Becker's Hospital Review

11 THOUGHT LEADERSHIP Michael Dowling: Maternal mortality isn't changing, so Northwell will By Michael Dowling, President & CEO of Northwell Health M aternal health outcomes for women of color are moving in the wrong direction. Healthcare has not treated women's health equitably. Most healthcare delivery has used the male model of medicine. Cardiac health was pri- marily seen as a men's issue versus women's issue, for instance. Most medical research has been done on men, not women. These troubling inequities drove Northwell in 2007 to create its Katz Institute for Women's Health, a com- prehensive network of experts devot- ed to every aspect of women's health. I am excited to announce that North- well is building upon the commit- ment to women's health equity with the launch of our Center for Maternal Health. This is the linchpin in our plan to reduce the rate of maternal mortal- ity in the United States — the highest among industrialized nations — and to specifically address health risks facing Black women, who are three times more likely to die from preg- nancy-related causes than their white counterparts in the U.S. Maternal health outcomes for wom- en of color are moving in the wrong direction. Long-standing disparities in healthcare and outcomes for peo- ple of color were laid bare through- out the COVID-19 pandemic, with racial disparities for maternal and infant health worsening. In 2019, the maternal mortality rate for Black women was 44 deaths per 100,000 live births. In 2020, the maternal mor- tality rate increased to 55.3 deaths per 100,000 live births. It is appropriate to state that Black mothers are not equitably treated by the U.S. health system. Their voic- es too often go unheard compared to their white counterparts. For in- stance, medical records of women undergoing C-sections showed that Black and Hispanic women reported higher pain scores than white and Asian women, yet received fewer pain assessments and lower doses of all pain medication, according to research out of UNCChapel Hill. This is unacceptable. Nearly 4 million women give birth in the U.S. every year. Northwell delivers more babies in New York than any single entity. The Center for Mater- nal Health brings a 360-degree ap- proach to improving maternal health by working throughout the contin- uum of care. It extends our reach to Black mothers in the community to address health conditions that can occur from pre-conception through the first year after delivery. It consid- ers social determinants that raise the risk of pregnancy problems among Black women. By focusing on the health and outcomes of Black women, we'll help everybody. The center launches with short-term goals to reduce C-section rates, track any complications at delivery, and reduce readmission rates for ma- ternity patients. Long term, we want to dramatically reduce the rate of maternal mortality. To accomplish this, the center, work- ing with the Katz Institute for Women's Health, will offer a range of programs and targeted solutions to move the needle in the right direction on ma- ternal morbidity among Black women. For instance, the program uses objec- tive, data-driven measures to automat- ically identify obstetric patients who are at increased risk of complications — a move that helps prevent lower re- ferral rates for Black women. Our Maternal Outcomes Navigation program ensures high-risk women have support outside of the health- care setting, whether that be be- tween prenatal appointments or in the postpartum period at home. A 20-month pilot program at three of Northwell's largest facilities showed this navigation reduced hospitaliza- tions caused by pregnancy-related, life-threatening problems by 47 per- cent among participating women — and by 69 percent among participat- ing Black women. Planning and development for the Center for Maternal Health took about a year. Physicians have led the effort, encouraged in seeing Northwell treat racial disparities in maternal health as a major priority. The center involves several key stakeholders across our in- tegrated system, including Northwell's departments of medicine, community health, obstetrics and gynecology, be- havioral health services, population health, and care management. The center pulls together robust resources from across the system and begins the fight against threats to maternal and infant health further upstream. Overall, too many women confront high levels of risk during pregnancy and childbirth in the United States, and the danger facing Black women is a national crisis. We must do better, and we can do better. Northwell has the structure, strategy, support and scope to drive holistic and inclusive change. Now we need to achieve it, with immediate and long-term out- comes that demonstrate success and move the needle in the right direc- tion for women and their babies. n

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