Understanding the Importance of Obstetrics Care & Health Equity

Chelsea Boog talks about obstetric health disparities and the importance of health equity strategies that improve access to care.

As part of Curi’s mission to help physicians in medicine, business, and life, the Health Equity Committee is committed to supporting our member practices in reducing the impact of health disparities on their patients.

The mission of our Health Equity Committee is to promote advocacy to reduce the risk of uninformed care/treatment and poor patient outcomes due to bias and/or health disparities. Advocacy is through engagement, education, and support to guide decision-making from a defined position.

Obstetrics (OB) is one of Curi’s highest-risk drivers, so it is imperative that we discuss OB along with health equity and access to care. Understanding health disparities in OB can highlight the need to address systemic inequities in access to care and social determinants of health (SDOH) to possibly decrease the number of OB claims. 

Maternal and infant health disparities show underlying social and economic inequities from health insurance coverage and education (literacy and language) to economic stability (income and employment). Other than social and economic inequities, the following complications contribute to high maternal mortality rates:

• Post-partum hemorrhage
• Infections (post-childbirth)
• Hypertensive disorders (i.e., preeclampsia)
• Complications from delivery
• Unsafe abortion practices 

OB Statistics

Significant racial disparities in maternal and infant health outcomes continue to persist. 

Pregnancy-related mortality rates among American Indian and Alaska Native (AIAN) and Black women are over three times higher than the rate for White women (63.4 and 55.9 vs. 18.1 per 100,000).^[1] 

According to the Centers for Disease Control and Prevention (CDC), the U.S. maternal mortality rate decreased to 18.6 deaths per 100,000 live births in 2023 (22.3 in 2022). Even though maternal mortality decreased, the maternal mortality rate for Black women in 2023 was 50.3 deaths per 100,000 live births, significantly higher than rates for white (14.5), Hispanic (12.4), and Asian (10.7) women.^[2] 

Based on the March of Dimes 2024 report, there has been a decline in maternity care access since the last national report in 2022, with more than 100 hospitals closing their obstetrics units.^[3] This impact has created a higher rate of inadequate prenatal care, especially among women of color and low-income areas. With the higher rate of inadequate care, fewer women are receiving the prenatal care that they need, which can lead to complications if not addressed in a timely manner. 

Case Studies

Below are examples of case studies based on elements of health equity. 

Social determinants of health

• Example: A pregnant mother lives in poverty with a lack of access to nutritious foods, and she does not have safe/stable housing, which leads to poor fetal development and an increased risk of preterm birth. 

Systemic issues

• Example: An African American woman experiences racial bias during the course of prenatal care. The provider often overlooks her concerns, stating that “it’s a common pregnancy symptom,” leading to delayed diagnosis of complications and poor outcomes. 

Maternal Mortality

• Example: A woman dies during childbirth. The woman spoke a different language, resulting in a lack of access to timely care and language/cultural barriers that contributed to her death. 

For an in-depth case example of maternal disparity, please see the case example from The Joint Commission. 

Elements of Health Equity Strategies

It is important that our insured facilities and practices have health equity strategies in place to ensure that every patient receives the best care possible, regardless of their ethnicity, sexual orientation, age, and background. These strategies can help address issues that lead to health disparities. 

• Community Engagement – We encourage facilities to take the time to partner with community organizations to understand the needs and barriers of different populations. Take time to identify disparities within the community and prioritize interventions.
• Culturally competent care – Support and assist in the recruitment, retention, and advancement of obstetrician-gynecologists and other healthcare professionals from racial and ethnic communities that are underrepresented in healthcare.
• Address SDOH – Screen patients for social determinants like housing instability, food insecurity, and transportation challenges. If the patient has challenges, have a process in place to connect patients with social services and community resources to address these needs.^[4]
• Provide outreach and education – Develop outreach campaigns to reach underserved populations, including pregnant women in rural areas or those with limited access to healthcare. Also, provide culturally appropriate health education on prenatal care, nutrition, and postpartum recovery.
• Healthcare provider training – Incorporate implicit bias training into medical education to address unconscious biases that may impact care delivery.
  
  Practice-level actions can include:
   
  • Chief Equity Officers: creating a role throughout the delivery system to ensure health equity remains on the system’s agenda. Chief Equity Officers are strategic leaders in the executive suite, with cross-functional oversight of the delivery system’s performance in serving the needs of patients and customers. The officers would focus on staff training, accountability, and how staff treat all patients.
  • Clinician Perspectives: implement implicit bias training for clinicians so they can understand different stereotypes/biases, increase opportunities for providers to interact with patients of different groups, practice partnership building between the clinician and the patient, and make it a standard practice for clinicians to use the “teach back” method with patients to ensure that patients understand their care/treatment plan.  

Specific areas to focus on for OB health equity

Strategies to achieve health equity in obstetrics (OB) include the following:

• Reducing maternal mortality disparities: Prioritize interventions for women at high risk of complications, including those with pre-existing conditions, advanced maternal age, or limited access to care. Acknowledge that the current system in place for providing care for OB patients causes harm, particularly for marginalized and minoritized communities, and contributes to preventable and premature death.
• Improve early prenatal care access: Implement strategies to encourage early prenatal visits and address barriers to early access.
• Addressing postpartum disparities: Provide postpartum care, including mental health support, breastfeeding assistance, and family planning counseling.

To get more information regarding health disparities in OB, please take the time to review the following webinars.

How Addressing Racial Health Disparities Can Help Providers Improve Care Delivery

Creating Health Equity & Justice in Reproductive Health

To learn more about addressing disparities in healthcare, please visit the Health Equity page on the Curi website.  

If you have questions about this topic, please call 800-328-5532 to speak with one of Curi Advisory's Risk Solutions Consultants.

[1] https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/

[2] https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023.htm

[3] https://www.marchofdimes.org/about/news/maternity-care-desert-report-reveals-millions-unable-to-accesscare#:~:text=Key%20findings%20from%20the%202024,hospitals%20closing%20their%20obstetric%20units

[4] https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health

The opinions and views expressed in blog posts on Curi’s site belong to and are solely those of the individual author, and do not necessarily reflect those of Curi Advisory or Curi Advisory’s parent or affiliated companies or their members, insureds, clients, customers, or partners. This post is for informational purposes only and it should not be construed or relied upon as medical advice.  If medical care is needed, please consult a qualified professional.

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