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From the President: Emerging Issues

 Reflections from the Summit: Maternal Mortality

In June the U.S. Health Resources and Services Administration brought experts from around the country and the world to Washington for the three-day Maternal Mortality Summit: Promising Global Practices to Improve Maternal Health Outcomes. Here are thoughts from two board members of the Association of Maternal & Child Health Programs who attended the summit. One of them, Karin Downs, also gave a presentation. See highlights of the presentations.

Karin Downs, RN, MPH
Treasurer, Association of Maternal & Child Health Programs Board of Directors
Director, Division of Pregnancy, Infancy and Early Childhood
Massachusetts Bureau of Family Health

With a spotlight on maternal mortality both in the U.S. and globally, the Maternal Mortality Summit stimulated discussion and culled best practices from national and international partners to highlight strategies to reduce maternal mortality. Delegates from Brazil, Canada, Finland, India, Rwanda, and the United Kingdom – along with national partners and the World Health Organization – shared best practices, reflections, and strategies they have used to address the worldwide crisis of maternal mortality. Throughout the summit advocacy groups and women who were personally touched by the death of loved ones grounded the discussions by highlighting the impact of the maternal deaths on children, partners, parents, and communities.

Three key messages resonated with me:

Health care system: While there is no perfect health care system in the world, the delegates from other countries described how a universal health care system contributes to continuity of care and underscored the concept of health care as a human right for all. In a country such as the U.S. that does not provide universal access to health care, there is an increased burden to identify strategies to ensure that not only do all people have insurance, but they have access to health care that is coordinated, of high quality, and meets the health care needs of individual women and their families at all periods of their lives and includes preconception, prenatal, intrapartum, postpartum, and well-woman care across the lifespan.

Community outreach: All participants described the importance of community outreach. Even in the most resource-starved communities and countries, developing outreach strategies is critical to engaging women, families, and communities in the health care system. In the United Kingdom, midwives visit all pregnant and postpartum women in their homes, and a large portion of births are attended by midwives. Rwanda has developed an extensive network of community health workers that serve a key family engagement function within the health care system. Others spoke of the value of doulas, who provide emotional and concrete support to families and women in pregnancy, during labor, and postpartum. Community outreach is a critical component of a health care system that provides a safety net for families who may, for many reasons, have challenges accessing health care.

Health equity as related to race: Recognizing that black women are two to four times more likely than those of other races to die in childbirth or experience severe maternal morbidity is critical to understanding health inequities that contribute to disparities in maternal and infant outcomes. Addressing inequities includes understanding both social determinants of health and the impact of racism on health outcomes. It requires understanding all levels of racism, including historical, structural, systemic, personally mediated, and internalized racism, and recognizing how those adversely affect maternal health outcomes.

 

Manda Hall, M.D.
Region VI Director, Association of Maternal & Child Health Programs Board of Directors
Associate Commissioner, Community Health Improvement Division
Texas Department of State Health Services

Attending the Maternal Mortality Summit was an opportunity to learn and share with experts from the United States and around the world. In addition to providing a global perspective, the summit focused on the role of the consumer and family, which are critical to our work in maternal and child health. The need to address disparities in maternal mortality and severe maternal morbidity was underscored throughout the summit. Exploring the different models of care coordination, including the role of public health nurses, community health workers, and midwives offered valuable examples of program and strategies to improve maternal health outcomes.

The best quote from this meeting, which I have shared with my team back home, came from Dr. Bill Callaghan, chief of the maternal and infant health branch in the division of reproductive health at the U.S. Centers for Disease Control and Prevention. Reminding us of what our goals should be in driving down cases of mortality and morbidity, Bill said, "We should be chasing zeros."