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Closing the gap: Addressing Black maternal mortality

Pregnant woman and doctor in doctor's office

Motherhood can be a time of joy and new beginnings. Every person deserves health and safety throughout their birthing journey, which can influence the well-being of mothers, children, families and their communities. But for many Black women, the reality is a disproportionate maternal mortality rate that continues to affect cities and counties across the nation—including the St. Louis area.

The statistics for Black mothers are stark and sobering: The Centers for Disease Control and Prevention (CDC) in 2021 reported that for Black women in the U.S., the mortality rate was 70 deaths per 100,000 live births—more than two times the rate for white women. In Missouri, health officials determined many of these pregnancy-related deaths were preventable.

The need for a comprehensive approach—from policy changes and health care training to community partnerships—is key to addressing Black maternal mortality disparities.

The sobering realities Black mothers face

Why is this still the case in 2024?

“Number one, it’s about structural racism and implicit bias,” said Yvonne Smith, director of patient care for women and infant services at Barnes-Jewish Hospital, part of BJC HealthCare. “It’s a bundling of things that creates an environment that puts a different level of stress on Black and Brown people in particular as they access health care, regardless of socioeconomic status."

Smith said the other problem is the general sentiment that Black women don’t feel they’re taken seriously when communicating with health care professionals about something that may be wrong.

“Data show that many Black women often feel unheard and disregarded when expressing concerns,” she said. “And if you feel like you might be treated poorly, you’re less likely to share those concerns or even to trust advice that providers might give.”

Additional factors such as inadequate access to quality health care—including comprehensive prenatal care—and socioeconomic disparities also contribute to this stark disparity. Black mothers in the area often face barriers such as transportation challenges, lack of access to healthy food and safe housing, insufficient green space for adequate time outside and financial constraints—all factors contributing to poor outcomes.

A multifaceted approach yields progress

The question that has become central to health providers and advocates is about what they can do—and are doing—about this discrepancy. The solution lies in a multifaceted approach that addresses both individual and systemic factors such as policy changes, changes to care frameworks and awareness, and community partnerships.

Advocating for policy changes

“Change happens with state policy,” said LaToya Daughrity, director of the Newborn Intensive Care Unit at St. Louis Children’s Hospital, part of BJC. “Black mothers need better access to health care. We must focus on resources and programs for moms when they discover they are expecting.”

Missouri extended Medicaid benefits for new moms from 60 days to a year postpartum in 2023. However, more access to pre- and postnatal mental health coverage is much-needed, Daughrity said.

Another key policy change involves doulas—including them on care teams and changing policy to include their reimbursement. A doula is a trained professional who provides continuous physical, emotional and informational support to their client before, during, and after childbirth. Doulas play a critical role in addressing biases in health care, especially where care team members don’t have similar lived experiences as many of the people they serve.

One of the major barriers to women accessing doulas is the cost of doula care, which is not covered by insurance. BJC is advocating for payors, Medicaid and private insurance companies to reimburse doulas for the critical services they provide. Policy change can be a long-term process. Recognizing the need for connecting women to doulas, BJC has contributed to three local doula organizations that offer support for mothers in need of doula services.

Training and educating our providers 

There is also a push across BJC to educate clinical care team members on the role of doulas and the importance of doula-friendly hospital environments. BJC’s Community Health Improvement team is collaborating with Jamaa Birth Village and women and infants leaders across the system on training aimed at educating clinical care team members on how doulas can provide culturally congruent care for parents and babies, and their key role in the pregnancy, birthing, and postnatal environments.

Culturally congruent care refers to having caregivers who look like the clients they serve.

Having a trauma-informed care framework within health care facilities—an approach that emphasizes safety, empowerment and healing—is also a critical component, according to Smith. “It’s asking women what’s happened to them instead of what’s wrong with them,” she said. “It’s about providing a safe, nonjudgmental space for care.”

BJC’s required trainings related to equity, implicit bias and trauma-informed care have helped caregivers recognize bias and take ownership in making a difference, Daughrity said.

These critical needs extend beyond training current team members and are reflected as new caregivers join the team.

“It’s helpful when you understand the culture,” she said. “And to do that, we have to center our patients and communities in our hiring process.”

Collaborating with our communities

Awareness is also critical for providers and the communities they serve. Daughrity said that through outreach like community health fairs, community baby showers, and collaborations with community organizations like Jamaa Birth Village, St. Louis Doula Project and St. Louis Area Diaper Bank, they can reach more women to offer resources and education. She also suggests a peer support group model as an effective measure to help facilitate communication with other Black mothers.

It’s important for Black mothers to be equipped with knowledge about their rights, the importance of self-advocacy and to have support in navigating the health care system effectively. For example, there is a focus in 2024 throughout BJC on increasing breastfeeding rates in Black mothers—another area where there is a large gap compared to white mothers.

Ultimately, both Smith and Daughrity say health care providers need to work with their communities to help design the solution.

“We want our patients to tell us their experiences, so we understand where we can improve. And we need to remember, they are the experts of their bodies,” said Smith. “We have to listen to what a mom says.”

Learn more about how BJC HealthCare works to remove health barriers and elevate the overall well-being of those in communities that have endured generations of disinvestment.

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