Last summer, a friend called me to let me know that her pregnant daughter was coming to visit and asked if she would have a safe delivery if she went into labor during her stay. At first, this question seemed strange to me, given that there were many excellent hospitals nearby, until I realized the real problem behind the question: my friend and her daughter are black.
It is an unacceptable fact that black women in America are more than three times more likely to die from pregnancy-related causes than white women. This is true regardless of education level, socioeconomic status, age, geographic location, and type of health care. Even healthy, well-known athletes Serena Williams and Allison Felix almost died during pregnancy and childbirth.
Yet the prevalence of pregnancy-related complications, especially among people of color, has only accelerated. A new study by the Blue Cross Blue Shield Association found that between 2018 and 2020, the number of pregnancies, births and postpartum complications in the US increased by 9%. Among Black, Hispanic, and Asian women on Medicaid, these complications were 73%, 28%, and 38% higher, respectively, compared to white women on Medicaid, indicating an unfair deterioration in the quality of care.
From blood clots during childbirth to postpartum depression, these complications often leave thousands of women struggling with traumatic, long-term health consequences and exorbitant medical expenses that affect families and entire communities. These complications permeate the entire health care system, highlighting deep-seated problems, including racial inequality, care bias and major chronic diseases. In mid-September, the Centers for Disease Control and Prevention released new data showing that 4 out of 5 pregnancy-related deaths are preventable. Women should be able to trust the care they receive before, during and after the birth of a child.
As health leaders, we have a responsibility to the women and mothers who trust us with their care. Actions start with solid data to tell where gaps exist and where resources should be allocated. After that, leaders should align their maternal health efforts with national standard-setters and work with these partners to improve and measure progress.
All corners of the healthcare system, from insurance companies and healthcare providers to health advocacy organizations, are coming together to solve America’s maternal health crisis. The BCBSA has set a goal of reducing racial disparities in maternal health by 50% by 2026. But to improve results, we need concerted decisions.
Insurers have been successful in expanding access to doulas. According to March of Dimes, doula support results in fewer caesarean sections, reduced time spent in labor, lower overall costs, and fewer complications. Payers also report improved outcomes when regular follow-up examinations of the newborn are combined with counseling for the mother. Integrating integrated services into primary health care settings can help identify and treat mental illness, the leading cause of pregnancy-related death, and reduce costs.
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