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The Blue Cross Blue Shield Association has released data showing evidence that women of color are at higher risk of pregnancy-related complications, regardless of having commercial health insurance or Medicaid.
Instead, the numbers indicate U.S. maternal health disparities are likely the result of broader health system and societal challenges, including underlying chronic conditions, racial inequities, and likely biases within the healthcare system itself.
Pregnancy-related complications have worsened 9% since 2018, with a marked increase during the COVID-19 pandemic, with some women of color at nearly 70% higher risk of pregnancy-related complications than white women.
The study, Racial and Ethnic Disparities in Maternal Health, examined the rate of childbirth complications in nearly 11 million U.S. births to women with either commercial insurance or Medicaid as measured by the Centers for Disease Control and Prevention’s Severe Maternal Morbidity Measure (SMM).
WHAT’S THE IMPACT
The analysis found Black, Latina and Asian women have higher rates of SMM than white women, regardless of age or type of health insurance. Preexisting health conditions, such as hypertension, diabetes or asthma going into delivery, strongly correlate with higher SMM and worse pregnancy complications, increasing the likelihood of a risky delivery or challenges postpartum.
While across all populations women ages 35-44 were identified as most likely to have an SMM event, Black women in this age range have a 66% higher rate of SMM and are more likely to suffer pregnancy-related complications than white women, the data showed.
Dr. Adam Myers, senior vice president and chief clinical transformation officer for BCBSA, said disparities are largely caused by implicit bias and systemic racism in healthcare – deep-rooted issues that need to be addressed.
“To achieve better outcomes, we need to make sure care before pregnancy is easily accessible and equitable for all women, in addition to robust prenatal care, and ongoing postpartum care to ensure the safety of future pregnancies,” said Myers.
BCBSA is attempting to make strides in this regard, launching its National Health Equity Strategy last year. The strategy lays out a plan to reduce racial disparities in maternal health by 50% over five years.
Among the components of this strategy: working with lawmakers to strengthen and scale policies that make care more equitable; creating incentives and trainings for providers to offer care that is sensitive and remove unconscious bias; addressing social drivers of health, focusing on root causes; and collaborating with industry partners to standardize data collection and analysis to better understand care gaps and create interventions that will address them.
BCBSA also developed a list of 10 actions organizations can adopt to improve maternal health and make a measurable difference in health disparities.
THE LARGER TREND
The federal government is also making a push to address racial and ethnic disparities. In late August, the Department of Health and Human Services, through the Health Resources and Services Administration, announced investments of more than $20 million to reduce disparities in maternal and birth outcomes.
The funding will help expand and diversify the workforce caring for pregnant and postpartum individuals, increase access to obstetrics care in rural communities and support states in tackling inequities in maternal and infant health.
Black women are three times more likely to die from a pregnancy-related cause in this country than white women, according to HRSA Administrator Carole Johnson.
These investments are part of the implementation of the White House Blueprint for Addressing the Maternal Health Crisis released in June.
In November 2021, HHS announced that more than 200 hospitals signed on to a new program, Perinatal Improvement Collaborative, a contract with Premier. The program evaluates how pregnancy affects overall population health by linking inpatient data of newborns to their mothers.