The impact of racism on maternal health outcomes | Ellen Stang

America's maternal mortality rate is the worst of all developed nations. There is truly no conversation about improving maternal health without health equity.

It was a challenging year for those of us working to improve maternal and infant health outcomes. The news cycle was fueled with tragic headlines, politically driven actions, and trend data pointing in the wrong direction.

Likely exacerbated by pandemic-era challenges, our maternal mortality rate – already the worst of all developed nationsrose an additional 14% year over year from 2019 into 2020. Personal choice and family planning came under scrutiny, threatening a woman’s ability to obtain contraceptives.

And, at a time when care is sorely needed, it is proving hard to find: this year’s March of Dimes Maternity Care Deserts Report notes that nationally, nearly seven million women have “nowhere to go” amidst a substantial uptick in maternity care access.

While the national dialogue around health has never been more animated – 25 states have extended postpartum coverage to a full year, the first CMS-approved health screenings for social determinants of health (SDoH), and a critical understanding of the need for better mental health care – there is truly no conversation about maternal health without health equity.

It all begins with bias

In myriad ways, the lived experience of implicit and systemic racism impacts the health and well-being of Americans nationwide.

From our country’s inception to early medicine and the beginnings of scientific research, racism is deeply woven into the fabric of daily life. Insidious, it rears its head in often invisible – yet impactful – ways. A professor of pediatrics at Johns Hopkins, Dr. Maria Trent, likened racism to a contagion: “[it] is a socially transmitted disease. It’s taught, it’s passed down, but the [health] impacts on children and families are significant.”

Data has long illustrated how this perpetuates inequalities within healthcare – specifically those within childbirth: The maternal mortality rate for non-Hispanic Black women is 3x higher than it is for White women, and for American Indian and Alaska Native women it is 2x higher.

While the social determinants of health account for around 80% of an individual’s overall health, they are only part of the story.

New research is illustrating the additive impact to health risk of racism alone. A study published this year found that within a hospital setting, Black mothers are 53% more likely than their Hispanic and White counterparts to die during childbirth. As the research controlled for a large set of influencing variables, including socioeconomic factors and insurance coverage, the authors attributed the outsized disparity in part to systemic bias within the healthcare system.

Disrupting the cycle

If racism is a socially transmitted disease, it is high time we inoculate.

Even implicit bias – which two out of three clinicians subconsciously hold – is proven to result in different standards of care and treatment options based on race alone.

One study revealed that even when symptoms and prognoses were kept identical, doctors were more likely to recommend advanced treatments for their White patients. When implicit bias can change the course of treatment plans and the level of care one receives, it becomes essential to develop standards of care that help ensure equitable care delivery for patients of all skin colors and backgrounds.

Disrupting the cycle begins by looking within and taking ownership for actions that may even unwittingly perpetuate discrimination and bias within the clinical setting. Today, storied organizations nationwide are joining this call to address racism head-on.

The American Academy of Pediatrics publicly vowed to “dismantle racism at every level” of the institution, and the American Medical Association released guidelines for anti-discrimination policies to proactively address inequities and foster a culture of diversity and equality for all patients and clinical staff.

While there are active steps individuals and organizations alike should adopt, a new generation of healthcare tools offer innovative ways to reduce or eliminate implicit bias from the outset.

Scientists are rewriting the script on evaluative health tools: newly objective screeners aim to reduce external subjectivity within pain assessments and researchers are reevaluating AI algorithms that may unintentionally sustain inequities. Real-time intervention platforms show promise for offering feedback on non-verbal cues and communication skills during patient-provider interactions to help foster healthier relationships within the clinical setting.

We have a lot of work to do

While much discussion is spent on confronting racism in healthcare, an important flipside to the conversation is the resulting loss of trust with patient populations. According to one patient sentiment survey, 55% of Black Americans report openly distrusting the healthcare system, and 7 out of 10 reported being treated unfairly. Systemic bias, health disparities, and a loss of faith in the industry has driven a wedge between patient and provider.

Unfortunately, trust is easy to lose, and hard to regain. This only means we have a lot of work to do.

For those of us actively pursuing real change, this is where we must begin. Providers have a unique opportunity to rebuild trust by acknowledging the wrongs of the past and establishing how their practices will act differently moving forward.

Trust is the currency upon which meaningful healthcare relationships are built; without it, it is impossible to deliver real care. Not only do so many of our new moms depend on it, but their babies and our future generations do too.

Ellen Stang, is the founder and CEO of ProgenyHealth. She also serves as a member of the National Board of Trustees for the March of Dimes and is a member of the Board of Trustees of Gwynedd Mercy University.