Maternal mortality is rare, but devastating. About 700 women die every year in the United States as a result of pregnancy or pregnancy-related conditions, and Black women are at a much higher risk.

Black women are three to four times more likely to die a pregnancy-related death as compared to white women, and this is true at every age, income and education level.

What’s behind the higher risk for Black mothers in North Carolina and across the country?

There are several factors, including higher rates of chronic conditions like hypertension and diabetes, experiencing medical bias within the healthcare system, and the impact of lifelong chronic stress and systemic racism.

Every woman who dies as a result of pregnancy leaves behind a family and a community – and health systems and hospitals in North Carolina are committed to reversing this trend and providing high quality, equitable care to all.

Our state is fortunate to have leading physicians, researchers and other healthcare providers passionate about providing excellent maternal care to all North Carolinians. One of these providers is Dr. Jasmine Johnson, a Maternal-Fetal Medicine Fellow in the UNC Department of Obstetrics and Gynecology.

Dr. Johnson is passionate about researching and eliminating disparities in obstetric care. She shared a few of the ways UNC Health and other North Carolina hospitals are working to improve care for Black women, as well as the opportunity each of us has to advocate for programs and legislation supporting equitable care across the state.

 

Better Access to Care

Not every woman in North Carolina has the same access to healthcare. Especially in rural areas, where North Carolina faces shortages of specialists like OB/GYNs, access to regular appointments isn’t a guarantee. Studies have also shown that a lack of transportation creates barriers to care access, especially for low-income and minority populations.

“I have patients that travel three hours for a prenatal visit,” Dr. Johnson said. “When you think about later in pregnancy, when you’re supposed to go every week, think about how much of a burden that is. Access and provider shortages are definitely an issue for women in North Carolina, especially in the rural areas of the state.”

Focusing on pregnancy is very important when we’re talking about decreasing maternal mortality, but ...we also have to think about ways that we can help women before they get pregnant.

One program addressing this issue is the Pregnancy Medical Home, launched by Community Care of North Carolina. This program enhances access to comprehensive care for pregnant Medicaid beneficiaries and promotes high-quality maternity care in more than 400 practices across North Carolina.

 

Expanding Medicaid

States that expand their Medicaid programs have improved rates of preterm birth and infant health, according to Dr. Johnson.

Presently, about half a million North Carolinians are in the “coverage gap,” meaning they don’t qualify for Medicaid, but they don’t earn enough to buy an insurance plan, which prevents them from getting the coverage they need. Black Americans disproportionally fall into these coverage gaps, and this affects the ability of Black women to get not only prenatal care, but also other kinds of medical care prior to becoming pregnant.

Health status before becoming pregnant affects the health of the pregnancy, which is why it’s so important to prevent and manage chronic conditions like diabetes and high blood pressure, which can lead to complications.

“Focusing on pregnancy is very important when we’re talking about decreasing maternal mortality, but I think that we also have to think about ways that we can help women before they get pregnant, to make sure that they are their best selves and they are best supported by their communities,” Dr. Johnson said.

North Carolina can increase access to affordable health insurance coverage through the NC Health Care for Working Families Act, a common sense solution to closing the coverage gap.

 

Standardized Best Practices

A lack of standardization in pregnancy care, especially during emergencies such as hemorrhage or hypertension, is another contributing factor in Black maternal mortality.

When hospitals and providers approach emergency situations differently, this can open the door to implicit bias, which can result in care delays and poorer outcomes for patients of color.

Many hospitals in North Carolina, including UNC Health facilities, have adopted a set of best practices and standards from the Alliance for Innovation of Maternal Health. This national data-driven maternal safety and quality initiative improves maternal safety and patient outcomes in North Carolina.

“Regardless of who you are, what your insurance status is, what your race is, you get the same treatment,” said Dr. Johnson. “If your blood pressure is high, it should be checked, and then rechecked 15 minutes later. If it’s still high, you get medication. When we standardize things, it helps avoid variability and issue that can arise with lack of knowledge or implicit bias.”

Standardization is one solution against biases that affect patient care, but North Carolina hospitals and health systems also implement training programs and medical education to address these issues and ensure all patients receive the highest quality care.

 “There is something subconscious in how we perceive each other,” Dr. Johnson said. “We have to acknowledge that, because biases exist, we all have them, and it plays out in how we care for patients.”

This is something addressed in the Patient-Safety Learning Laboratory at North Carolina Women’s Hospital at UNC-Chapel Hill, where patients are involved in sharing their experiences with adverse pregnancy outcomes and emergencies.

“That’s going to be how we move the needle,” said Dr. Johnson, “because we all think we know what the right answers are, but we need to talk to patients.”

How can you support North Carolina hospitals and health systems in their efforts to improve rates of Black maternal mortality in the state?

Check out the Black Maternal Health Momnibus Act of 2020, a series of bills and legislation that address the maternal mortality crisis, co-sponsored by U.S. Representative Alma S. Adams, representing North Carolina’s 12th Congressional District, and contact your elected officials and ask them to support these bills and to expand Medicaid in North Carolina.

Share these posts with your friends and family to spread awareness about Black maternal mortality and solutions we can implement in North Carolina.