It has long been known that the maternal mortality and infant mortality rates in the US rank among the highest in the developed world, with both rates soaring even higher within the Black population. Even after years of research, these numbers remain on the rise. Addressing the problem will require an ecosystem-wide approach to improved care access and health education.
Understanding maternal mortality: Challenges and trends
The Commonwealth Fund reported that in 2020 the maternal mortality rate in the US was three times that of other high-income countries, with the maternal mortality rate of Black patients tallying more than double the average rate and three times higher than that of white patients.
There are several reasons experts believe the US maternal mortality rate has worsened for a decade while other nations have improved, including:
- Lack of access to equitable prenatal care, particularly among the Black community.
- Gaps in insurance coverage that leave many mothers without adequate post-partum care.
With a goal of improving maternal outcomes nationwide, in 2022 the White House released a “Blueprint for Addressing the Maternal Health Crisis.” Its five-point plan comprises:
- Increasing coverage for maternal health services, including behavioral health, to 12 months post-partum.
- Creating quality initiatives aimed at ensuring evidence-based best practices are employed, pregnant patients’ and their families’ wishes are heard and respected, and bias and inequities are reduced.
- Improving data collection on maternal health and population- and community-related indicators.
- Expanding and diversifying the perinatal workforce, including midwives, doulas, and home nurses.
- Strengthening economic supports for people before, during, and after pregnancy.
The importance of patient education in maternity care
As the government pursues systemic change, there are steps that providers and payers can implement immediately in patient and member interactions to help improve maternal care and maternal health equity.
An NPR report describes how simple interventions, like remote blood pressure monitoring and preeclampsia education, can go a long way to reduce harms, and how standardizing decision-making protocols can help eliminate the potential for bias and subjectivity.
Using evidence-based content in health tech is critically important.
That includes patient education, which functions “almost like an ally,” explains Evan T. Heigert, creative director for patient engagement at Wolters Kluwer, Health. “It’s another piece of that puzzle to help make sure patients ask the best questions and the best information is getting out there.”
Patient education and engagement that is relatable to patients’ lives, situations, and cultures can also go a long way toward building trust, he adds. “There’s so much information out there, especially when you're a pregnant person; it can be overwhelming to try and gather it all at the same place. So, finding authentic ways of building trust and delivering education and knowledge over time is really key to encouraging better behaviors.”
Supporting healthy pregnancies: The role of health plans in maternity care education
Working directly with members, payers have the ability to deploy engagement and education programs to positively impact outcomes.
Member education throughout the pregnancy journey
As an example, Heigert cites the addition of longitudinal content on pregnancy in the UpToDate® Journeys solution, with a critical focus on diversity, equity, and inclusion. New and revised content in written, visual, and multimedia patient-facing materials is intended to address the glaring disparities in maternal mortality and morbidity among non-white patients.
UpToDate Journeys offers educational content from pregnancy, through childbirth, and three months post-partum. “It’s addressing the experience and giving them content along the way,” Heigert says. “It meets them where they're at and prepares them to understand the valuable information” they’ll be told by providers and caregivers.
“The approach is how to talk to patients less from a clinical perspective and more from an allyship or supportive approach,” Heigert explains. That includes explaining a patient’s surgical and medical choices and understanding where and when they have control; helping them understand what their body might experience; and even walking through options of support caregivers, like doulas, and what they contribute (and cost).
“It’s about giving more power back to the birthing person,” he says. “We very deliberately wrote empowering content realizing that you may have, as a patient or health consumer, experiences in the past where you felt out of control or you weren’t respected, or you were forced into certain decisions that you feel like you didn't have a say in. It’s really supporting that idea that you do have the power, and you can ask questions, and you can push back, and it’s up to you to make decisions that feel right to you.”
Helping patients find a voice
Part of that meant addressing the disparity in Black maternal mortality head on.
“We made the purposeful choice to use an African American voice artist to deliver [maternity and postpartum] content,” Heigert says. “We can never replace that one-to-one connection with a care person or a care team. But if we're able to provide content in a voice that comes from your community, if we're able to address cultural bias head on and address that in an evidence-based and honest way, we're building back that trust in ways that maybe [patients] are not getting from talking even face-to-face with somebody that’s not from their own community.”
While patient education is by no means a fix-all, Heigert says that member engagement materials that are developed using evidence and principles of diversity, equity, and inclusion can serve to bridge certain divides and fill important gaps that are needed, particularly in maternity care where health equity is such a pressing concern.
“One thing we can do through patient education that uses diversity and understanding what challenges patients have from various communities, using voices of people from their communities, is that we can almost serve as a proxy for those clinicians and care teams that do represent those underrepresented perspectives in healthcare.”
Learn more about member education and engagement solutions for care management and download the whitepaper “Filling the healthcare gap: A care management opportunity” to gain insights on supporting members with health education materials.