Public Health

7 keys to improving U.S. maternal health now

Georgia Garvey , Contributing News Writer

What’s the news: The AMA has released a comprehensive list of recommendations to improve U.S. maternal health amid the highest maternal mortality rates of any developed country in the world. To bolster the Biden administration’s efforts to advance maternal health, the AMA has worked collaboratively over the last year with numerous members of the Federation of Medicine, including relevant specialty societies, state medical associations and physicians from rural areas.

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“We appreciate the administration’s action on this worsening problem that is immune to easy fixes and simple remedies,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “The administration has correctly noted that the maternal health crisis is at the intersection of multiple complex issues, including health equity, adequate access to health care, socioeconomic factors and more, making the maternal health crisis an issue that will require large systemic changes to successfully address.”

In a letter to Health and Human Services Secretary Xavier Becerra (PDF), the AMA recommended that the Biden administration take steps in these seven key areas to:

  • Ensure feasibility and implementation of Core Alliance for Innovation on Maternal Health patient-safety bundles and checklists.
  • Expand evidence-based programs to treat substance use disorder in pregnancy and postpartum (PDF).
  • Address social determinants of health among patients who are pregnant or postpartum by enhancing medical-legal partnerships.
  • Promote telehealth and home monitoring during pregnancy and the postpartum period and address barriers to providing remote patient care.
  • Ensure the acquisition of the right type of data.
  • Address physician workforce needs in maternity care.
  • Use new payment models to prevent maternal deaths.

The recommendations come among alarming health care industry trends affecting the accessibility of obstetric care, particularly after delivery, and the need to improve patients’ health care experience.

“More than one-third of the rural hospitals that still have labor and delivery services are losing money on patient services overall, putting their ability to continue delivering maternity care at risk,” AMA Executive Vice President and CEO James L. Madara, MD, noted in the letter to HHS.

Why it’s important: More women in the U.S. die from pregnancy-related complications than in any other developed country. According to the Centers for Disease Control and Prevention, about 1,205 pregnancy-related deaths occurred in 2021. Moreover, there are deep racial and ethnic inequities in maternal mortality that must be addressed through concrete actions at the federal level.

“Given the remarkable advancements in science and medicine over the last 30 years, it is shocking that women in the United States are at a greater risk for pregnancy-related death today than they were in the 1990s, and the mortality rate for Black women is significantly higher,” said Willie Underwood III, MD, chair of the AMA Board of Trustees, in a recent AMA webinar on maternal health.

“Black women are three to four times more likely than white women to die from pregnancy-related causes. Indigenous populations are two to three times as likely,” Dr. Underwood said, also pointing out that 80% of all maternal deaths are preventable.

For Black and Indigenous pregnant patients, “birth inequities arise at the intersection of discrimination by race and gender,” said Jennifer Brown, health equity director for the AMA.

Discrimination, implicit bias, and obstetric unit closures in rural and urban areas are factors, she said, noting that some of the most frequent underlying causes of pregnancy-related death are:

  • Cardiac and coronary conditions.
  • Thromboembolism.
  • Cardiomyopathy.
  • Hemorrhage.
  • Sepsis.
  • Mental health conditions, including deaths of suicide, overdose or poisoning related to substance use disorder.

Together, these accounted for over 75% of pregnancy-related deaths,

Another panelist was Michael Rakotz, MD, the AMA’s vice president of health outcomes.

“Over the last decade, the AMA has developed and disseminated an evidence-based quality improvement program, AMA MAP™ hypertension, that has demonstrated improvement in blood-pressure control for adult patients with hypertension in primary care settings,” Dr. Rakotz noted.

The AMA is continuing to collaborate with interested parties in this space and is convening clinical subject-matter experts to identify and disseminate effective strategies and best practices to improve care of patients with hypertensive disorders of pregnancy, he added.  

Perinatal mental health disorders are also a common and significant complication of pregnancy and the postpartum period. Up to 20% of women in the U.S. are estimated to experience perinatal depression or anxiety, said Maryanne C. Bombaugh, MD, MSc, a member of the AMA Council on Legislation.

She noted that the American College of Obstetricians and Gynecologists, along with the AMA and five other medical associations, established Behavioral Health Integration Collaborative. The effort is equipping physicians and their practices with the necessary knowledge to overcome obstacles and sustain integrated care for their patients and families, Dr. Bombaugh added. That includes integrating mental health care into the ob practice.

Learn more: The webinar is available to watch on demand. The AMA is committed to improving maternal health outcomes in the U.S., supporting a variety of strategies to address this crisis.

Find out what’s behind the spike in U.S. maternal mortality.