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Provider Spotlight: Addressing Structural Racism in Maternity Care

By: Dr. Susan Beane, Executive Medical Director, Healthfirst; and Dr. Wendy Wilcox, Chief Women's Health Officer, New York City Health + Hospitals

In New York State, Black pregnant patients are five times more likely to die in pregnancy or childbirth than white pregnant patients.

Even more alarmingly, 78% of those deaths were preventable.

This is not a New York-specific issue — nationwide, maternal mortality rates for Black women are three times higher than white women, according to the Centers for Disease Control and Prevention (CDC). In fact, the CDC established Black Maternal Health Week, recognized each April, to bring awareness to the disparities.

The CDC indicates that four key factors contribute to these disparities. Each factor — variations in care quality, the presence of underlying chronic conditions, implicit bias in the practice of medicine, and structural racism — can trace its roots to an American medical system built on a foundation of segregation and discrimination starting in 1619.

Only recently have healthcare stakeholders recognized the enormity of reversing this trend. A recent commentary on the health impact of racism in The New England Journal of Medicine suggests the medical and public health communities’ roles in dismantling structural racism involves nothing less than “turn[ing] a lens on themselves” to reflect on how the industry persists in racist practices, how it harms Black patients, and how interventions can narrow inequitable gaps in health.

Healthfirst provider partner New York City Health + Hospitals has done just that. Here, Dr. Wendy Wilcox, the public health system’s chief public health officer, shares details of its Maternal Mortality Reduction program, which launched in 2018.

Maternal care improvements spur change

With support from City Hall, New York City Health + Hospitals launched our Maternal Mortality Reduction Program in 2018. In the years since, the program has met its initial goals to improve postpartum visit compliance, increase WIC and SNAP enrollment, and increase referrals for behavioral health and dental care.

Two initiatives have served as cornerstones of the program. One is the opening of simulation labs in six acute care facilities to train maternity and postpartum staff on some of the top causes of maternal mortality, including cardiac disease, obstetric hemorrhage, and severe hypertension in pregnancy. Critically, the simulations include mannequins of color — mannequins that look like the patients we serve.

The other is the Maternal Home. Like our patient-centered medical home that addresses clinical, behavioral, and social needs in chronic care management, the Maternal Home provides wraparound services for maternity patients. Since its inception, the Maternal Home has served 1 in 6 pregnant patients throughout the entire health system, 75% of them Black or Hispanic.

We’re just as proud of how the program has started to shift the mindset of New York City Health + Hospitals leadership. In November 2020, our system changed our policy on toxicology testing to require written consent before administering a drug test to pregnant and postpartum women.

We made this announcement in advance of an investigation into discriminatory screening practices by the New York City Commission on Human Rights— practices that led to a disproportionate number of Black children being placed in foster care and caused further mistrust of medical providers. Our leaders acknowledged that the status quo represented an example of structural racism and was denying many of our patients the medical care they needed.

The first step in addressing structural racism in health and medicine is acknowledging that it exists. The next step is to acknowledge that it won’t be easy to fix, as our current system has been 400 years in the making. From there, health system leadership must get the message to all providers who work with patients that they’re committed to providing more equitable care and meeting the needs of patients who have been overlooked for far too long.

This is the second in a series of posts highlighting Healthfirst partners who are working to address various forms of health inequity for the New Yorkers we jointly serve. Our first post looked at Northwell Health efforts to leverage clinical and non-clinical data to address disparities in care related to COVID vaccinations and unmet social needs.