Equity issues drive rise in U.S. pregnancy-related risks

Last summer, a friend called to tell me her pregnant daughter was visiting and wondered if she’d be safe delivering her baby if she went into labor during her stay. The question initially struck me as odd, given that there were plenty of excellent hospitals nearby, until I realized the real concern behind the question: My friend and her daughter are Black.

It’s an unacceptable fact that Black women are more than three times more likely to die of pregnancy-related causes in America than white women. That holds true regardless of education level, socioeconomic status, age, geography and type of healthcare coverage. Even healthy, high-profile athletes Serena Williams and Allyson Felix nearly died during pregnancy and childbirth.

And yet the prevalence of pregnancy-related complications, particularly for people of color, has only accelerated. New research from the Blue Cross Blue Shield Association found that between 2018 and 2020, pregnancy, childbirth and postpartum complications in the U.S. increased by 9%. Among Black, Latina and Asian women on Medicaid, these complications were 73%, 28% and 38% higher, respectively, than white women on Medicaid—representing an inequitable deterioration of care.

From blood clots during labor to postpartum depression, these complications often leave thousands of women grappling with traumatic, long-lasting health implications and exorbitant medical expenses that affect families and entire communities. These complications pervade the entire healthcare system, highlighting deeply ingrained issues, including racial inequities, bias in the care provided, and underlying chronic conditions. In mid-September, the Centers for Disease Control and Prevention published new data detailing that 4 in 5 pregnancy-related deaths are preventable. Women should be able to trust the care they receive before, during and after the birth of their child.

As healthcare leaders, we have a responsibility to the women and mothers who entrust us with their care. Action starts with robust data to inform where gaps exist and where resources should be allocated. From there, leaders must align their maternal health efforts with national standards-setting organizations and work with these partners to improve and benchmark progress.

All corners of the healthcare system—from insurance companies and providers to health advocacy organizations—are coming together to address America’s maternal health crisis. BCBSA set a goal to reduce racial disparities in maternal health by 50% by 2026. But to drive toward improved outcomes, we need concerted solutions.

Insurers have seen success with boosting access to doulas. According to March of Dimes, support from doulas results in fewer cesarean sections, shorter time spent in labor, lower overall costs and fewer complications. Payers have also seen improved outcomes when a newborn’s regular follow-up screenings are combined with a consultation for the mother. Integrating comprehensive services into primary care settings can help identify and treat mental health conditions, the leading underlying cause of pregnancy-related deaths, while also curbing costs.

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