This is a cliched but true statement: the COVID-19 pandemic laid bare societal inequities in the U.S., from both the socioeconomic and racial contexts. It also drew attention to disparities that persist in maternal and infant health and associated mortality. In 2020, for example, a majority of pregnancy-related mortality was documented among American Indian and Alaska Native (AIAN), Hispanic, and black women. Specifically,

• Pregnancy-related mortality was 3X higher among AIAN and black women compared with white women
• Black, AIAN, Native Hawaiian and Pacific Highlander women also have higher rates of preterm births, low birthweight births, and lack of access to late or prenatal care

Maybe this is just about the socioeconomic differences in our society, right? Wrong! College-educated black women (which may be considered a surrogate for socioeconomic parity) had higher pregnancy-related mortality compared to white women with the same educational attainment or with less than a GED! Black women in the high-income strata are as much at risk of dying during the first postpartum year as the poorest white women. Pregnancy-related complication rates (maternal morbidity) that lead to ICU admission are higher among AIAN, black, Asian, and Hispanic women.

There is no denying the correlation between socioeconomic gaps and access to adequate health insurance or medical care. Together, these factors can explain the dismal maternal and infant health outcomes among populations of color. However, studies show that racism is not far behind and that discrimination does drive disparities after controlling for social and economic factors. Black women surveyed by KFF shared experiencing discrimination from their healthcare provider or other medical staff because of their skin color.

Steps are being taken, and resources diverted, to address disparities and improve maternal and infant health outcomes, such as:

• Expanded access to coverage and care
• Increased access to providers and services focused on maternal and infant health
• Diverse workforce
• Improved data collection and reporting

Issue Receives Federal Support

The Biden-Harris Administration is backing this effort by the healthcare community to move the needle on reducing maternal morbidity and mortality rates in the U.S. In June 2022, the administration released a blueprint that shared concrete steps being taken to address these challenges, including:

• Baseline health and safety requirements for hospitals with obstetric services, such as ensuring adequate supplies in the ER for obstetric emergencies and annual staff training on maternal health practices
• Extended postpartum Medicaid coverage for new moms for up to 1 year after delivery and encouraging use of doula services
• Launch of a National Maternal Mental Health Hotline
• Incentivizing OB/GYN healthcare providers to serve areas with high need through scholarship and loan repayment assistance programs

In November 2024, CMS released new safety standards for staff and organizations that deliver obstetric services, including staff training on evidence-based maternal health practices and updating the QAPI program, which monitors quality of care.

Only time will tell whether these programs have it right.
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