Spring 2022

Addressing the Maternal Mortality Crisis Through Innovation and Collaboration for Equity

article summary

A team of maternal and child health experts at UNC is bringing attention to alarming inequities in maternal mortality and how to address systemic racism in health care.

The National Center for Health Statistics released a report in February 2022 stating that the number of maternal deaths during pregnancy and the first six weeks after childbirth increased 14%, from 754 deaths in 2019 to 861 deaths in 2020. Black women experienced the most deaths, with their mortality rate three times that of white women. These additional deaths are alarming and represent a trend in maternal deaths in the United States that has been worsening since 2000.

by Dorothy Cilenti, DrPH, Kristin Tully, PhD, Suzanne Woodward, Piia Hanson, MSPH, MBA, Alison Stuebe, MD

The preventable nature of maternal mortality and inequities by race in the U.S. call attention to the ways we have constructed health care and our society. Numerous media outlets, including The New York Times, The Washington Post, NPR and others covered this new report with calls to action. 

When considering causes of racial and other inequities in maternal mortality, it is essential to consider the health care system and acknowledge racism and other forms of bias within policies and interpersonal interactions. Innovative practices in public health and clinical care, pay structures and measurement are a part of identifying what is working well in maternal health and establishing accountability.

UNC is a hub of action to address maternal mortality with an explicit focus on health equity. 

In response to worsening maternal health outcomes, the Maternal Health Learning and Innovation Center (MHLIC), housed at UNC-Chapel Hill with funding from the Maternal and Child Health Bureau and the Health Resources and Services Administration, works with diverse stakeholders to promote evidence-informed approaches that center equity and value the perspectives of people with lived experience. In partnership with many organizations, the aim is to identify engagement and policy levers that accelerate the implementation of innovations. Many of these innovations are being launched or expanded in states and regions that are transforming their health systems to be more data driven, equitable and responsive to the needs of pregnant people and their families. 

The COVID-19 pandemic and response unmasked persistent, multilevel problems, such as gaps in access to health care, lack of adequate care coordination, suboptimal health care working conditions, variation in nurse-to-patient ratios, and misalignment between women and their health care teams in terms of racial and language concordance. In addition, the evolving nature of COVID-19 science meant that messaging around key components of health decisions changed over time.

It is now known that pregnant people are a priority population to serve with COVID-19 vaccines, because they are at a higher risk of severe illness from the virus. Gillings Distinguished Scholar of Infant and Young Child Feeding Alison Stuebe, MD, was at the forefront of calling for new parents and their newborns to remain together during COVID-19 and establish exclusive and continued breast/chestfeeding, which is consistent with World Health Organization guidance.

"This virus unmasked the multiple ways that biomedical approaches fail to address the social contexts and structures that determine health and well-being."

— Alison Stuebe, MD

“Early recommendations to separate birthing people from their infants illustrate the failure of reductionist approaches to the COVID crisis,” Stuebe says. “This virus unmasked the multiple ways that biomedical approaches fail to address the social contexts and structures that determine health and well-being.” 

Stuebe and Kristin Tully, PhD, assistant professor of obstetrics and gynecology, lead a Patient Safety Learning Lab (PSLL), funded by the Agency for Healthcare Research and Quality, to evaluate journeys through care and reengineer systems to be more effective, just and enjoyable. The lab’s interdisciplinary team partners with parents, companions and health care team members to redefine what it means for mothers and birthing people* to be safe and well in this country.

Health and safety are positive concepts which mean much more than surviving a pregnancy. Care during this precious part of our lives should foster autonomy, provide timely access to relevant information, promote self-efficacy and belonging for new families to thrive, and be structured for clinicians to offer respectful, equitable and supportive care.

The research and capacity-strengthening work at UNC complements activism in maternal health to transform health care and public health in this country. Respectful, equitable care requires a diverse workforce, and Gillings has been at the forefront of efforts to advance this work.

The Carolina Global Breastfeeding Institute at Gillings is providing technical assistance to historically Black colleges and universities (HBCUs) and other organizations serving communities of color to develop internationally credentialed lactation consultant training programs. Educational grants to diversify the workforce are among the comprehensive strategies included in the Black Maternal Health Momnibus Act of 2021, a set of policy proposals that is critical to advance birth equity and improve the quality of care for all. In addition, UNC’s Kathryn Menard, MD, MPH, is a member of the U.S. Secretary’s Advisory Committee on Infant and Maternal Mortality which has proposed a set of recommendations to address the unacceptable disparities in infant and maternal outcomes. 

This is an exciting time for the Gillings School and faculty, staff and students at other schools to be a part of real, sustained change for maternal, infant and family health. Unfortunately, there is an immense need to improve our society and the inclusivity and patient-centeredness of health care services.  

Learn more about MHLIC, PSLL and colleagues’ work to make real, sustained change: maternalhealthlearning.org, postnatalsafety.com, newmomhealth.com, Carolina Global Breastfeeding Institute.

*We use the term birthing people in addition to mothers to promote inclusive and affirming care for all who give birth.

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