The mortality rate for expectant Black mothers is more than twice the rate for white mothers, according to the new America's Health Rankings Health Disparities Report. Dr. Janice Huckaby explains why -- and how to address it.
The mortality rate for expectant Black mothers is more than twice the rate for white mothers, according to the new America's Health Rankings Health Disparities Report. Additionally, between 2005 and 2019, the maternal mortality rate for Black mothers increased 22%. What's driving these maternal health disparities? Dr. Janice Huckaby, Chief Medical Officer Maternal Child Health for Optum Population Health Services, shares her thoughts.
Ira Apfel00:05
Hello, and welcome to UnitedHealth Group’s Weekly Dose Podcast, where we'll get you up to speed on the latest trends shaping the future of health care. I'm your host, Ira Apfel. This week we're talking about maternal health disparities, particularly the alarming difference in mortality rates by race and ethnicity. The mortality rate for expectant Black mothers is more than twice the rate for white mothers, according to the new America's Health Rankings Health Disparities Report, that's one of the widest disparities in women's health. Additionally, between 2005 and 2019, the maternal mortality rate for Black mothers increased 22%. And during the same timeframe, it increased 55% for white mothers and 23%. You can read the whole report at America'sHealthRankings.org. So what's driving these maternal health disparities? And what's been the response? Dr. Janice Huckaby, Chief Medical Officer Maternal Child Health for Optum Population Health Services, is here to provide some insights. Dr. Huckaby, welcome to the podcast.
Dr. Janice Huckaby 01:08
Thank you for having me.
Ira Apfel01:10
So let's start with a little bit of your background, your training is in obstetrics and gynecology. What are you seeing in your practice regarding maternal health? And what different today?
Dr. Janice Huckaby 01:22
Well, you know, for a long time, we I think kept on the micro level in terms of complications or things that we would see in our practices, and everybody would have an occasional patient who had bleeding or things like that. But it's really been in the last few years that we've become more aware of, on a macro level, the extent of poor maternal health outcomes, and then the effect that race and ethnicity have on those outcomes. You know, we do know that each year 700 women die of complications related to childbirth, and that African American women are two to three times more likely to have that happen than their white counterparts. And similar discrepancies exist when it comes to near misses or complications, such as hemorrhage requiring transfusion, etc. So I think that the big difference is that, that we're much more aware now on the on a macro level of the extent of some of these problems.
Ira Apfel02:28
And what would you say are the biggest maternal health care gaps that you see, not just the numbers that you have relayed there? There's some pretty stark numbers. But in terms of the care itself, what are you seeing?
Dr. Janice Huckaby 02:42
Well, there's, there's several, um, you know, first of all, there are areas in the country where we have real access problems. They're counties where there's no OB-GYN or maternal care available, no hospitals that do the deliveries, so access is an issue. But even in areas where there might be seem to be plenty of doctors, we still don't see people taking advantage of that. And very often that can be caused by problems with insurance coverage, or payment. But sometimes it's just a deep distrust of, of the health system. Taking the reverse angle to the previous question, what are the biggest health challenges for moms to beat? That's a great question. Um, you know, I think that that the ideas of access and payments still are big challenges for a number of women, um, for others, the underlying conditions that they may have coming into the pregnancy, you know, maybe they're diabetic, or they have high blood pressure, or issues. For some women, it's trying to find a provider that looks like them, you know, that that's maybe in their race or ethnic group. And for some women, it's just overcoming, especially in this age of COVID, the fear of going back to health providers in general, for fear that, you know, they could be becoming ill with COVID, or something like that.
Ira Apfel04:09
Yet, that brings me to my next question, which is, what has been the impact of the pandemic on maternal care? What are what are you seeing what's gone worst? And also, are you are you learning anything positive to take away any kind of learning or teaching set, you're going to use going forward?
Dr. Janice Huckaby 04:30
No, that's, that's a very fair question. I think that they're some of the challenges we faced with COVID. You know, when things kind of shut down, obviously, women still needed to have care. And OG-GYN historically may not have used telehealth or some of the digital options out there as extensively. And so we saw a big uptick in that. We saw, you know, more virtual care happening, and I think that's a positive actually, that will pull through. You know, now that we're entering more of a post COVID era, another thing that we learned was that people are more open to those digital experiences, yes, but they still want to feel that sense of community. And we saw an increase in virtual care communities, if you will, women who might be at the same place in a pregnancy connecting virtually through Facebook or other means to share some of those experiences. For time when COVID was at its peak, you know, people were concerned about being in hospitals and that type of thing, I do think that we are seeing that, you know, ease and that people are, are comfortable returning to hospitals again, but I do think that going forward, we'll see more care around how many people are in the delivery room and some of those kinds of measures to keep other diseases maybe from being brought in from the outside. So the digital piece and its adoption, I think, is one of the real positives, that we'll see going forward and probably was long overdue.
Ira Apfel06:14
Now, recently, United Health Foundation released its America's Health Rankings, health disparities report, and there are a ton of data and findings from that report. How does research like this help clinicians like you, and care groups do a better job of providing better maternal health care?
Dr. Janice Huckaby 06:36
You know, the, the health disparities report didn't necessarily drill down into it to the community level the way some of the others have. But what it did show was that we still have continuing gaps, even with improvements. You know, there were many states that saw improvements, let's say, in infant mortality, but there was still a wide gap between communities of color, and their white counterparts. We might see the same thing around education and in common those type of things. Where data like this is important, I think is in the in the clinic in the office, it certainly attunes you, I think, to look more at the whole picture of the patients sitting in front of you, not just the pregnancy, but in the community. Is she suffering from homelessness? Does she have food insecurity and those type of things, so I think they raise awareness. And then I think they also give an opportunity for clinicians and other people who care about the health of their communities to more actively engage in those kinds of discussions with local leaders or lawmakers, who may be framing policy that will impact the health of community.
Ira Apfel07:56
UnitedHealth Group, as I'm sure you know, they do a lot of partnering in maternal health care to improve the outcomes for moms to be and they partner with national organizations, some local ones and some government agencies. Why is partnering so important in maternal health?
Dr. Janice Huckaby 08:15
You know, that's, that's a great question. And I think it's because this issue is not one that we can say, oh, if you just do x, then you'll get why there's so many widespread contributors to maternal health outcomes, that having partnerships is, is crucial. No one entity could do it by themselves, not the government, not health systems, not provide physicians. And so I think that's one reason that united has, has done that in terms of partnerships. And I'm really proud of the fact that yes, we do have partnerships with organizations like march of times with big national footprints. But we also have partnerships with local organizations in their communities, they're having a huge impact, like cradle Cincinnati, in Ohio, that's had a very positive impact on women's health and infant health. And so I think that those partnerships, distributing them between large and then small, is a crucial aspect to success. And the local aspect, working with local groups, like the one you just mentioned, Cincinnati, that helps because it kind of really gets that that last mile of delivery, so to speak, where you can really reach individual moms in the neighborhood, correct? It does, and I really like that expression about the last mile because, you know, it's one thing to look at and then an issue and say, Oh, we think from 50,000 feet that this particular intervention will be helpful. It may be quite different on the ground and those locations. And these are those local organizations know their communities. Well, they know the resources and the challenges and they are uniquely positioned to make a difference.
Ira Apfel10:11
So we've talked a lot about the stark disparities, but what gives you hope?
Dr. Janice Huckaby 10:17
What gives me hope is that, that we've, we've seen the problem. And I think it's been seen by enough people for long enough that it's not going to go away. And so I think that recognizing that it's there is a huge step forward. Because I think that that many physicians, myself included, when you're in practice, again, you're focused on your practice your patients, and yes, there might be an occasional bad outcome, but you don't realize it's part of this, this greater picture and that there might be other underlying issues that needs to be addressed. So first of all, it gives me a lot of hope that we've recognized it. Second of all, I think that we have advances now in data science and technology that can help us address it. I think we're able to use machine learning and things like that to comb through medical histories or claims to look for the signals that might indicate that a pregnancy is going to be complicated or have a poor outcome. And third of all, is I think that we have, you know, a level of clinical knowledge, and all that that will help us as well. We're able to do things with ultrasound and imaging, and testing to check on the health of a mother and her developing baby that I think will also help us address this as well. So those three, three things give me a lot of hope, as we look to the future.
Ira Apfel11:54
Dr. Janice Huckaby, thanks so much for being on the podcast today.
Dr. Janice Huckaby 11:58
Thank you so much, Ira.
Ira Apfel12:00
That's it for this episode of UnitedHealth Group’s Weekly Dose Podcast. Thanks for listening and have a great rest of your week.