November 4, 2018 Liz Borkowski, MPH 1Comment

Last week, two opinion pieces highlighted solutions to the US’s shameful rates of maternal mortality, and the appalling racial disparities in risk of death during and after childbirth. One piece focused on steps hospitals can take immediately to respond to situations that arise during labor, and the the other addressed the larger context.

In the New England Journal of Medicine piece “What We Can Do about Maternal Mortality — And How to Do It Quickly,” Susan Mann, Lisa M. Hollier, Kimberlee McKay, and Haywood Brown recommend ways to address three of the most common preventable complications of giving birth: postpartum hemorrhage, severe hypertension, and venous thromboembolism. They advise that facilities take these steps:

  • Implement Alliance for Innovation in Maternal Health bundles (best practices for improving safety) in all birthing facilities.
  • Implement multidisciplinary staff meetings or huddles to assess and review each obstetrical patient’s risk factor, along with pre-surgery briefings and consultation with patients.
  • Simulate obstetrical emergencies to practice responding.
  • Use the Maternal Health Compact, which formalizes existing relationships between lower-resource hospitals that transfer pregnant people when they require higher levels of maternal care and the referral hospitals.

These are steps hospitals can implement quickly to save many lives. But we also need interventions to improve public health so that fewer serious complications arise and Black women stop bearing a disproportionate share of harm. In the Black Women Birthing Justice piece “An inconvenient truth: You have no answer that Black women don’t already possess,” Karen A. Scott, Stephanie R. M. Bray, Ifeyinwa Asiodu & Monica R. McLemore point out that the growing interest in addressing maternal mortality rates and disparities must center Black women:

In determining how those resources are invested, we must question the frame of various stakeholders (i.e., birth workers, clinicians, funders, perinatal & systems re-designers and policymakers) currently participating in conversations about Black women and maternal health. This frame is too often defined by a default that is not based on Black women’s experiences or that of Black people. As a consequence, assumptions about Black women’s inability to know what they need drive where resources are invested and in whom. More often than not, problems and solutions end up being defined by people who are not Black. The lack of inclusion of Black voices further perpetuates a default standard that begets inadequate and irrelevant analyses and solutions. In short, there is no answer to solving this crisis that Black women do not already know. It is in their lived experiences and resilience that drives innovation and belonging — and we as stakeholders should take heed.

They recommend four broad solutions: Authentic engagement with Black women, investment in Black women (as a future workforce and in general), unapologetic support of Black women in paid leadership and research roles, and reinvestment in the social safety net. As early steps, they also highlight some specific legislation — the MOMMA Act, the Maternal Care Access and Reducing Emergencies (CARE) Act, and the Preventing Maternal Deaths Act/Maternal Health Accountability Act — as well as initiatives to allow Medicaid coverage for doula care in several states.

Such policy changes are only small steps toward addressing social determinants of health and fixing the larger problems of systemic racism both within and outside of health care system. So let’s improve hospital care, while also following the advice of the Black women who are leading us toward healthy equity. One place to start is the Black Mamas Matter Alliance, which envisions “a world where Black mamas have the rights, respect, and resources to thrive before, during, and after pregnancy.”


Recent related posts:

ProPublica’s exploration of why black mothers are more likely to die
Improving maternal health in the US requires better policies and less racism
Addressing black maternal mortality: Large and small steps


One thought on “Two perspectives on reducing US maternal mortality

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.