On Maternal Mortality – It’s Time for Real Change and Real Solutions

Our nation has the highest maternal mortality rate among developed nations — and that’s despite the focus, hard work, and investment of millions of hours and dollars on this critical issue. Not only does maternal mortality remain stubbornly high — recent data shows that it is on the rise . This is especially alarming when we know that approximately 80 percent of pregnancy-related deaths are preventable .

With these deep and troubling outcomes in maternal care, we, as people who work in healthcare, have to ask some hard questions about why this is still happening — and build on the real solutions that have promise to reverse this trend.

We already know some of the key problems that have put us in this position. The most obvious, and most devastating, are the significant, deep-seated health disparities in care. Thousands of women die of maternal causes every year — and the mortality rate for Black women was reported as nearly three times the rate of white women in 2021.

This comes on the heels of shocking new data from the CDC, that found that one in five American women reported mistreatment from a healthcare provider during their pregnancy. That’s bad enough, but for Black and Hispanic women, it’s one in three. One in three.

The CDC data cover a wide range of experiences: 28.9 percent of respondents reported experiencing some form of discrimination during their maternal care, including 40.1 percent of Black respondents and 36.6 percent of Hispanic respondents. Others report feeling ignored, or even experiencing physical or emotional abuse. All of it is unacceptable.

Disparities in maternal care start early. There are real barriers to accessing prenatal care. Too many people want to get care, but can’t afford it or can’t find the care they need. Black women are nearly twice as likely to have a birth with late or no prenatal care compared to white women, and the type of healthcare coverage and English language proficiency may further reduce access and use of electronic healthcare technologies for those looking to receive care via telehealth.

Compounding both issues is a true staffing problem: there’s already a large OB-GYN provider shortage, made worse by conditions in a field known for its extremely long training periods and high malpractice insurance rates.

While there is a lot of good work being done to solve these problems, we also must acknowledge what isn’t working. Well-intentioned federal programs that don’t actually get care where it’s most needed , for example, will not make an impact in actually getting expectant mothers the care that they need.

Here’s what we can do, both in the public and private sector, to meaningfully reduce maternal deaths.

To start, we need to remove barriers to prenatal care. There are a lot of great models to follow — one being senior care. We should take the approaches that we’ve seen are successful in caring for seniors: great service, care close to or in the home, and easy to navigate systems and tech, and apply them to prenatal care.

We also need to recognize that postpartum care is critical for the success and health of the baby and the mother. In order to fill gaps that currently exist in postpartum care, we should treat it like post-acute care, coordinate it from the moment of delivery, and ensure there is adequate follow-up and a true, positive experience here. That also includes ensuring new mothers have adequate mental health support following their childbirth.

Perhaps most importantly, we need to launch a concerted nationwide initiative to eliminate bias, including unconscious bias, in maternal care among all providers — physician and non-physician. I was encouraged to see the Biden Administration making it a priority in their Blueprint for Maternal Health , and I hope that’s the first of many steps to come.

And finally, we need to make sure the millions invested in maternal care innovation directly deliver new resources and support to underserved communities, as well as places that lack healthcare infrastructure and providers. This will require real innovation from CMS to both ensure that those on Medicaid can get support and help ensure that the clinics providing care to underserved areas have the resources they need for their patients.

Maternal mortality does not have to be an intractable problem in our healthcare ecosystem, but it will take a coordinated, consistent effort to change course. I am hopeful that the collective brainpower and commitment of those across healthcare will recognize this critical problem, because we must develop approaches here that really work.