“The health of our nation is dependent on the health of our mothers.” – Deborah Kilday
Despite persistent efforts to reduce maternal pathology and mortality rates nationwide, the number of maternal deaths per 100,000 births continued to rise through 2019 (a year before the global pandemic would impact these data.) Socio-economically marginalized groups continue to bear the brunt of these outcomes, with Black mothers in particular experiencing higher rates of complications at delivery, resulting in disproportionate rates of cesarean sections, traumatic births, and both infant and maternal mortality compared to their White counterparts. Leveraging data and system-wide collaboration between practitioners, staff, hospital administrators, and even legislators are key to improving Black Maternal Health–as are efforts by individuals to acknowledge, engage with, and support Black mothers’ needs and concerns throughout pregnancy and delivery.
What is Black Maternal Health Week?
Black Maternal Health Week was officially recognized by the White House in 2021, and the important work of improving Black maternal health outcomes continues this year. Developed and initiated by The Black Mamas Matter Alliance (BMMA), Black Maternal Health Week is a week of awareness, activism, and community-building aimed at amplifying the voices of Black mothers, bringing visibility to Black-led maternal health initiatives and centering the values and traditions of the reproductive and birth justice movements.
Premier, leads with Black Maternal Health data
Improving Black maternal health begins with listening and understanding what barriers to care exist for Black mothers, and what the data on maternal outcomes shows. Engaging with individuals and consulting the data are the two prongs of the solution–leveraging qualitative and quantitative insights to create meaningful improvements in Black maternal health. The HHS Perinatal Improvement Collaborative, overseen by the U.S. Department of Health and Human Services (HHS) Office on Women’s Health (OWH), is using timely data, analytics and performance improvement methodologies from Premier to improve care. The collaborative consists of more than 220 hospitals nationwide, caring for diverse populations in all 50 states. The analysis of these dynamic data sets will help inform what needs to be done, and whether or not individual initiatives to improve care are effective.
I sat down with Lauren Nunally MPH, BSN, Senior Clinical Consultant, Women and Infants Service Line, Premier and Deborah Kilday, MSN, Principal, Women and Infants Service Line, Premier to discuss this expansive effort, and to ask a few questions about what Black Maternal Health Week means for Black mothers, mothers in general, and the physicians caring for them.
Understanding the state of Black Maternal Health today
Looking at data from the last 20 years, this Premier analysis found that delivery-related maternal deaths have decreased over those two decades. However, severe maternal morbidity (SMM) increased by 38 percent. SMM includes unexpected outcomes of labor and delivery, which significantly impact a mother’s health. Black women had an 84% higher hate of SMM than white women.
Deborah Kilday shared the importance of understanding patients’ health histories BEFORE they are admitted to the hospital. “We’re finding that, overall, chronic conditions and complications are significant risk factors associated with mortality and morbidity. So understanding those before they’re admitted to the hospital is key,” she says.
Empowering hospitals and physicians with understanding and actionable insights involves data analysis efforts like the HHS Perinatal Improvement Collaborative, as well as individual work and community collaboration.
What Physicians Can Do:
I asked what physicians and individuals can do to improve outcomes for Black mothers. Nunally offered the following best practices:
- Believe Black Mothers. “A common theme [in anecdotes about poor maternal outcomes among Black women] is that they often report not being listened to,” Nunally says. Physicians face competing priorities, but centering care on the patient is necessary to improve health outcomes.
- Earn patient trust. “There is the mistrust of the system by a lot of Black and Brown birthing people, simply because of what’s happened historically in some medical institutions” Nunally says, alluding to incidents like the infamous Tuskegee Experiments.
- Participate in implicit bias training. “There are a lot of organizations, such as the March of Dimes, that have incredible implicit bias programs,” Nunally says. She also recommends providers check out the Disparities Solution Center.
- Understand factors that impact Black mothers. “It could be transportation, it could be the lack of access to be able to provide quality health care,” explains Nunally. She asserts that providers need to identify their own biases and recognize how these may impact outcomes. Implicit social and economic biases are common, she says, and understanding how these biases and other factors limit Black mothers’ health access is key.
Collaboration is a cornerstone of success
Kilday emphasized that data is used to increase understanding of infant and maternal health. But, she says, in order for collaborative efforts to leverage these data and succeed, dedicated community partners need to be involved. This is not about startling statistics or data, she emphasizes–it is about relationships.
The Collaborative is striving to test interventions and protocols to reduce preventable deaths and complications among mothers and their babies. Data and insights from the collaborative will be used to generate solutions for safer obstetric and neonatal care that can be implemented nationwide. The effort is guided by an external advisory panel comprising more than 20 expert clinicians and thought leaders, and patient partners from MoMMA’s Voices, and the National Birth Equity Collaborative (NBEC) all focused on the leading causes of maternal mortality and morbidity.
“MoMMA’s Voices and NBEC are key partners in this work. We are looking at overall health equity, particularly for women of color, and they can help us understand biases, how to identify them and how to address those inequities as they are occurring.”
Measuring outcomes matters and can help us overcome these inequities. Premier continues to measure how much success has been achieved on the journey to better healthcare for all mothers. Our hope for the future is that there will be no disparities for our nation’s mothers, particularly, our Black mothers. Collaboration, education, evaluation, and understanding are part of that work.
Final thoughts
Sharp Index is dedicated to improving physician mental health. Part of that work is increasing the number of Black physicians providing care for Black mothers. We need to improve medical education, recruit more Black physicians to the field of medicine, and improve awareness about tools physicians can use to overcome implicit biases. Institutions should have a plan for inclusion, and individuals should understand how to give great care to Black mothers.
