Elizabeth Cherot, the first physician to lead the organization, talks about the rise in deaths tied to pregnancy, maternity care deserts, and structural racism.
From the alarming number of deaths tied to childbirth to the number of communities without obstetric services, Elizabeth Cherot says it’s clear that maternal health isn’t getting enough attention.
Cherot, the president and chief executive officer of the March of Dimes, points to her organization’s recent research. A March of Dimes analysis found that roughly one in three U.S. counties can be classified as maternity care deserts. Those counties don’t have hospitals with labor and delivery units or any obstetric providers.
“It tells you we're not prioritizing Moms, who are the entryway into the healthcare system,” Cherot says.
Cherot joined the March of Dimes as the chief medical officer in January 2023. In July, she was named CEO, and she became the first physician to lead the March of Dimes.
In an interview with Chief Healthcare Executive®, she talks about her goals in her new role, the need to improve care for women during and after pregnancy, and the undeniable role structural racism has played in maternal mortality. She also discusses steps the health system could be taking to help women and babies.
Cherot says March of Dimes can play a role as a “convener,” bringing together providers, payers and funders to improve maternal health.
“People ask me all the time, which lane does the March of Dimes swim down? And I always say, actually, we're the swimming pool,” Cherot says.
(See part of our conversation with Elizabeth Cherot. The story continues below.)
‘Moms and babies at the center’
Cherot, a fellow of the American College of Obstetricians and Gynecologists, has spent almost 30 years at the bedside delivering babies and taking care of mothers. She says she’s “definitely an OB at heart.”
She says that experience informs her new role leading the March of Dimes.
“I have that lens of really being boots on the ground, with moms and babies, with good and bad outcomes that I've seen,” she says.
Cherot has treated women with preeclampsia and seizures, and also had conversations with patients suffering from depression. So besides her medical experience, she also understands the emotional weight patients are carrying.
“I really believe in putting moms and babies at the center of what I do. I also talk a lot about being accountable,” Cherot says. “I think it's really important to do what you say you will do. And I think that's the lens I can bring.”
Cherot takes the role at a time when there’s growing attention to maternal health in America, which she says is nothing short of a “crisis.”
The numbers bear out the assessment.
Maternal deaths rose 40% in 2021 compared to the previous year, according to figures from the National Center for Health Statistics. From 2019 to 2021, maternal deaths rose 60%. And compared to 2018, the maternal mortality rate has risen 89%, according to the new federal data.
In addition to the alarming rise in maternal deaths, as many as 60,000 women annually suffer serious pregnancy complications, the Commonwealth Fund estimates.
Even with growing attention on maternal mortality in recent years, Cherot laments the fact that the nation is not only failing to make progress but is actually slipping backward.
She’s mystified that so many aren’t aware of the problem.
“I find it fascinating when people say to me, ‘I didn't know,’” Cherot says. “And people are still saying that. This has been going on through the last two decades.”
‘The wrong direction’
Amid the worsening figures on maternal health, more hospitals are shuttering their maternity wards, Cherot laments. She understands the financial dilemma many hospitals are facing, but the development doesn’t bode well for improving maternal health.
“We're going in the wrong direction,” she says. “So you continue to see hospitals closing labor and delivery units, birth centers closing. There aren't providers in counties across the country. That's what a maternity care desert is. We're seeing a lot in the news about hospital closures. And so moms are driving much further to get care.”
More than 5.6 million women live in areas with little or no maternity care services, according to an analysis released by the March of Dimes. Nationwide, about 1 in 10 women don’t live within 30 minutes of a birthing hospital.
Patients in North Dakota must drive more than 32 miles, on average, to reach a hospital providing obstetric services, the greatest distance in the nation. Patients in Kentucky must travel 20.3 miles, on average, to a hospital with obstetric services, while those in Tennessee must go 15.9 miles.
While many maternity care deserts are in rural areas, they exist beyond farm country. The March of Dimes analysis found 40% of America’s maternity care deserts are in urban areas.
“It’s affecting a lot more women than people realize,” she says.
“It’s something that this country needs to look at as a priority and it definitely does not.”
The March of Dimes, working with University of Maryland Capital Region Health, operates a mobile unit offering health services for mothers and babies in Washington, D.C..
Cherot says telehealth and remote patient monitoring can help offer better care for patients during and after pregnancy, and can be especially valuable for patients who don’t have easy access to their providers.
In assessing the nation’s maternal health crisis, Cherot says racism can’t be ignored as a contributing factor.
Black women are 2.6 times more likely to die of maternal causes than white women, according to data from the Centers for Disease Control and Prevention.
Even among women with higher incomes and higher education levels, Black women still have worse outcomes, Cherot notes.
“There's clearly some structural racism within our healthcare system that we have to solve,” Cherot says.
If healthcare leaders are serious about addressing maternal mortality and morbidity, then racial disparities must be addressed, she says. Black infants are also more than twice as likely to die before their first birthday than white patients.
“You have to talk about race,” Cherot says. “It's fundamentally part of it.”Cherot also stresses that gaining better insights into the social drivers affecting the health of Black and Brown women is key to closing some of those disparities in outcomes.
“We really need to stay focused because they have the worst outcomes,” Cherot says. “And if we don't address it head on, it's going to be worse for everyone else. But we have to acknowledge right away that Black and Brown women just have the worst outcomes and it shouldn't be.”
Hospitals, payers and providers need to collaborate and address the maternal health crisis, particularly for women in minority populations, she says. The March of Dimes wants to partner with all of these players.
“We all have to get together and acknowledge that this is a big problem in the United States,” Cherot says. “Other countries are doing much better, and we are not. So we have to start addressing the real issues behind it.”
The health system could help improve maternal health by offering more access to doulas. The March of Dimes has pushed for increased access to doulas, who support patients during and after pregnancy. The organization has called for more training and development of doulas, and for payers to offer coverage for doula services.
She also would welcome support from hospitals and health systems. “That would be a place that I think that hospital systems could really partner with us,” she says.
Cherot said she would like to see more mobile health services available for mothers and babies. Only 2% of all mobile health units are in the maternal and infant space, she notes.
“That's crazy,” Cherot says. “You can do mammograms, people do blood drives, people do primary care … why aren't we really partnering to get maternity care?”
As much as anything else, Cherot says hospital and healthcare leaders need to put more time and energy into improving health services for mothers and babies.
“I would hope and would want that maternal health gets prioritized because I don't think it is,” Cherot says.