October 29, 2021

A deep dive into the 'maternal health equity crisis'

Daily Briefing

    Health equity is a topic long talked about in health care circles, but there's one specific area of health equity the United States is woefully behind in—maternal health.

    Radio Advisory's Rachel Woods sits down with Callie Chamberlain, co-director of social responsibility at Optum and a trained birth doula, and Advisory Board's Darby Sullivan to discuss the dire state of maternal health in America and the role the entire industry plays in supporting pregnant people.

    Addressing the root causes of maternal health inequity

    Read an excerpt from the interview below and download the episode for the full conversation.

    Rachel Woods: Let's make sure we understand why this problem exists. Darby, explain to me some of the root causes of maternal health and equity in the United States.

    Darby Sullivan: Yeah, sure. So according to the research, we see this crisis in part, because of kind of the intersection of two forces. So on the one hand, the legacies of structural systemic racism that we've been talking about for the past year and a half more and more, and on the other hand, the sort of systemic deprioritization of women's health across the lifespan in favor sometimes of fetal outcomes. So those two things together, I think have uniquely led to the maternal health equity crisis.

    Woods: Darby, those are two, I mean, they're humongous challenges to solve. And so part of me is thinking, no wonder folks focus on quick wins, or low hanging fruit, or aren't able to actually get to these root causes because you are talking about upending the structure of the United States. My question is how, how can organizations of all kinds start to chip away at these underlying issues?

    Callie Chamberlain: We are just beginning here to be clear. I think two things are really important. One is that each of our philanthropic organizations that we're supporting, which is out there in the world, not necessarily about us as the second largest health care company in the world, changing our business practices.

    Each of these grant partners has an executive sponsor. The intent of that is for the sponsor to serve as a senior advisor to the organization, to look for opportunities for Optum to even more deeply support their work. And also to think about the relationships and the communities, the insights that we're learning from our work to pull back into how we think about creating products and services within our organization.

    So that's one of the ways in which we're advancing, I think equity and deepening relationships with communities. That's really important because it's not just, again, out there. It's like coming into the organization as well.

    The second thing is thinking about how you align your priorities to what you say that you care about. One of the biggest things that I would love to see Optum do is to have really incredible best in class paid parental leave policies.

    I would love to see us lobby in ways that actually prioritize the things that we're doing externally and the things that we say that we care about internally. There's a gap there for a lot of organizations because we're in a capitalistic society, for profit environments. And also there's so much space to walk the line and I'd love to see us move closer to that in the future.

    Woods: And this is not just a lesson about one organization or one major health care company. Every single person who is listening to this podcast needs to think, what am I doing now to make progress and how can I think bigger? How can I do more? How can I address every aspect of equity, not just my patient outcomes, but also my own people, right? My own workforce, as well as my community.

    And frankly, that's the message of equity period. I think it just plays out really, really specifically when we talk about maternal health. Darby, what do you think? How can organizations again, from across the industry, address some of these root cause issues?

    Sullivan: Yeah, I think on the one hand, leaders from organizations can sort of say, I'm actually making a change to my benefit structure in a way that will have far reaching impacts. That's relatively an easy step to make compared to sort of the other complex changes that orgs have to make.

    To stay at a high level, we recommend tactics that fall into three key categories. The first being primarily for provider organizations. So those are the ones that are actually owning that patient interaction. We recommend that they start with sort of these no regrets safety protocols because too often the standard evidence-based OB protocols that vastly reduce the instances of never events, those are not being used in a standardized way.

    Woods: Meaning they're only used for say white pregnant people.

    Sullivan: Or not, or maybe they're just sort of—some care teams know how to do it. Some care teams don't.

    Woods: So just the basic way that we have care variation in general, we're not focused enough on it in this particular space.

    Sullivan: Exactly. And that's sort of like, do that immediately. After those are in place, then I think you can start to build those feedback mechanisms to try to get a sense of, okay, what are the broader causes of this beyond just sort of the care variation that we might see.

    That means expanding an existing with maternal mortality review board to make it more of a perinatal review committee so that you catch problems that happen prenatal and postpartum, as well as during the delivery. In addition to sort of the basics of gathering data stratified by race, to see where disparities prop up.

    Woods: And I would say that's the best practice for the patient outcomes piece. And then you pair that with what Callie was saying, which is how do we support our own workforce? How do we address this problem in the community?

    Let me reveal to both of you, some of the pushback that I get and the pushback kind of centers around this idea that this is not my problem. This is not my problem to solve, or maybe this is not my problem because folks incorrectly think I have a pretty homogeneous patient population. So this isn't a problem for my organization, which Callie very eloquently said, nope, it doesn't matter if you're a pregnant person in United States. This is a problem period.

    But the other kind of not my problem moment that we're having right now comes out of some very specific policy changes that have happened in the last several weeks. Of course, I'm talking about Texas and I get a little bit afraid that organizations, provider or otherwise who are not in Texas, are looking at what's happening and saying, see, it's bad there. They are the ones that need to focus on maternal health, perinatal care, etc. but we're actually okay, wherever we are in the country. What do you say to that pushback?

    Chamberlain: I think that's part of the problem is that mentality that like the problems exist out there and they're disconnected from anything that has to do with me or the things that I care about. That's just simply not true.

    We live in the world together and the things that affect one group of people are affecting us all in some kind of way. And so I think one of the really incredible examples of social responsibility is Salesforce who offered the opportunity for their staff that were located in Texas to relocate as a result of this law.

    I think that's a really good example of an organization that's not in health care, but knows that they have a stake in the ground because they have people that work for them that are there. And they're saying, let me think differently about how I can show up in this moment.

    Sullivan: Yeah. I think it's also important for all organizations in health care to realize just how tied abortion and maternal outcomes are or women's outcomes are. Zooming out a little bit. We know that pregnancy is more dangerous to health than an abortion is in terms of, mortality, morbidity.

    We know that. And research shows that the people who are most likely to seek an abortion include people of color, low-income people, those with chronic conditions, those that are experiencing the adverse social determinants of health. Those are the people, the very same people that are most likely to have serious complications during pregnancy.

    So any restriction on abortions will inherently worsen outcomes for patients, especially patients of color, which is of course concerning from a preventative standpoint. If one of your goals is to improve maternal health and improve maternal health equity, you have to also keep abortion care as part of that strategy.

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