Becker's Hospital Review

12 EXECUTIVE BRIEFING 2 EXECUTIVE BRIEFING SPONSORED BY Maternal health disparities: How focusing on provider awareness, protocols and standardization can change the trajectory M aternal health disparities are deeply rooted and multifaceted, affecting public health, individual health and society — and they can be improved via the healthcare setting. Considering this issue's close link to patient safety and quality, which have drawn a tremendous amount of attention and process improvement efforts in recent years, maternal health disparities continue to largely fly under the radar. Becker's Hospital Review recently spoke with Khadeja Haye, MD, TeamHealth's national medical director of obstetrics and gynecology, about the causes and impacts of maternal health disparities, the role that implicit bias plays in reinforcing these disparities and how organizations can mitigate disparities and biases by establishing processes that standardize care for all patients. The issues that Dr. Haye discussed exist within the context of broader health disparities, which are health differences between people rooted in social, economic or environmental disadvantage. Maternal health disparities are growing Maternal health disparities refer to differences in health status among pregnant women that are often exacerbated by healthcare-related factors, such as lack of access to care, deficient care or inequitable treatment due to implicit bias. The most adverse expression of this type of disparity is maternal mortality. According to the National Center for Health Statistics, in 2021 the maternal mortality rate in the U.S. was 32.9 deaths per 100,000 live births, a 38 percent increase from 2020 (23.8 maternal deaths per 100,000 live births) and a 64 percent increase from 2019 (20.1 maternal deaths per 100,000 live births). "These rate increases are why the conversation around maternal health disparities is getting so much more focused," Dr. Haye said. "We understand maternal health disparities have a direct impact on the rising maternal mortality rates in the U.S." The causes of maternal health disparities are multifactorial There are many factors at play that impact maternal health disparities. Key among them are social determinants of health, which include transportation, food, economic stability, education, community and the healthcare system itself. "If someone is subjected to food insecurity, it impacts how they work and live or — if they go to school — how they focus on their education, which impacts their ability to earn an income, which impacts their ability to get a good-paying job that has insurance, which impacts the care they receive and their access to care," Dr. Haye said, tracing food insecurity's chain of effects and impact on health disparities. Economic discrepancies are another common reality for patients from disadvantaged backgrounds, which often cause many individuals to forego necessary care. This can have especially pernicious effects when it comes to maternal and prenatal care. "Women with fewer resources are less likely to access prenatal care early, and we know that early access to prenatal care has an impact in terms of outcomes," Dr. Haye said. She noted that women with limited access to care tend to have more "catastrophic" presentations. However, factors that contribute to maternal health disparities are not only on the patient side; they can also come from healthcare institutions and providers themselves. One example is implicit bias, which is a pervasive issue in healthcare and refers to deeply held beliefs that may cause one to act favorably or dismissively toward people of a particular gender, age, race or ethnicity. "Implicit bias shapes how we view and interact with patients, which shapes the care we provide to them and ultimately impacts outcomes," Dr. Haye said. Another healthcare variable that influences maternal health disparities is care quality. Research suggests that hospitals in communities with a higher percentage of Black residents tend to be associated with a higher risk of severe maternal morbidity compared to hospitals in communities with lower minority populations. In addition to minority women and women with low incomes, those in rural areas tend to be heavily affected by maternal health disparities. There is a great deal that providers can do to address maternal mortality and maternal health disparities For providers, the first step to mitigating the effects of health disparities on maternal health and maternal mortality is awareness in recognizing there is a problem. Becoming aware and educating themselves on the topic and all of the factors that negatively impact maternal health disparities is a must-do for providers who wish to do right by their patients.

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