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Title V Technical Assistance Meeting

 Turning the Focus to Equity to Reduce Maternal Mortality

nadia22.jpgBy Nadia Laniyan
Program Associate, Women's and Infant Health
Association of Maternal & Child Health Programs     

The rising maternal mortality ratio in the U.S. continues to generate alarm and confusion[i], as seen in recent reporting by National Public Radio and ProPublica. Although the attention to maternal mortality is welcome, one part of the story hasn't received the coverage it deserves: the disparity in pregnancy-related mortality between black and white women.

The disparity is significant even when controlling for age, socioeconomic status and education. Between 2011 and 2013, black women in the United States were more than three times more likely to die of a pregnancy-related death than white women.2

What can we do about it? In a recent American Journal of Public Health article, "Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology," the authors urge us to act:

"Instead of sitting back on the reflexive defense that racial disparities are too complex for us to do anything about, what if we decided to try anyway? What if every obstetrics and gynecology department made racial equity in known areas of disparity the priority of all quality improvement projects? For researchers, how would your study designs change if the primary metric was whether they helped black women? How would your interventions be modified if you could not claim success without racially equitable outcomes? Let's start with these challenges and learn what works, together. We can prioritize racial equity in women's health, but we must actively choose to do so. How can we look at the evidence and do anything else?"  [ii]

Centering Equity picture.jpgSuch calls to action have prompted organizations and researchers to act with renewed intentionality to address the racial disparity in maternal mortality, and to use a health equity lens. For example, this year the National Healthy Start Association Spring Conference was dedicated to the topic of maternal mortality and morbidity and health equity; session topics included "Disparities, Quality, and Severe Maternal Morbidity," "Black Mamas Matter – Birth Equity and Human Rights" and "The Connection Between Negative Encounters Between Black Youth and Police to Depression During Pregnancy."

Other projects and initiatives acknowledge, characterize and put in place solutions to confront this crisis. AMCHP would like to share with you one example of how a state is tackling the challenge, as well as new resources launched by national organizations.  AMCHP wants to hear from you as well: Tell us what you are doing and what you need to address health equity in maternal mortality, at mmr@amchp.org.

A Reproductive Justice Framework

We invited Melanie Rouse, Virginia's maternal mortality projects coordinator, to briefly tell you about the state's use of a reproductive justice framework to infuse equity into its maternal mortality review. Reproductive justice can be defined as the right for women to maintain personal bodily autonomy, have or not have children, and parent their children in safe and sustainable communities.[iii] Melanie writes:

"The team elected to use the reproductive justice framework because it links reproductive rights with social justice and is based on a human rights framework. The team is exploring how this framework can be used to improve the case summaries and to guide the case review." Read  her full piece (370 words).

Resources for Health Equity in Maternal Mortality Prevention

alliance 1.jpg


AIM Peripartum Racial Disparities Bundle

The Alliance for Innovation on Maternal Health has created patient safety bundles that are a collection of best practice resources with the goal of creating standardized processes used in hospitals and clinics for maternity care. A new bundle, the Reduction of Peripartum Racial/Ethnic Disparities, stresses the importance of recognizing race and ethnicity in clinical spaces. The bundle equips users with resources related to staff education, collection of race/ethnicity-based data, and building a culture of equity so that the needs of ethnic and racial minorities are a priority in the clinical setting.

black mamas.png Black Mamas Matter Toolkit

The Black Mamas Matter Toolkit is a product of the Black Mamas Matter meeting hosted by the Center for Reproductive Rights and SisterSong Women of Color Reproductive Justice Collective. The toolkit is composed of advocacy and policy resources, as well as personal narratives that convey the importance of maternal health care for all women from a human rights-based perspective.

jane crow.jpg Jane Crow Project

The Jane Crow Project, founded in 2009 by journalist Rita Hensley Jensen, seeks to address the high maternal and infant mortality rates in the population of African-Americans in the United States through the exploration of how the effects of racism can have negative implications on African-American women's maternal health. Jensen plans to turn the findings of this project into a book and other multimedia products.

review.pngBuilding U.S. Capacity to Review and Prevent Maternal Deaths Equity Analytic and Programmatic Framework

The Maternal Mortality Review Information Application (MMRIA) is a standardized data system developed by the CDC Division of Reproductive Health as part of the Building U.S. Capacity to Review and Prevent Maternal Deaths mmria.JPGinitiative.  MMRIA is available to jurisdictions to support essential maternal mortality review functions that enable data to be combined across jurisdictions for national learning that was previously not possible. 

To maximize the ability of review committees to acknowledge that '"place matters," MMRIA will soon feature additional tools to build the capacity of reviews for conducting analyses that incorporate geospatial data to provide contextual information on where a woman lived for review discussions, and support programmatic actions that address equity based on the results of these discussions.  Future Building U.S. Capacity to Review and Prevent Maternal Deaths reports will feature frameworks that enable  review committees to examine cases with a health equity lens and address the issue in their committee reports.  The MMRIA team would like to hear how we can best support efforts of maternal mortality review committees to promote health equity. Write to mmriasupport@cdc.gov.

For nearly 10 years, AMCHP has collaborated with national partners to build the capacity of state-based teams, with a special focus on Title V programs, to conduct maternal mortality and morbidity surveillance, including maternal mortality review, and translate those findings into population-based action. For more information visit Review to Action.org.

[i] MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues. US National Library of Medicine National Institute of Health . Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001799/

[ii] Eichelberger, K. Y., Doll, K., Expo, G., & Zerden, M. L. (2016). Black Lives Mater: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology. AJPH Perspectives, 106(10), 1771-1772

[iii] Reproductive Justice. (n.d.). Retrieved May 12, 2017, from http://sistersong.net/reproductive-justice/