Black Maternal Health’s Ongoing Mandate for Change  

Original story posted on: April 21, 2021

How national initiatives are addressing ongoing gaps in care for pregnant women of color, and those of child-bearing age.  

Last week was all about the Centers for Disease Control and Prevention (CDC) declaration that racism is a public health crisis. Yet, amid the popularity of that messaging, another relevant story got second billing.

April 11-17 marked the fourth annual Black Maternal Health Week, representing a clear-cut population health priority. I wanted to take this opportunity to review how national initiatives are addressing ongoing gaps in care for pregnant women of color, and those of child-bearing age. 

Current facts point to mandates for action:

  • The U.S. has the highest rate of maternal mortality among developed nations, with the rate rising steadily for the past 40 years.
    • Reported pregnancy-related deaths in the U.S. increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017.
  • The ratios identified across ethnic and racial groups are unconscionable:
    • 7 deaths per 100,000 live births for non-Hispanic Black women.
    • 3 deaths per 100,000 live births for non-Hispanic American Indian or Alaska Native women.
    • 8 deaths per 100,000 live births for non-Hispanic Asian or Pacific Islander women.
    • 4 deaths per 100,000 live births for non-Hispanic white women.
    • 6 deaths per 100,000 live births for Hispanic women.
  • Several pregnancy-related factors potentially contributing to death have declined, such as hemorrhage, hypertensive disorders of pregnancy (e.g., preeclampsia, eclampsia), and anesthesia complications. Though with chronic diseases on the rise, and especially for minority communities, these diagnoses (including chronic heart disease, diabetes, and cerebrovascular events) factor heavily in maternal morbidity and mortality rates.
  • Reviews from Maternal Mortality Review (MMR) Committees across 25 states are worth the time to review. Having sat on Virginia’s state MMR committee, I can attest to the rigor and commitment of those engaged in reviewing all pregnancy-related deaths, including deaths occuring within one year of giving birth.
    • A lengthy data brief and interactive map is live on the CDC ERASE Maternal Mortality Among the key findings:
      • Two out of three pregnancy-related deaths occur outside of the day of delivery or the week postpartum.
      • The leading causes of pregnancy-related deaths varied by race/ethnicity. Black mothers are almost three times as likely to die in childbirth compared to other racial and ethnic groups.
      • Two out of every three deaths were determined to be preventable.

At the end of 2020, the U.S. Department of Health and Human Services (HHS) set the following thresholds to improve maternal health by 2025:

    1. Reduce maternal mortality rate by 50 percent;
    2. Reduce low-risk caesarean deliveries by 25 percent; and
    3. Control blood pressure in 80 percent of reproductive-age women.

The White House Proclamation for Black Maternal Health Week 2021 set the perfect tone: “the United States must also grow and diversify the perinatal workforce, improve how we collect data to better understand the causes of maternal death and complications from birth, and invest in community-based organizations to help reduce the glaring racial and ethnic disparities that persist in our health care system.” 

Our Monitor Mondays Listeners Poll asked how much our listeners and their organizations prioritized initiatives to address maternal mortality for women and youth of color for 2021. There were a wide range of responses, and they appear here. We can and must do better to address this population health mandate.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting of the social determinants of health (SDoH) every Monday during Monitor Mondays, 10 a.m. Eastern.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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