Highlights from the 2018 Maternal Mortality Summit hosted by New York Academy of Medicine on February 14, 2018

As a student midwife on the precipice of beginning a career in midwifery and primary and reproductive health care, I feel so honored to have attended the Maternal Mortality Summit. It was an honor just to be in the room—a space where people representing private organizations, public health organizations, and the government could work to develop and implement strategies for maternal mortality and health disparities. Even as a student, I felt like I had a seat at the table and that people were ready to listen. You could feel the buzz in the room–this intense pull to communicate with one another, collaborate, and get things done. Let’s start with some data from the summit to keep in the foreground…

• Maternal Mortality Rate (MMR) in NYS from 2013-2015 was 20.9 per 100,000 births.
• MMR was 3.5x higher for black women (MMR of 55).
• In 2010, NYS was 46^th in maternal mortality, and in 2016 NYS went to 30^th.
• The average birth costs $9,000, and Severe Maternal Morbidity (SMM) birth costs around $14,000.

I want to take a moment to highlight Dr. Joia Crear-Perry, MD, FACOG, founder and president of the National Birth Equity Collaborative. She demanded the room and captured the audience with her keynote presentation, “Systems and Policies Driving Black Maternal Health Inequities.” She discussed how structural racism, social determinants of health, and implicit bias shape hospital policy and patient care. Here are main ideas from her presentation.

• Institutional racism, class oppression, and gender discrimination and exploitation are the root causes of power and wealth imbalances in housing, education, air and environmental quality, access to resources, social networks, and job security—imbalances that subsequently lend to psychosocial stress and unhealthy behaviors that then lead to disparities in health.
• Because of housing segregation, hospital policymakers, and the discrepancy between private insurance and Medicaid reimbursement, hospitals in New York have become segregated and differ in the quality of care they give to women and families.
• The clinical and the social must come together to dismantle systems of power and racism that have created racial disparities in maternal mortality. Providers, people in public and private health sectors, and community leaders must be trained in racial and reproductive justice and must practice with a racial equity lens, must be actively anti-racist, and must center the most marginalized.

Key takeaways from speakers, panels, and breakout groups:

• The central driving force of the widening racial health disparity in maternal and infant mortality is structural racism dating back to slavery, Jim Crow, and redlining. The experience of systematic racial bias–not “race” itself­–compromises health. This is a public health crisis in which issues of chronic stress and disease that leads to poor health outcomes disproportionately affects communities historically impacted by oppression and racism.
• The current system of reviewing and accounting for maternal deaths is flawed and leads to misclassification. We need a new nationally standardized system that is not based on death certificates to document maternal mortality. Moreover, the maternal mortality review committee generally relies on volunteers, as it currently not embedded as a core public health function.
• Providers and stakeholders need to promote well woman care; at every visit and with every woman, providers should discuss reproductive plans, prescribe contraception if appropriate, and address risk factors and chronic conditions.
• “Would you like to become pregnant in the next year?” is a simple question that gives providers the opportunity to gauge patients and start a dialogue with them about their health and resources; it is a question that can help patients start pregnancy as healthy as possible.
• During the community-based interventions break out session, we brainstormed together about interventions we have seen in our communities and about interventions we would like to see. People had ideas about community based doula programs, doulas for incarcerated women, home visiting programs, car services for labor/delivery covered by Medicaid, labor rooms instead of hospital rooms, incentivizing providers for good outcomes, radio shows, centering model of pregnancy, improved sexual education in schools, peer to peer models, and more.

Cool organizations/projects discussed at the summit:

• New York Safe Motherhood Initiative’s statewide Obstetric Hemorrhage Project is at 75 birthing hospitals in NYS.
• From the recommendation of the Council on Women and Girls, a new State Maternal Mortality Review board has been created as part of the NYS 2018 agenda to develop recommendations to improve maternal outcomes.
• States differ on how they collect data for maternal deaths, which makes accounting for maternal mortality and morbidity difficult. Reviewtoaction.org is a site that helps states create review committees, connects people to one another, and standardizes data collection.
• National Birth Equity Collaborative is an organization that seeks to reduce Black maternal and infant mortality rates through research, family-centered collaboration, and advocacy.
• Black Mamas Matter is a Black women-led cross sectoral alliance in Atlanta that centers Black mamas to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice.
• NYS Perinatal Quality Collaborative has obstetric and prenatal projects using quality improvement science; they provide guidance and tools to improve maternal healthcare and to support the maternal mortality review process.
• SMM Surveillance project funded by Merck for Mothers used discharge data and matched death certificates with birth certificates; they disseminated a final report and estimated medical costs of SMM.
• Maternal Intentions Program in Harlem, part of the Northern Manhattan Perinatal Partnership, works with women in their last trimester and postpartum women who have been diagnosed a chronic disease and/or have had complications in a previous pregnancy. They take a two-pronged approach of community stakeholder engagement and direct health services.
• Denise Boles has the radio show called “In the Light of Birth”

Some good quotes

• “Racism is the risk factor, not blackness.” –Dr. Joia Crear-Perry, MD, FACOG, founder and president of National Birth Equity Collaborative
• “What is it like for the most marginalized person in the community to seek care, enter your space, and get treated, and what barriers are they facing?” ­­–Dr. Joia Crear-Perry
• “There is no acceptable rate of maternal mortality.” –Dr. William Callaghan, MD, MPH, Chief of Maternal and Infant Health Branch in the Division of Reproductive Health and the CDC

-Marlies Biesinger, midwifery student class of 2020 at Columbia University School of Nursing