Introduction
Equity in maternal and infant health is a cornerstone of a thriving society. When mothers and infants thrive, the positive effects extend to families, communities, and the broader economy. Unfortunately, not all mothers and infants experience the same outcomes. Among high income or developed countries, the United States continues to have the worst outcomes for maternal mortality [8]. In the United States, significant disparities persist, particularly among racial and ethnic minorities and economically disadvantaged populations. Maternal related deaths in the United States are largely preventable and are made worse for women of color [4]. For instance, Black women are three times more likely to die from pregnancy-related causes than White women [5], and the infant mortality rate for Black infants is more than double that of their White counterparts [2]. These statistics emphasize the urgent need to prioritize equitable maternal and infant health programs.
Addressing these disparities is not just a moral imperative but a societal necessity. Improved maternal and infant health outcomes contribute to healthier communities, reduced healthcare costs, and a more productive society [7]. However, achieving equitable outcomes, requires confronting and overcoming systemic barriers that perpetuate disparities. This blog explores the current challenges in maternal and infant health care, strategies for increasing health equity, and a call to action to ensure every mother and baby receive the care they deserve.
Challenges in Maternal and Infant Health
Social Drivers of Health (SDOH):
The conditions in which people live, work, and play significantly impact maternal and infant health. Factors such as housing instability, food insecurity, transportation barriers, and limited access to education create disparities in health outcomes. For example, women living in food deserts may struggle to access nutritious food during pregnancy, increasing the risk of complications such as gestational diabetes or low birth weight [6]. Addressing these social drivers is critical for fostering equitable health outcomes for moms and babies.
Implicit Bias in Healthcare:
Implicit bias among healthcare providers can lead to differences in care delivery, contributing to adverse outcomes for marginalized populations. Studies have shown that Black and Hispanic women are less likely to receive appropriate pain management and are more likely to have their health concerns dismissed [3] or overlooked during pregnancy and postpartum [1]. Overcoming these biases requires intentional efforts to recognize and address prejudice in clinical settings.
Access to Care:
Many women face significant barriers to accessing prenatal and postpartum care, including geographic isolation, lack of transportation, and inadequate health insurance. Rural communities often experience a shortage of obstetric providers, forcing women to travel long distances for care. Medicaid expansion has improved access for many, but gaps remain, particularly in states that have not adopted expansion. Ensuring comprehensive and accessible care is fundamental to reducing disparities.
Additionally, addressing women’s health before conception is critical to reducing maternal mortality and improving pregnancy outcomes, particularly for women of color disproportionately impacted by systemic racism and women in rural areas with less access to care. Preconception care ensures that women enter pregnancy healthier, reducing the risks of complications like high blood pressure and diabetes, which are more prevalent in historically underserved communities. By prioritizing equitable access to preventive healthcare, we can help break down barriers rooted in systemic inequities and promote healthier pregnancies and better outcomes for all women. [4]
How can we increase equity in maternal and infant health?
Culturally Responsive Care: Culturally responsive care respects and integrates patients' cultural values, beliefs, and practices into their healthcare, while simultaneously addressing the challenge of implicit bias in healthcare.
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Cultural Humility Training: Providing training for providers and clinical teams on cultural humility fosters understanding and reduces implicit bias. This approach encourages providers to view patients as partners in care by improving communication and building trust.
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Culturally Appropriate Practices: Developing care plans that incorporate culturally relevant practices can enhance patient engagement and outcomes. For example, acknowledging traditional birthing practices or dietary preferences can create a more supportive care environment.
Integrated Care Models: Integrated care models bring together various aspects of healthcare to provide holistic support for mothers and infants.
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Maternal and Mental Health Services: Linking maternal health with behavioral and mental health services ensures comprehensive care. Addressing postpartum mental health conditions such as depression and anxiety is critical for maternal and infant well-being.
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Community Health Workers (CHWs) and Doulas: Including non-clinical, yet highly supportive specialists such as CHWs and doulas as part of the healthcare team bridges gaps between patients and providers. These professionals offer culturally aligned, patient-centered support, improving health outcomes and patient satisfaction.
Policy Advocacy: Advocating for systemic changes is essential to advancing equity.
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Medicaid Expansion: Expanding Medicaid coverage to include comprehensive maternal and infant health services ensures more women have access to necessary care. This includes extending postpartum Medicaid coverage beyond the current 60-day limit in many states. North Carolina is an example of a state that expanded its postpartum Medicaid coverage from 60 days to 12 months.
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Health Plan Accountability: Encouraging all health plans to prioritize maternal and infant health through better coverage, support for integrated care, finding ways to address the social drivers of health and funding for evidence-based programs can result in systemic improvements.
Call to Action
Equity in maternal and infant health is within our reach, but it requires a collective effort. Policymakers, healthcare providers, health plans, community organizations, and individuals all have roles to play. Advocating for policy changes, supporting culturally responsive care, and addressing social drivers of health are critical steps toward creating a system where every mother and baby can thrive.
We must also elevate the voices of those directly affected by disparities. Engaging communities in the design and implementation of maternal and infant health programs ensures they meet the unique needs of diverse populations. Together, we can dismantle barriers, promote equity, and build a future where every mother and baby has an equal opportunity to thrive.
Citations:
1 Badreldin, N., Grobman, W. A., & Yee, L. M. (2019, December). Racial disparities in postpartum pain management. Obstetrics and gynecology. https://pmc.ncbi.nlm.nih.gov/articles/PMC6905121/
2 Hill, L., Rao, A., Artiga, S., & Ranji, U. (2024, October 25). Racial disparities in maternal and infant health: Current status and efforts to address them. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/
3 Nguyen, T. T., Criss, S., Kim, M., De La Cruz, M. M., Thai, N., Merchant, J. S., Hswen, Y., Allen, A. M., Gee, G. C., & Nguyen, Q. C. (2023, December). Racism during pregnancy and birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern women. Journal of racial and ethnic health disparities. https://pmc.ncbi.nlm.nih.gov/articles/PMC9713108/#:~:text=Results,%E2%80%9Cband%2Daid%20solutions.%E2%80%9D
4 NIH - National Heart Lung and Blood Institute. (2021, April 26). Systemic racism, a key risk factor for maternal death and illness. https://www.nhlbi.nih.gov/news/2021/systemic-racism-key-risk-factor-maternal-death-and-illness?utm_
5 Njoku, A., Evans, M., Nimo-Sefah, L., & Bailey, J. (2023, February 3). Listen to the whispers before they become screams: Addressing black maternal morbidity and mortality in the United States. https://pmc.ncbi.nlm.nih.gov/articles/PMC9914526/
6 Santas, C., & Hoke, K. (2024, November 22). Food insecurity and pregnancy: Addressing inequities through “food is medicine” initiatives. Network for Public Health Law. https://www.networkforphl.org/news-insights/food-insecurity-and-pregnancy-addressing-inequities-through-food-is-medicine-initiatives/#:~:text=Babies%20born%20to%20food%20insecure,to%20develop%20health%2Drelated%20challenges
7 Save the Children Federation, Inc. (2015). State of the world’s Mothers report 2015 . https://image.savethechildren.org/state-of-the-worlds-mothers-report-2015-ch11041621.pdf/m35a78i85873w34fj73qn82s2bpdyyr3.pdf
8 The Commonwealth Fund. (2024, June 4). Insights into the U.S. Maternal Mortality Crisis: An international comparison. https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison
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