivery.

Jaime Bland, DNP, RN, is president and chief executive officer of CyncHealth, the designated health information exchange for Nebraska and Iowa. Since being appointed CEO in 2018, Bland has piloted CyncHealth’s strategic growth beyond the established health information exchange and Prescription Drug Monitoring Program to include 3 new entities—CyncHealth Advisors, the CyncHealth Foundation, and the Nebraska Healthcare Collaborative. In addition, the Iowa Health Information Network (IHIN) recently joined CyncHealth; Bland serves as IHIN’s president and CEO. Under her leadership, CyncHealth is transforming to become a regional health data utility. Prior to her work with CyncHealth, Bland held leadership positions in regional, national, and international markets within the public and private sectors. She has extensive experience in establishing and leading care management, population health and clinical quality initiatives, and she holds advanced degrees in informatics and a Doctor of Nursing Practice in Public Health-Global Health Nursing from Creighton University in Omaha, Nebraska.