👋 Welcome back from what we hope was a rejuvenating summer. In between much-needed time away, we’ve been busy at Burke advancing early childhood initiatives and efforts to improve maternal health. This issue of Starting Early dives into causes of maternal mortality, including an interview with maternal health advocate Kimberly Seals Allers. Please take note of a new regular feature in Starting Early: “Tools You Can Use.”
For the first time in a century, maternal mortality and “near misses” are on the rise across the US, especially among Black women.
An American mother today is more likely than her mother was to die in childbirth. This maternal health crisis has long-term consequences for families and communities. As Dr. Neel Shah, a maternal health advocate, says: “Maternal health is a bellwether for the well-being of our society as a whole… Every injustice in our society shows up in birth outcomes.”
Despite today’s dire situation, progress is being made. In 2018, only 3 states had higher maternal and infant mortality rates than New Jersey; now, 21 states are higher. Much of the improvement can be credited to New Jersey First Lady Tammy Murphy’s collaboration with agencies and organizations across the state as part of Nurture NJ’s vision for New Jersey to become the safest state in America to have a baby.
I hope you’ll be inspired to find new ways to make this critical issue part of your work.
Atiya Weiss
Executive Director
1 big thing: What’s driving the US maternal mortality crisis?
When Olympic sprinter Tory Bowie died in childbirth, alone in her home, it once again brought attention to the issue of Black maternal health, regardless of income or educational attainment. But recognition and awareness are just a start. Understanding the underlying causes of these healthcare disparities is essential to solving this crisis.
The problem: US maternal death rates have more than doubled over the past 20 years and are highest among Black women. The US spends the most on healthcare, yet has the worst outcomes among wealthy nations. And as many as 60,000 U.S. women are affected by ”near misses” in childbirth each year – unexpected outcomes of labor and delivery with serious short- or long-term harm to health.
Why is this happening?
- Money talks: As US hospitals shift to a for-profit model, medical care increasingly focuses on containing costs. Maternity care providers typically are paid for the volume and technical intensity of the care they deliver. Four of every five maternal health dollars are spent around the time of birth, instead of during prenatal and postpartum care – which present the greatest opportunities to address mental health and social needs. Focusing on cost and profitability has also led to more maternity care deserts – counties where little or no maternity care is available.
- Intensity of care:Â On the continuum of maternal healthcare, 2 extreme situations exist:Â too much, too soon and too little, too late. Some mothers get more costly intervention than they need (such as low-risk c-sections) and others get less prenatal care, often too late in pregnancy.
- Racism: Unequal treatment according to race is a key risk factor for maternal death and illness. From limited healthcare availability to ineffective and often disrespectful treatment by healthcare providers, Black women face worse healthcare outcomes – regardless of income and education.
- The “weathering” effect: Due to the prolonged stress of living under adverse social conditions, many culturally-oppressed or economically-disadvantaged people experience poorer health outcomes. Contributing factors include food and housing insecurity, educational disparities, racism, and isolation.
Bottom line:Â The maternal health crisis is a symptom of many systemic challenges. An equitable standard of care would make sure women are believed and heard, improving outcomes for mothers and babies.
2. What’s working
💡 Most maternal health deaths are preventable. Proven public health approaches can save lives.
- New national playbook: Building on the success of NurtureNJ, the National Governors Association wrote the first Maternal and Infant Health Playbook. This policy roadmap covers the entire pregnancy and a full year after birth, including underlying issues that can lead to poor maternal health. Recommendations include more maternal health funding and research, expanding Medicaid to 365 days postpartum, reducing racial disparities in care, expanding paid family leave, enhancing food assistance for families, and building the pipeline of diverse midwives and doulas.
- Centering women’s voices: Recognizing the importance of listening to and acting on women’s concerns, the CDC launched a national “Hear Her” campaign. One way it’s being implemented in New Jersey is through the Greater Newark Health Care Coalition. The campaign includes social media assets and tools for healthcare providers, partners, and community members to increase support for moms to be.
- Other initiatives are proving helpful in and beyond New Jersey:
✅ Community Doula programs are expanding in the Trenton area with recent funding from the US Department of Health & Human Services.
âś…Â Nurse visit programs provide every new mom with an in-home visit from a medical professional soon after birth.
✅ More states are embracing Centering to connect pregnant women and moms in peer groups that result in better healthcare.
✅ Expanding the use of midwives, which can save $11.6 million per 10,000 births per year. Integrating midwives into maternity care improves health outcomes by reducing disparities and alleviating the workforce shortage.
✅ The federal Black Maternal Health Momnibus Act is a legislative package of 13 bills aimed at addressing many root causes of the Black maternal health crisis, investing in community-based organizations, growing and diversifying the perinatal health workforce, and expanding access to maternal mental healthcare.
— US Sen. Cory Booker of New Jersey, a co-sponsor of the legislation
3. In search of a 5-star birthing experience with Kimberly Seals Allers
Starting Early sat with Kimberly Seals Allers, health strategist, author, journalist, and thought leader on maternal and infant health and breastfeeding. She shared insights gained in her groundbreaking work on improving birth equity for Black and brown people. With advocacy and technology solutions, Allers seeks to change the maternal and infant health narrative to embrace the joy of parenthood and to raise the standard of care expected by and for people of color.
Through her nonprofit Narrative Nation, Allers launched 2 key projects: Birthright, a podcast highlighting joyful black birthing stories; and Irth (as in “birth” but without the “b” for bias), a digital platform featuring crowd-sourced reviews of OBGYNs, birthing hospitals, and pediatricians.
Through Irth, “We’re pushing to learn what a 5-star experience is for Black and brown people,” says Allers. The back-end data is also used to educate providers and create strategic improvement plans for hospitals and health systems. “I don’t think we’ll get anywhere without accountability and transparency,” she adds. “And we can’t continue trying to solve this problem from the grave. Figuring out what went wrong after somebody dies can’t be our best approach.”
Allers is a passionate advocate for breastfeeding among Black women. “When we look at breastfeeding, we need to look at the ways that Black women, because of systemic racism when we were enslaved, were being used to breastfeed the children of our oppressors, and not breastfeeding our own children,” says Allers, who links this history to shorter breastfeeding duration among Black women. She also points out the importance of not just advancing policies that support breastfeeding but also enforcing them so Black women aren’t put in the difficult – and sometimes dangerous – position of standing up for their rights in public.
Don’t miss the full interview for more detail on Allers’ perspective on solutions for improving the health and well-being of women of color.
Follow and support the work of Kimberly Seals Allers and Narrative Nation.
4. Tools you can use
Check out these practical tools for parents, caregivers, and families:
- Available for several years in Europe, a test for pre-eclampsia is now approved for use in the US.
- Not sure when you should be concerned? Here’s a list of 10 pregnancy symptoms that warrant a call to your healthcare provider, and take this CDC quiz to test your knowledge
- For mothers-to-be and their support networks, this handy list from the Nurse-Family Partnership provides information on pregnancy resources, food and housing assistance, doula and midwife networks, and more.
- This screening tool and scoring guide for postnatal depression should be used at all postnatal doctor’s visits. The American Congress of Obstetricians and Gynecologists developed this FAQ for patients.
- Welcome Baby provides mothers under a certain income level with a single, comprehensive package containing everything a mom needs in the first 4 weeks of a newborn’s life.
The roundup
- Investing in the future: We’re proud to share that Burke Foundation doula partner HealthConnect One received a $3.5 million gift from Mackenzie Scott. 🎉
- Spreading the word: The New York Times published a recent op-ed “More Mothers Are Dying. It Doesn’t Have to Be This Way.”
- Bridging the gap: This podcast, featuring NJ First Lady Tammy Murphy and Community Health Acceleration Partnership Director Wendy McWeeny, examines how philanthropy can form the “connective tissue” between government and community.
- Celebrating Joy: Listen to Kimberly Seals Allers, HealthConnect One’s Twylla Dillion, Brown University’s Emily Miller, and Burke’s ED Atiya Weiss speak about Birth, Joy, and Justice at the 2023 Aspen VisionXChange, livestreamed and also presented on public radio.
- Listening and learning: Nicole Lamborne, VP of Clinical Operations for Women’s Services at Virtua discusses the evidence-based Team Birth program, designed to enhance communication between patients and providers.
- Looking beyond the US: The Gates Foundation just released its 2023 Goalkeepers’ Report on innovations in global maternal and infant health.
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