TThe maternal mortality crisis in the United States continues to worsen. After rising steadily over time, annual death rates have soared to shocking levels. 40% only in 2021, according to the Centers for Disease Control and Prevention. Moreover, black women are 2.6 times more likely die of maternity-related causes than white women. Such results transcend class—twice as many black women in the highest-income groups die within a year of giving birth. same Fair for your kids. These horrifying statistics show that the world’s richest country is in a much worse crisis than any other high-income country.
As we celebrate Black Mothers Health Week 2023, we recognize the urgent need to overhaul the systems and structures that make this possible. Our experiences as former governors and former secretaries in the US Department of Health and Human Services tell us that transformation is possible. But addressing this pressing issue will require national commitment, targeted investment in culture-sensitive approaches, revised reimbursement policies, and more attention to women’s health in general.
As Co-Chairs of the Aspen Health Strategy Group, representing both sides of the political landscape, we have recently led senior leaders in healthcare, business, philanthropy, technology and other sectors in an in-depth search for solutions. The result is a report for 2020, Conquering the Maternal Mortality Crisis in the United Stateswhich calls for multifaceted action to focus maternal care outside of hospital settings.
Our work has convinced us that conversations about maternal mortality tend to underestimate one of the most powerful tools at our disposal: community-based models that take into account the nuances of culture and language. They tend to take a more individualized approach to pregnancy, take into account its social, emotional and health impacts, and address social determinants and structural inequalities that can undermine maternity care. The result is often improved maternal outcomes at a lower cost, while at the same time increasing maternal satisfaction. native people.
However, at present, the birth center in the United States is a hospital equipped with technology that treats every birth as if it required intensive medical care. Indeed, childbirth is the most common reason for hospitalization. in this country. This focus on acute care is reflected in provider staffing and training that enhances the role of professionals, payment plans that do not cover the full range of ancillary services, and regulatory structures that prioritize hospital needs over patients. The result is a system that fails parents and their children.
However, there are proven alternatives that do work. Midwives, who are much more common outside the United States, can provide many antenatal and obstetric services while remaining vigilant about the possible need for interventional obstetric care. Community health workers, doulas, and other service providers who are able to integrate family and social support with proper health care also fall on the prenatal and postnatal continuum. They often have local roots, come from the backgrounds to which they are inclined, and respect the need to provide ongoing family-oriented support.
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We believe the federal government should fund efforts to increase the number of licensed midwives and other local health care providers to take full advantage of their experience and skill set. States should develop accreditation and scope standards to enable community perinatal care providers to use their full breadth of knowledge. Guided by the pursuit of quality and fairness, hospitals must turn to external resources and prioritize less urgent services, even if this reduces their income. Employers, public and private insurance companies must also ensure coverage for adequate care for the mother outside the hospital.
None of these will adequately reduce maternal mortality unless accompanied by affordable insurance that covers community services, guarantees continuity of care, and addresses chronic medical and social conditions that often cause the most harm. Medicaid, especially in states that have expanded the program, does provide significant coverage, but many women get pregnant before they become eligible and usually lose benefits after 60 days. after birth.
While recent federal improvements allow, but do not oblige, states to expand postpartum coverage by a year, broader improvements in residential care in general are important. Limited midwifery reimbursement is a huge shortfall, meaning that many women have to pay out of pocket to access these services. And there are several payment models for stable housing, adequate nutrition, and other social interventions that are critical to good health.
The national maternal mortality emergency calls for a comprehensive response, and health systems, third-party payers, regulators, accrediting organizations and employers can help by shifting the burden to the public. Pregnant populations should be included in any modernization effort and supported by adequate funding and training. Moreover, it is especially important to empower organizations that serve black women with leadership. Across all sectors, aggressive action to combat deep-seated racism and racist practices is also fundamental to progress. The global effort to reverse this epidemic can no longer be delayed.
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