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Addressing Health Equity Within Maternal Health

Dr. Creshelle Nash, MD, MPH, CHIE
Medical Director, Health Equity and Public Programs

Becoming a mother should be a joyous time filled with love, support, and excitement. Unfortunately for many, particularly women of color and women living in rural areas, this experience can be filled with uncertainty and complications. I was born prematurely in Miller County, Arkansas, in 1968, the same year Dr. Martin Luther King Jr. was killed. Overcoming my 50/50 chance of survival and being raised by my mother to pursue my career in medicine and public health, I’ve seen firsthand how health disparities have negatively impacted individuals and our communities, especially expectant mothers. For many women, the unseen impact of the social and physical environment they live in can be fatal. It is up to us to address health inequities to provide the best care possible for expecting mothers.

What The Numbers Say

While great strides have been made in medical care, these disparities persist at the expense of new mothers’ lives. Across the United States, pregnant women from low-income neighborhoods are more than twice as likely to die from complications related to pregnancy or childbirth than those in most other high-income countries in the world. Looking further, it becomes alarmingly clear that women of color are disproportionately impacted, with women in majority Black and majority Hispanic communities respectively experiencing a 63% and 32% higher rate of severe maternal morbidity (SMM) than women in majority white communities.

We’re seeing these disparities taking a toll on expectant mothers in our own state as well. In Arkansas, which has the highest maternal death rate in the nation, the maternal mortality rate is 50% higher than the national rate. These women are our friends, our sisters, our family, and our neighbors. They are women whose health complications will jeopardize their lives and the lives of their babies.

We hold the power to turn these trends around. In fact, new CDC data on maternal mortality estimates over 80% of pregnancy-related deaths were determined to be preventable. Regardless of race, ethnicity, or socioeconomic status, all women deserve to have a safe, healthy pregnancy and birth. At Arkansas Blue Cross and Blue Shield, we are dedicated to collaborating with lawmakers and partner organizations to understand and eliminate these disparities that impede access to care.

How Can We Eliminate Barriers to Care and Further Health Equity? 

BIPOC (black, indigenous, people of color) expectant mothers seeking care are up against numerous barriers/obstacles, including structural discrimination and implicit bias inside and outside of the healthcare delivery system. These factors result in significant differences in access and quality of care received. These structural and systemic forms of discrimination permeate women’s life and pregnancy experiences, preventing them from having access to the equitable physical and emotional health care that could save their lives.

With so many environmental, structural, and systemic barriers there is no simple, nor fast fix. However, together we can all do our part by working together to bring about a more equitable future through expanded health services, community investment, and taking a whole-person health approach to care.

For example, healthcare organizations can expand their services to underserved areas and increase the diversity of their workforce, making affirming, quality care more easily accessible. Knowing that 20% of Black mothers and 18% of Hispanic mothers feel that their provider did not spend enough time with them, our doctors can make sure we are listening to our patients and advocating for all aspects of their care.

Where We Are Going

We need to invest upstream in communities with the most need. Our Blue & You Foundation awards $3M annually to nonprofit and government organizations investing in the health of Arkansans and the communities where they reside. By strengthening communities and working side by side with community leaders, legislators, and providers supporting policies that help women and families, we change the trajectory of the state’s health and move closer to improved long-term health outcomes.

And we can take a holistic view on what it means to be healthy. One of the ways we work to provide quality care to all our members at Arkansas Blue Cross and Blue Shield is through our whole person approach to healthcare. Instead of focusing on a specific function of health, we help address the many interconnected factors that play a role in patients’ lives. Understanding how history, policy and socioeconomic disparities are connected to physical and behavioral health, we are working to find high-risk mothers early and developing programs to make a difference for Arkansans, like access to our care management and social work teams and comprehensive health education resources.

I encourage individuals and organizations to reflect and identify areas where they can make an impact as well. It’s up to all of us to protect expectant mothers so that they can live full, healthy, happy lives as their families grow.

Learn more about the obstacles Black mothers are facing in my article for the Arkansas Democrat-Gazette.


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