Solutions for Maternal Healthcare Equity

We need to change our healthcare values. We need to value pregnant women and children, especially those in rural areas and limited (and worsening) access. The closure of maternity services in rural hospitals has reached alarming levels, more than half (58%) no longer offer labor and delivery services. In 10 states more than 2/3 of hospitals do not offer these services. (https://lnkd.in/gXm8yzX3)  In the last 4 years, >80 rural hospitals have ceased delivering babies, forcing long travel times, often >50 minutes to access care (https://lnkd.in/gGJGn4g9). This lack of local maternity services not only discourages adequate prenatal and postpartum care but also elevates the risk of complications and mortality for both mothers and infants.  Financial strains are a significant contributor to this crisis; many rural hospitals face increasing costs to maintain adequate staffing, while reimbursements from private insurance and Medicaid often fall short of covering these expenses. More than one-third of the rural hospitals that remain open have been losing money. Over 700 rural hospitals lost money in 2023-24, and nearly 400 had losses of 5% or more.  1/3rd of rural hospitals providing maternity care reported financial losses on patient services in recent years. Who is next to close their OB and newborn services? ⭕ This has real, NEGATIVE impact. I have witnessed firsthand how these limited services can result in the unnecessary death of a baby and mother. To sustain rural maternity care, we need policy changes that incentivize hospital collaborations, payer reforms that support shared-risk models, and investment in telehealth/remote monitoring and mobile care solutions: 🟢 Require health insurance plans, including Medicaid, provide reimbursements that fully cover the costs of delivering high-quality maternity care in rural settings. 🟢 Strengthen workforce recruitment and retention: Implement targeted strategies to attract and retain teams of physicians, midwives, advanced practice clinicians, and nurses—in rural communities, ensuring that maternity services are adequately staffed. 🟢 Mobile OB/GYN teams could rotate, serving multiple rural hospitals 🟢 Invest in rural healthcare infrastructure: Allocate resources to modernize and equip rural hospitals, enabling them to offer comprehensive maternity services. 🟢Leverage technology 🟢Take every opportunity to leverage economies of scale 🟢Small rural hospitals could partner with larger regional hospitals to create shared maternity care programs. 🟢Insurers could create regional maternity care bundles, where multiple hospitals and providers share reimbursement for maternal care. 🟢#AI risk assessment tools and smart wearable technologies could help triage high-risk pregnancies remotely and direct appropriate care. We need to value the health and well-being of pregnant women and their babies in rural areas. #UsingWhatWeHaveBetter

Yesterday, January 23, 2024, was #maternalhealthawarenessday with a tagline: “Access in crisis.” Indeed, with the unacceptably high maternal mortality and morbidity in the United States, every day should be maternal health awareness day and tagged access in crisis until concerted efforts to dismantle systemic challenges and barriers through actionable policy and programmatic interventions to protect pregnant and postpartum patients are in place. Based on my research and work, I want to see: ✴ Every pregnant and birthing patient with adequate and comprehensive insurance coverage for reproductive services, preconception, prenatal, and one-year postpartum care.  ✴ Continued equity-focused and culturally competent public health education and campaigns must be central to improving access to care.  ✴ Healthcare provider training and education to equip providers to provide trauma-informed and strength-based care is essential.  ✴ Community engagement harnessed and strengthened, especially as adverse social determinants of health contribute significantly to maternal health outcomes.  ✴ We must work to reduce maternal mental health conditions, chronic diseases, and some cancers that disproportionately impact women and mothers.  ✴ Access to telehealth services and remote monitoring should be in place regardless of geographic location to continuously monitor high-risk pregnancies.  ✴ More patient safety initiatives and bundles addressing maternal mental health and substance use are needed.  ✴ Quality data and surveillance systems must be in place to inform policies that protect and not harm mothers, particularly Black mothers and mothers of color. ✴ And, of course, the elephant in the room: MORE FUNDING. Without funds, we will continue to progress backward. All stakeholders: policymakers, clinicians, academicians, community organizations, and the private sector must work to connect and not break the silos. There is no universal answer, considering the intersectionality of maternal health. Nonetheless, we must continue to advocate and resolve to leverage our expertise under one umbrella to protect every pregnant and birthing individual.  The American College of Obstetricians and Gynecologists (ACOG) posters are sobering. Still, I am hopeful that we can reverse these trends with recent efforts like the Centers for Medicare & Medicaid Services, Transforming Maternal Health Model, and other innovations geared towards improving maternal health. #maternalhealth March of Dimes

In health care, the impact of bias is especially profound. In maternal care, it can be a matter of life and death. Implicit biases tied to race, socioeconomic status, and cultural background often contribute to disparities in prenatal and maternal care, with underserved communities experiencing the brunt of these consequences. Exploring new ideas and perspectives to enhance prenatal care is something I’m committed to. The power of the collective to brainstorm new ideas, test and learn is priceless. Here are some things I've been thinking about: 💡 Community-centered prenatal programs. Instead of relying solely on traditional education models, we need community-centered programs. These initiatives should engage local leaders, organizations, and community members to co-create educational content that resonates with the specific needs and cultural contexts of the community. 💡 Leverage mobile health clinics. Accessibility is a major barrier, especially in rural or underrepresented areas. Mobile clinics can bring prenatal care directly to the community through screenings, education and consultations—ensuring that no one is left behind due to geographical or transportation challenges. 💡 Peer-to-peer support networks. Establishing peer support networks in underrepresented communities can be a game-changer. Connecting expectant mothers with peers who have navigated the health care system successfully can provide invaluable insights, emotional support and encouragement. 💡 Access to doulas. Doulas can be powerful allies for Black women in navigating the health care system. They offer physical, emotional and informational support to their client before, during and after childbirth and are advocates for them when they are most vulnerable. BJC HealthCare is proudly advocating for policies that improve access to and compensation for doulas. 💡 Collaborative partnerships. Building strong partnerships with local organizations, community leaders and non-profits is essential. By pooling resources and expertise, we can create a comprehensive network that addresses not only medical needs but also social determinants of health, such as housing, nutrition and economic stability. In addressing prenatal care for underrepresented communities, it's crucial to adopt a holistic and community-driven approach. I’d love to hear from colleagues—how are you addressing this issue? Let me know in the comments. #CycleBreakers #NextGenLeaders #SCCProud Progress West Hospital

⏭️ Next generation #maternalhealth centers women’s voices and experiences AND leverages the best of #digitalhealth and #AI to inform, empower, and triage. It is also fueled by courageous, transparent organizations willing to test their innovations using randomized trials. 📱 Jacaranda Health’s AI-enabled digital health tool PROMPTS has reached nearly 2.5 million pregnant and postpartum women across Kenya. PROMPTS is designed to “empower mothers to seek care at the right place and time” using push and pull messaging and an AI-enabled clinical helpdesk. Why do I believe in a tool like PROMPTS to save moms and babies? 💡  It leverages #behavioralscience to design smart, high-impact messages (“nudges”) 🤲 It involves true community engagement so we talk TO women instead of AT them 🤝  It builds on genuine public sector partnership to create complementarities with the health system at scale Our publication in PLOS Medicine (bit.ly/3S4D3w8) reports on the results of an #RCT testing the impact of PROMPTS among over 6,000 pregnant and postpartum women across Kenya. We report on more results than I can discuss here, including a careful exploration and synthesis of all of our pre-specified outcomes. The takeaway I will highlight here: ⚡ We can catalyze improvements in #postpartum care quality by empowering women with information about the care they should be getting. #Postpartumcliffs are alive and well in Kenya—as they are elsewhere. PROMPTS not only increased the chances that women actually received timely and complete postpartum care, but increased the likelihood that they were actually examined, counseled and heard. 🦻 We need more rigorous evidence of what works in digital maternal health. We need more innovation at scale. We need to center women’s voices and experiences and dignity. Harvard University Harvard Medical School MD/PhD rockstar Raj Vatsa, PhD led this work. Funding from Gates Foundation and what used to be #USAID/DIV Essential collaborations from the full team at Jacaranda Health (Sathy Rajasekharan, Anneka Wickramanayake, Sharon Akinyi, Dr. Sarah Little, Cynthia Kahumbura (BEng, MBA)), Innovations for Poverty Action (Gakii catherine, John Mungai), Margaret McConnell, Wei Chang. https://lnkd.in/eqkU-bm3

Bridging the gap: Improving maternal and child health in rural Nigeria In my journey as a physician and global health advocate, I have witnessed firsthand the great disparities in healthcare access between urban and rural areas in Nigeria. One of the areas where this divide is most pronounced is in maternal and child health, where rural communities face immense challenges that often go unnoticed. To start with, maternal mortality in Nigeria remains one of the highest globally. A 2023 report from the World Health Organization revealed that Nigeria accounted for 12 percent of global maternal deaths, stillbirths and neonatal deaths — the second largest in the world. This high prevalence of maternal death in the country can be linked to inequities in access to health services during pregnancy and childbirth implying that rural areas account for a significant portion of these deaths. As the founder of one of Africa's largest youth-led health advocacy organizations the SLUM AND RURAL HEALTH INITIATIVE NETWORK , I have dedicated my career to addressing these disparities. Our mission is to provide equitable healthcare access to underserved communities, ensuring that no one is left behind. So here, since women have to travel long distances to access basic prenatal and postnatal care, establishing well-equipped healthcare centers in these regions is crucial. It's high time we prioritized building and upgrading rural health clinics to provide comprehensive maternal and child health services. In addition to this is the reality of severe shortage of trained healthcare professionals in rural areas. I believe that incentivizing healthcare workers to serve in these communities through better remuneration, career development opportunities, and improved living conditions can help address this gap. No doubt, many maternal and child health issues stem from a lack of awareness and education. So I believe that Community-based health education programs focusing on prenatal care, safe delivery practices, and child nutrition can empower women and families to make informed decisions about their health. There's also a need to ensure a steady supply of essential medications, vaccines, and medical equipment is vital. In this regard I believe that Public-private partnerships can play a significant role in facilitating the distribution of medical supplies to remote areas. Improving maternal and child health in rural Nigeria requires a concerted effort from all stakeholders—government, healthcare providers, NGOs, and the private sector. We must work together to create sustainable solutions that address the unique needs of rural communities. So I invite everyone to join us in our mission to bridge the healthcare gap in rural communities in Nigeria. Together, we can create a world where every woman and child has access to the care they deserve, regardless of their location. Photo credit: World Health Organization #maternalhealth #children UNICEF MacArthur Foundation

AI Could Help Close Health Equity Gaps—Or Make Them Worse. The Choice Is Ours. 🤔✊🏾 A couple of weeks ago, I had the honor of serving as an expert panelist at the The George Washington University- Milken Institute School of Public Health, speaking on "The Role of AI in Advancing Health Equity." 🎤✨ Even now, the urgency of that conversation still sits with me. The digital divide is growing, misinformation is rampant, and ongoing threats to Medicaid funding could push health equity even further out of reach—especially for Black women, who are already 3 to 4 times more likely to die from pregnancy-related complications. If Medicaid funding is cut, this number will likely rise. 💡 What does that mean in real terms? ❌ Less access to life-saving maternal health care. ❌ More families in maternal health deserts left behind. ❌ Fewer investments in technology like AI-powered mobile apps that could help detect preeclampsia and gestational diabetes before it’s too late. This isn’t hypothetical—it’s life or death. During the March of Dimes Virginia State Advocacy Day, I had the opportunity to advocate in real-time for a Virginia bill aimed at reducing maternal hypertension and gestational diabetes. This bill proposes a pregnancy mobile application for Medicaid-eligible individuals, providing life-saving education, resources, and support—especially for those in maternal health deserts. 🏥🤰🏾 ✨ Imagine the impact: ✔️ AI-powered tools that have the potential to detect high-risk conditions early— but only if we ensure investment and equitable access. ✔️ Culturally informed healthcare resources, available anytime, anywhere. ✔️ More Black mothers and babies surviving & thriving. 🚨 This is why these conversations matter. AI and tech must be leveraged for good—but only if we ensure equitable access, community-driven solutions, and policy alignment. 💡 As I prepare to head to Capitol Hill today for March of Dimes — March for Change, I carry these conversations with me. Speaking on panels is great and an honor—but policy change is where real transformation happens. 🚀❓ Where do you see AI making the biggest impact in health equity? Drop your thoughts below. 👇🏾 #ThrowbackThursday #HealthEquity #AIForGood #BlackMaternalHealth #MarchForChange #PublicSpeaker

🚨 Centers for Medicare & Medicaid Services just announced 15 states chosen for the Transforming Maternal Health (TMaH) Model that focuses on improving maternal health care for people enrolled in Medicaid and Children's Health Insurance Program (CHIP). ✨ California is one of them! The model will enable participating state Medicaid agencies (SMAs) to develop a value-based alternative payment model for maternity care services through a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy. Model includes: 💠 Goals to reduce disparities in access and treatment by improving outcomes and experiences for mothers and their newborns and reducing program expenditures. 💠 States include: Alabama, Arkansas, California, District of Columbia, Illinois, Kansas, Louisiana, Maine, Minnesota, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia, Wisconsin 💠 3-year Pre-implementation Period: when states receive targeted technical assistance to advance each model element and a 7-year Implementation Period to execute the model. 💠 3 key pillars: 1. Access, Infrastructure, and Workforce: Increase access to birth centers and midwives, access to perinatal community health workers and doulas, and data collection, exchange, and linkage through improvements in electronic health records and health information exchanges 2. Quality Improvement and Safety: Implement “patient safety bundles,” or specific protocols that promote the reduction of avoidable procedures, leading to improved outcomes, promote achieving “Birthing-Friendly” designation, and introduce an option to promote shared decision-making between mothers and providers 3. Whole Person Care Delivery: Institute evidence-based medical and social risk assessment to drive risk-appropriate care, deliver care consistent with individual preferences, routinely screen and follow-up for perinatal depression, anxiety, tobacco and substance use during prenatal and postpartum periods , incorporate, home monitoring and telehealth technology for birthing people who have medical conditions like gestational diabetes and hypertension that complicate pregnancies, routinely screen and follow-up for HRSNs and establish reliable referral pathways to and from community-based organizations to address HRSNs, develop and implement Health Equity Plans for the local population as well as cultural competency technical assistance for providers #maternalhealth #valuebasedcare #equity #wholeperson https://lnkd.in/gy6wM96Z

4 in 10 babies in America are now born on Medicaid. In several states it's more than 50%. Value‑based care is about bending the cost + quality curve. The most leverage we get is ensuring mothers and their newborns avoid unnecessary disease and complications; many of which become lifetime cost burdens. These high ROI, pro-health, strategies include: • Comprehensive prenatal visits & nutrition support • Early screening for hypertension, diabetes, & substance use • Evidence‑based doula and lactation services • Post‑partum mental‑health check‑ins • Seamless hand‑off to pediatric primary care and social resources Investing in these strategies isn’t charity; it's good value based care. #ValueBasedCare #MaternalHealth #Medicaid #PopulationHealth

My colleagues Munira Z. Gunja, Evan D. Gumas, Relebohile M. and I published The Commonwealth Fund study- addressing US Maternal Health Care and International Comparisons: Key Findings: -Significant disparities persist- Equity needs to be at the center of all efforts -Most maternal deaths occur postpartum, stressing the need for comprehensive postpartum care. -Countries with the lowest maternal mortality rates prioritize midwifery and comprehensive care that extend beyond health care We Must Act By: -Supporting Community-Led Care Models -Expanding Access to Midwives and Diverse Care Teams -Diversifying the clinical workforce (Midwives and Physicians) -Ensuring Comprehensive Prenatal and Postpartum Coverage -Providing Paid Parental Leave Let's work towards equity and safety for all moms and birthing people. We know what to do! Together, we can make a significant difference. #MaternalHealth #HealthEquity #BlackMaternalHealth #IndigenousHealth #HealthcareReform

Today is Policy Day of Black Maternal Health Week, so let’s talk about a few policies we should implement to improve maternal health care for Black pregnant people. Here’s a to-do list for policymakers on this year’s BMHW: ✔️ Expand Medicaid to 12 months postpartum in all 50 states: Dr. Jessica Pineda of Brown University found that “Black mothers are twice as likely to experience maternal mental health conditions but half as likely to receive treatment compared to White mothers.” Expanding Medicaid could help expand access to vital mental health services for conditions like postpartum depression. ✔️ Expand Medicaid to cover doula and midwife care: OB-GYN Dr. Dawn Owens Robinson said “Doulas save lives,” and the data proves it. Doulas help reduce disparities in Black maternal health care, and shouldn’t just be a privilege for the wealthy. ✔️ Protect reproductive rights: Black women living in states where abortion access is restricted face disproportionate risks from unintended pregnancies. Access to the full spectrum of reproductive care is important for maternal health overall.