Turning insights into action: building a U.S. health system that delivers for all women

pregnant black woman

Dr. Mary-Ann EtiebetDr. Mary-Ann Etiebet, Associate Vice President, Health Equity, Merck, has more than two decades of experience working across the public and private sectors to improve health outcomes for underserved populations and transform healthcare delivery on the frontlines.

At Merck, Dr. Etiebet is responsible for the development and execution of the company’s first enterprise-wide health equity strategy. She is also the former lead of Merck for Mothers, Merck’s $650 million global health initiative that has increased access to quality maternal healthcare and family planning services for more than 20 million women in over 60 countries.

Note: The thoughts and sentiments expressed in this article are those of Dr. Mary-Ann Etiebet alone and reflect her personal experiences.

An inequitable history of care

Despite increased attention from policymakers and other leaders across the healthcare continuum, the U.S. still has a shockingly high maternal mortality rate that is nearly double the average rate of all high-income countries—a public health crisis that continues to worsen.

While the rate of pregnant women dying from delivery-related causes in the hospital has declined by more than 50% in recent years, this progress is not experienced equally by all women, and it is offset by the fact that many maternal deaths happen during pregnancy or in the postpartum period. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 75% of maternal deaths happen either during pregnancy or between one week and one year postpartum.

In particular, pregnancy and the postpartum period are exceptionally precarious for women from historically marginalized backgrounds and women of color living in the U.S.

A rising tide does not lift all boats—and a retreating tide uncovers even more disparities

As the U.S. health system has been challenged in recent years by the COVID-19 pandemic, climate and humanitarian crises, and economic instability, we have seen disparities increase. Complications during and after pregnancy have become more dangerous for Black women, who are now two to three times more likely to die from pregnancy-related causes than white women. And women from historically marginalized backgrounds are now more likely to face structural barriers to care, such as a lack of access to insurance, culturally appropriate health services, and high-quality healthcare facilities, exacerbating their maternal health outcomes.

Further, while we know social determinants of health are key contributors to disparities in maternal health outcomes, it is also important to acknowledge that they don’t tell the full story. A recent study of two million births from 2007 to 2016 in California (the state with the most annual births) revealed that Black mothers have significantly worse health outcomes than their white counterparts, regardless of socioeconomic status. Maternal mortality rates were equally as high between the highest-income Black women and low-income white women.

This data adds to a growing body of evidence and lived experience that reaffirms higher rates of pregnancy-related deaths among women of color are driven by how systemic racism shows up in our healthcare ecosystem. It, too, underscores that racism is in fact a pervasive and underlying social determinant of health.

The time is now to accelerate action to reverse the alarming trends in maternal mortality

Armed with real-world data and tested solutions, we as a society are now in a better position than ever before to address the stark racial inequalities around maternal health outcomes in the U.S. However, to make true progress, we need to work across silos to rebuild our health system in a way that weakens and dismantles—instead of remains blind to or reinforces—the impact of systemic racism:

  1. Expanding access to perinatal support services: Knowing most maternal deaths occur outside of the hospital, our first lines of prevention, defense, and response must meet women where they are. Policymakers need to redefine perinatal care to include ongoing physical, social, and psychological services and support for women in their homes and communities—i.e., new standards for comprehensive, integrated care should go beyond pregnancy care to address medical risk factors, co-morbidities and well-women care for the full 12-month postpartum period. These health services are vital, and to help make them accessible to all women, we should be devoting more resources to leveraging training and certification programs to expand our doula workforce.
  1. Increasing screenings and care for maternal mental health: Despite mental health conditions being among the most common complications during pregnancy or in the first 12 months after delivery, these conditions often go undiagnosed and untreated. Solving this problem requires policy change. We need to make mental health screenings a required component of perinatal care and ensure these screenings are covered by health insurance, along with other mental health services. In addition, to fully implement the most recent mental health guidelines from the American College of Obstetricians and Gynecologists (ACOG), we need to provide more support for the continued education of all healthcare professionals who interact with people who are or were recently pregnant.
  1. Recruiting and helping providers to deliver culturally appropriate care: Given studies suggest that when providers and patients share the same race or ethnicity, it improves shared decision-making and reduces implicit bias, we must remain focused on building a diverse pipeline of healthcare providers. At the same time, we also have a responsibility to train all providers to deliver high-quality care that is grounded in cultural humility and in alignment with each person’s unique circumstances, values and needs.
  1. Enhancing doctor-patient communication: More than 80% of U.S. maternal deaths are preventable, underscoring the importance of strengthening communication between providers and patients, and empowering the latter to recognize potential pregnancy-related complications through ongoing education. And, when it comes to identifying maternal health warning signs, the entire healthcare ecosystem has a role to play in improving health literacy, including governments, non-profits, community-based organizations, and the private sector.

Collaboration leads to inclusive strategies

At Merck, we have seen firsthand the power of partnerships and cross-sector collaboration. For more than a decade now, we have been working with like-minded partners to develop and implement new and impactful strategies for improving maternal health outcomes through Merck for Mothers, our $650 million global initiative to help create a world where no woman has to die while giving life.

In the U.S., we have helped prevent pregnancy-related deaths by supporting the CDC with sharing potentially life-saving messages about urgent warning signs through the “Hear Her” campaign, and worked with the Institute for Healthcare Improvement to reduce disparities in maternal care by improving how healthcare professionals respond to obstetric emergencies. Currently, we are also supporting community centered maternal health solutions through our Safer Childbirth Cities initiative, a national movement powered by coalitions of community-based organizations in 20 U.S. cities.

The root causes of inequities in the U.S. are multifactorial and steeped in social determinants of health—including systemic racism—and therefore, we must take a multipronged approach to addressing them. The only way to achieve real change is by combining actions, knowledge, and resources from across all segments of society. Together, we can rebuild a health system that is antiracist and delivers for all women.

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