Addressing the Maternal Mortality Crisis and Inequity in U.S. Healthcare

The United States lags astonishingly far behind other industrialized countries in maternal health. The rate of maternal death in the U.S. is nearly three times higher than France, for example, and more than seven times higher than Germany. And when you peel back the layers, it’s apparent these statistics, however alarming, don’t demonstrate the full depth of the issue.  

For every instance of maternal mortality, for example, there are an estimated 20 to 30 cases of Severe Maternal Morbidity (SMM), defined by the CDC as “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.” Black and Hispanic women are especially vulnerable. Compared to White women, for example, the risk of SMM is 92% higher for Black women. 

SMM has steadily increased in the United States in recent years and now affects more than 50,000 patients annually. Tragically, nearly two-thirds of these cases could be prevented via appropriate intervention. The cost is high in both human and financial terms. From conception to five years postpartum, the estimated cost of nine maternal morbidity conditions for all pregnancies and births in 2019 was $32.3 billion, amounting to $8,624 in societal costs per birthing person.    
So what can be done to address this avoidable health crisis?  

A New Kind of Maternal Health 

More than 70% of pregnant women are using digital tools. Providing virtual maternal health services that leverage mobile apps and digital technologies can play a key role in helping pregnant women and new mothers receive the medical care they need in a timely manner. Traditional member portals (digital front doors) have historically focused on enabling self-service and call deflection. Fortunately, a new generation of member portals are leveraging user-friendly CX, channel-of-choice communication, AI, the science of behavior change, and other tools to increase engagement and build ongoing relationships with patients. This digital-first approach meets and engages pregnant and postpartum women where they are, understanding and proactively supporting them with real-time, relevant needs. These portals also make many services more accessible, from finding a provider and scheduling appointments to providing educational materials and enabling health plans to engage in proactive outreach. This kind of engagement is especially important in rural areas, which are disproportionately affected by maternal health “deserts,” caused by the fact that 25% of all rural OB units closed in the United States between 2011 and 2021. 

Serving the Underserved 

Health inequities are high among expectant and postpartum mothers. In 2022, for example, the mortality rate among Black women was 49.5 deaths per 100,000 live births, compared to just 19 for White women. Factors contributing to this high disparity include wealth inequality, structural and institutional racism, and implicit bias by healthcare professionals. Additionally, polls show an overwhelming distrust of healthcare providers among Black Americans, which creates a major barrier to seeking quality and comprehensive prenatal and postnatal care. For example, a poll conducted by The Undefeated and the Kaiser Family Foundation (KFF) found 7 in 10 Black Americans believe that people are treated unfairly due to racial bias when seeking medical care. 

While many of these issues are complex, digital solutions offer more accessible and equitable care through convenient connection to clinical care and a personalized experience that demonstrates trustworthiness and engages populations who live in medical deserts. Secure chat and clinical video calls allow for risk screening and intervention at the point of engagement and provide convenient access to working women. Education around risk factors such as vaping, drinking, and missed appointments is critical for this population and the community. A digital engagement gives pregnant women a clinical resource for identifying early warning signs and supporting specific needs. It also offers the opportunity for care coordination by bringing providers, clerks, case workers and nursing together, as well as technical tools such as AI and bots, in a unified care services approach. 

Stakeholders are starting to understand that a longitudinal approach to maternal care is needed. Establishing relationships before, during and after birth can ensure health for the woman and child. Other ways to better serve underserved and rural populations include providing support in multiple languages, employing a diverse staff, and providing patient educational materials that are clearly written and easy to understand.  

Securing the Data 

Gathering health equity information, screening for social risks, and identifying interventions are the first of many steps needed to leverage data effectively. Working toward HEDIS® gap closure for prenatal and postpartum visits as well as ensuring that immunizations occur is another strategy to begin improving outcomes and data reporting. 

Any maternal health digital program should be fully HIPAA compliant with HiTRUST certifications and compliance with SOC 2 types I and II audits.  Role-based permissions and smart-routing logic should be leveraged to ensure patient data is shared on a minimally necessary, as-needed basis.  

Pager Health recently established a new collaboration with League, the leading healthcare consumer experience platform, to create a Maternal Health Solution that delivers engagement, social-risk screening, navigation, behavior-based rewards and virtual-care services at scale. Simply by initiating a chat conversation, expectant and postpartum mothers can immediately access a nurse for clinical guidance and compassionate support. Connect with Pager Health to learn more.