The time for addressing care inequities is now

The CDC recently published a new report documenting the rise of maternal deaths and care inequities in the United States during 2018–2021 and particularly alarming racial disparities. They found:

• Approximately one in five mothers overall, and approximately 30% of Black, Hispanic, and multiracial mothers, reported mistreatment during maternity care. 
• Approximately 40% of Black, Hispanic, and multiracial mothers reported discrimination during maternity care
• 45% of all mothers reported holding back from asking questions or discussing concerns with their provider. 

Women deserve better. We are capable of better. 

These findings are sobering, and unacceptable, although  all too familiar. It’s been established that 4 out of every 5 maternal deaths are preventable, and that Black women are 3X more likely to die from maternity related complications. Yet, there’s still not sufficient urgency to solve these issues. 

The industry must critically examine our current policies and care delivery methods. What we have been doing isn’t working. Despite spending an estimated $108 Billion on women’s health each year, outcomes are deteriorating. Clearly this isn’t about spending more money — this requires a holistic and intentional approach. We must move towards a more equitable and accessible system and improve the care individuals receive.

To make real change that will positively impact women’s health outcomes and experiences, let’s consider these 4 approaches:

1. Implement a Respectful Maternity Care Framework. 

What is a respectful maternity care framework? It’s a theoretical framework based on the birth experiences of Black mothers to inform the ways hospitals and health systems can better provide respectful, affirming care to mothers throughout their maternity care. This framework complements existing provider educational tools and promotes anti-racist and birth equity practices, such as shared decision making.  

We’ve partnered with the National Birth Equity Collaborative on these Respectful Maternity Care Framework guidelines and highly recommend it for any provider. 

2. Hear what needs to be heard. 

Advocacy movements have long disputed that, although individuals are raising concerns, many social inequities are rooted in a lack of true listening, willingness to learn, and listening with an intent to take action. Brené Brown coined the phrase “giving ears to the earless” to capture this idea. This concept is particularly relevant issues underpinning health inequities 

Right now, millions of women are going to medical appointments, knowing and feeling with certainty that something is wrong, only to have a doctor downplay and write off their symptoms.

Known by some as medical gaslighting, this phenomenon disproportionately affects women, particularly women of color.  For example, a study released nearly two decades ago showed that women are systematically prescribed lower amounts of pain medication after reporting similar levels of pain compared to their male counterparts. 

Too frequently, women are telling providers their concerns, issues and symptoms, but their voices are falling on deaf ears. There is systemic deafness. It’s incumbent on providers to truly listen to and hear their patients’ concerns. 

Provider organizations and health systems can tackle this issue by undergoing gender bias training, re-examining practices associated with “routine” procedures that have been highlighted as painful by patients (e.g., IUD implantation), and requiring empathy training for providers. 

3. Leverage doulas, midwives and community based care to combat care inequities 

Services provided by doulas and midwives are often not reimbursed by payers, despite their proven value. Studies show that expectant mothers matched with a doula had better birth outcomes than did mothers who gave birth without involvement of a doula. These data suggest doula-assisted mothers were:

• four times less likely to have a low-birth-weight baby
• two times less likely to experience a birth complication involving themselves or their baby
• significantly more likely to initiate breastfeeding.

Inclusion of doulas are even more important for Black women and other women of color. As Dr. Joia Crear-Perry, Founder and President of RH Impact (formerly known as The National Birth Equity Collaborative) noted, doulas are successful in many communities, particularly those underserved by the healthcare system, because they provide personalized social support before, during, and after delivery. By extending the provider network, individuals are more likely to receive racially concordant care, which improves outcomes. 

4. Invest and integrate preventative, personalized digital health solutions 

Investing in digital solutions that also deliver 1:1 connections with care experts improves health literacy and self-advocacy , supporting individuals who might otherwise be anxious to discuss issues with their providers or feel dismissed by them. This form of coaching is proven to work. 

A recent survey of Ovia members found those who interacted with the Care Team are more likely to report taking control of their health. For example, compared to Ovia users who did not engage with the Care team, members who did reported they were: 

1. 270% more likely to report that Ovia Health helped them answer a pressing health question
2. 79% more likely to report that Ovia Health helped them self-identify a health condition/symptom 
3. 136% more likely to report that Ovia Health encouraged them to reach out to their provider
4. 36% more likely to use employer/health benefits

Personalization and prevention are key. Women don’t always recognize symptoms and other telehealth focused plans don’t help them see trends, because they’re not interactive or focused on prevention. They’re reactive. Solutions that leverage patient-reported data can provide early identification of rising risks and alert individuals to seek care when they need it and empower coaches with these insights to ask the critical questions of the members and equip individuals to advocate for themselves.  

That’s why I joined Ovia Health — to be part of the solution that can really help. To address care inequities. In the last year alone, we’ve been able to deliver 198,000 critical alerts that helped women recognize potential issues and get the care they needed.*   

Those interventions can help women avoid preterm delivery, reduce the risk of preeclampsia or gestational diabetes, and increase recognition of symptoms related to conditions such as PCOS or endometriosis, which can take up to 10 years to diagnose. The potential of preventative digital health — vs reactive digital solutions — is exciting. We can alter the trajectory of care. We can address care inequities.

We cannot afford to wait longer to invest and evolve women’s health care. Outcomes aren’t improving. These data suggest care is more dangerous now for women than it was 5 years ago. Though changing the system to improve women’s health is a daunting task, collectively we can. Ovia will continue to invest directly in approaches that will improve health outcomes. Let’s reverse the trends together with urgency.

*Ovia Health Quicksight data as of 8/24/23