Addressing Racial Disparities in Maternal Health
Editor’s note: Sg2 Fellow Jeremy C Miller, MD, contributed to this post, a version of which was originally published in Sg2 parent company Vizient Inc’s 2020 Corporate Responsibility Report.
On Tuesday, April 12, 2021, the White House issued a proclamation designating April 11–17 as Black Maternal Health Week. President Biden recognized that Black women experience a maternal mortality rate that is two to three times higher than other demographic groups and that more than 60% of these deaths are preventable.
Excess maternal mortality among Black women is multifactorial and calls for action on multiple fronts. Black pregnant women are more likely to have difficulty accessing care, and evidence suggests that even after correcting for this disparity, Black women are also more likely to have difficulty obtaining care that is appropriate. Care disparities, however, are just one part of the picture. The White House proclamation also recognizes that systemic discrimination impacts a variety of social determinants of health including housing, nutrition and workplace environment.
Accordingly, we are called upon to invest in data collection to foster a better understanding of maternal mortality and severe obstetric morbidity; to expand and diversify the workforce dedicated to maternal (and fetal) health; and to do more at an organizational and societal level to address demographic inequities in terms of social determinants of health.
Black Maternal Health on Chicago’s West Side
As part of Sg2’s commitment to making a difference in social determinants of health and improving health outcomes for the underserved in our communities, in 2019, Sg2 partnered with West Side United—a Chicago collaborative of six hospitals and community partners united in their common vision to improve neighborhood health—to address the dire disparity in maternal health among Black women. Because while a Black mother living in America is more likely to die in childbirth than a White mother, that disparity jumps in Chicago.
Our approach leveraged a collaborative design process engaging a cross-section of more than 20 local community and provider organizations to map the patient journey and potential solutions. We also conducted focus groups with mothers and identified their challenges and fears—like feeling judged and dismissed, dismay at the lack of choice in directing their care, confused by poor bedside communication and misinformation, pain and frustration around breastfeeding challenges and an overall isolation due to breakdowns in continuity from prenatal to delivery to postpartum care.
CenteringPregnancy Program Overview
Through this culturally competent, patient-centered design process, the CenteringPregnancy program at the University of Illinois Center for Women’s Health was born. Centered around an innovative model of group care, women participate in 10 prenatal visits following the first trimester—and each visit is two hours long, allowing ample time to listen, answer, advise and connect. Following their appointments, women at CenteringPregnancy participate in a small group meeting with eight to 10 other women of similar gestation or infant age. Facilitated by prenatal staff, the group discusses nutrition, stress management, pregnancy complications, relationship issues, labor and delivery, among other important topics relating to mothers’ physical and emotional well-being.
Evidence-based outcomes include a reduction in preterm births including accounting for racial disparities, improved outcomes within high-risk pregnancies among teenagers, increased rates of breastfeeding, improved self-care and self-confidence among mothers and an estimated cost savings of over $2,000 per mother receiving prenatal care through CenteringPregnancy.
Sg2 West Side United Project Team
- Project Lead: Brianna Motley
- Project Manager: Andrea Cladek (Sg2 Alumna)
- Project Analyst: Afnan Ullah
- Subject Matter Experts: Karyl Kopaskie, PhD, Rhae Ana Gamber, Jeremy Miller, MD, FACOG
- Project Advisor: Jay Warden
- Client Relations: Becca Segel
Sources: Centering—A Snapshot; CenteringPregnancy; Centering Pregnancy at the University of Illinois Center for Women’s Health; Practical Applications of the Centering Pregnancy Model of Care; Sg2 Analysis 2019.
Tags: care continuity, equity, innovation, maternal health, patient-centered care, pregnancy, prenatal care, racial health disparities, West Side United