Taking Action to Reduce Maternal Health Disparities

This week marks Black Maternal Health Week, started five years ago by the Black Mamas Matter Alliance and officially recognized by the White House since 2021 as an initiative to advance maternal health equity and spur action.

One year ago, the Blue Cross Blue Shield Association set a bold goal to reduce racial disparities in maternal health by 50% in five years. Over the last 12 months, we uncovered key insights to inform our work ahead and drive similar action throughout the maternal health ecosystem.

What We’ve Learned

The U.S. maternal death rate rose sharply in 2020 during the COVID-19 pandemic. Black women are three times more likely to die from childbirth complications than White women, and face a 70% higher risk of severe maternal morbidity (SMM), or life-threatening events, than any other racial groups—often related to conditions that require close attention throughout a woman’s pregnancy.

These disparities span education levels, socioeconomic status, age and geography—pointing to deeper-seated issues like underlying chronic conditions, racial inequities and bias within the health care system that must be addressed systemically and across a woman’s life span—not just while she is pregnant.

Meaningful actions must combat the cultural, operational and structural barriers that have created inequities that exist today, while also addressing disparities in maternal health. Here’s what we’ve learned so far:

• Maternal care must be culturally conscious and competent: Implicit bias, and lack of cultural humility and awareness, create a trust barrier in patient-provider relationships. This can not only deepen disparities but also puts the effectiveness of maternal care at risk.
• Data is critical to measure impact: There are significant gaps in available health equity data. Without access to the right data, or usage standards, it is hard to measure disparities and even more difficult to solve for them.
• Postpartum care is vital maternal care: Addressing maternal equity gaps requires us to rethink the full spectrum of maternal care, especially during the post-delivery period.

Ten Actions to Advance Maternal Health Equity

Guided by the actions underway by BCBS companies, we identified 10 tangible steps organizations can adopt to improve maternal health and make a measurable difference in health disparities:

?1. Engage maternal voices and community stakeholders to craft, build and sustain a holistic maternal health program. Form public and private partnerships to address root causes of disparities, inequalities and social determinants of health.

2. Provide access to cultural humility and unconscious bias training for everyone in the maternal care continuum.

3. Include nurse midwives and birthing centers in provider networks and design programs to increase education and awareness for members.

4. Facilitate access to doulas and community health workers for maternal support services.

5. Implement facilitated self-management or peer prenatal care models such as CenteringPregnancy.

6. Expand benefit coverage to ensure postpartum care including behavioral health care to one year post-delivery.

7. Align quality measurement with national standards-setting organizations and tie back to provider quality programs.

8. Join and participate in a Perinatal Quality Collaborative.

9. Implement value-based contracts specific to maternal health.

10. Amplify programs of special significance such as vaccination programs with a focus on COVID-19 and influenza.

One of the ways BCBS companies are carrying out these actions, is by partnering with the March of Dimes and other local organizations to offer implicit bias and education training – with the possibility of reaching the nearly 1.7 million providers in BCBS networks. Providing access to cultural humility and implicit bias training can help those involved in patient care to recognize their own biases, as well as address systemic bias that exists at an organizational level. Bias can manifest itself in many ways, and it’s up to all of us to act, regardless of industry or sector.

While each of these 10 actions represents work prioritized by BCBS Companies, we encourage other organizations and leaders to identify how the actions could be applied to their work.

A Renewed Call to Action

We alone cannot measurably impact the health inequities women of color face today. And if the pandemic has taught us anything, it’s that we cannot solve system-wide problems in a vacuum—particularly when lives are at stake.

We’re calling upon leaders in the public and private sectors to adopt these 10 actions, as well as advocate for mothers across the country through policy and partnerships:

• Congress should pass the Congressional Black Maternal Health Caucus' Momnibus package which takes steps to improve health outcomes for pregnant women and mothers of color, their babies and their families.?
• States should adopt the American Rescue Plan Act provision—giving the option to extend Medicaid coverage from 60 days to a full year postpartum—which can positively impact the 43% of all births in the United States covered through Medicaid.
• Health care professionals and providers should partner with organizations that provide implicit bias and cultural humility training, similar to the efforts underway with BCBS companies and the March of Dimes.

It is with both gravity and optimism that we invite policymakers, insurers, employers, hospital groups, and private practices to work toward a shared vision of safer, equitable care for all mothers.