Journal of Science Policy & Governance
Volume 24, Issue 01 | April 30, 2024

Policy Brief:  ​Reducing the Risk of Maternal Morbidity and Mortality for Underserved Women

Simisolaoluwa Olabode (1), Lana Ruvolo Grasser (2)
  1. Wayne State University, Department of Public Health, College of Liberal Arts and Sciences, Detroit MI, US
  2. Wayne State University School of Medicine, Department of Psychiatry and Behavioral Neurosciences, Detroit MI, US

​Corresponding author:  [email protected]​​
Keywords: health policy; maternal health; health disparities; health equity
https://doi.org/10.38126/JSPG240112 ​

Executive Summary

Maternal morbidity and mortality rates have been increasing in the United States. These outcomes are especially devastating for women of color, namely Black women, who are almost three times more likely to die from pregnancy complications, even when accounting for social factors. Disparities also persist for low-income women, veterans, and those in rural environments. To promote maternal health equity, we advocate for the passage of the Black Maternal Health Momnibus Act, which aims to address maternal health disparities for underserved populations. Further, many local and state initiatives can also aid in reducing maternal morbidity and mortality.

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Background header image courtesy of ACC.org
Simisolaoluwa Olabode (she/her) is a second-year undergraduate student majoring in Public Health, with a minor in Medical Humanities. As a Wayne Med-Direct scholar, Simi aims to pursue a career in medicine and public service through policy. Simi is a member of the National Science Policy Newtork’s chapter at the Wayne State University campus, Science Policy-Detroit. 

Lana Ruvolo Grasser, Ph.D. (she/her) is a translational neuroscientist who uses  neuroimaging and psychophysiological measures to study posttraumatic stress, irritability, anxiety, and their treatment in youth. She received her BS from Michigan State University and her Ph.D. from Wayne State University. Dr. Grasser received the 2022 International Society for Developmental Psychobiology Dissertation Award for her work titled, “Biomarkers of Risk and Resilience to Trauma in Syrian Refugee Youth”. She is also passionate about science policy and advocacy,  is a member of the National Science Policy Network, and was the 2022-2023 ACNP/AMP BRAD fellow.

Acknowledgements
Thank you to Dr. Hilary Marusak, Mr. James Williams, and the SciPol Detroit group at Wayne State University for their support to engage in science policy and advocacy training.

References

  1. ​“About the IMPROVE Initiative.” Eunice Kennedy Shriver National Institute of Child Health and Human Development. Accessed March 13, 2024. https://www.nichd.nih.gov/research/supported/IMPROVE/about. 
  2. Admon, Lindsay K., Jamie R. Daw, Tyler N. Winkelman, Katy Backes Kozhimannil, Kara Zivin, Michele Heisler, and Vanessa K. Dalton. “Insurance Coverage and Perinatal Health Care Use among Low-Income Women in the US, 2015-2017.” JAMA Network Open 4, no. 1 (January 27, 2021). https://doi.org/10.1001/jamanetworkopen.2020.34549. 
  3. Alkema, Leontine, Doris Chou, Daniel Hogan, Sanqian Zhang, Ann-Beth Moller, Alison Gemmill, Doris Ma Fat, et al. “Global, Regional, and National Levels and Trends in Maternal Mortality between 1990 and 2015, with Scenario-Based Projections to 2030: A Systematic Analysis by the UN Maternal Mortality Estimation Inter-Agency Group.” The Lancet 387, no. 10017 (January 2016): 462–74. https://doi.org/10.1016/s0140-6736(15)00838-7. 
  4. Allen, Heidi, Sarah H. Gordon, Dennis Lee, Aditi Bhanja, and Benjamin D. Sommers. “Comparison of Utilization, Costs, and Quality of Medicaid vs Subsidized Private Health Insurance for Low-Income Adults.” JAMA Network Open 4, no. 1 (January 5, 2021). https://doi.org/10.1001/jamanetworkopen.2020.32669. 
  5. Barnes, Jennifer, and Jennifer Theule. “Maternal Depression and Infant Attachment Security: A Meta‐analysis.” Infant Mental Health Journal 40, no. 6 (August 15, 2019): 817–34. https://doi.org/10.1002/imhj.21812. 
  6. Benoit, Diane. “Infant-Parent Attachment: Definition, Types, Antecedents, Measurement and Outcome.” Paediatrics & Child Health 9, no. 8 (October 2004): 541–45. https://doi.org/10.1093/pch/9.8.541. 
  7. Black Maternal Health Momnibus Act. Bill (2023). https://www.congress.gov/bill/118th-congress/senate-bill/1606 
  8. Carruthers, Charlene A. Unapologetic: A black, queer, and feminist mandate for radical movements. Boston, MA: Beacon Press, 2019. 
  9. Chapman, Elizabeth N., Anna Kaatz, and Molly Carnes. “Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities.” Journal of General Internal Medicine 28, no. 11 (April 11, 2013): 1504–10. https://doi.org/10.1007/s11606-013-2441-1. 
  10. Coley, Sheryl L., Jasmine Y. Zapata, Rebecca J. Schwei, Glen Ellen Mihalovic, Maya N. Matabele, Elizabeth A. Jacobs, and Cynthie K. Anderson. “More than a ‘Number’: Perspectives of Prenatal Care Quality from Mothers of Color and Providers.” Women’s Health Issues 28, no. 2 (March 1, 2018): 158–64. https://doi.org/10.1016/j.whi.2017.10.014. 
  11. ​​Costa, Caroline M. “James Marion Sims: Some Speculations and a New Position.” Medical Journal of Australia 178, no. 12 (June 2003): 660–63. https://doi.org/10.5694/j.1326-5377.2003.tb05401.x. 
  12. Creanga, Andreea A., Carla Syverson, Kristi Seed, and William M. Callaghan. “Pregnancy-Related Mortality in the United States, 2011–2013.” Obstetrics & Gynecology 130, no. 2 (August 2017): 366–73. https://doi.org/10.1097/aog.0000000000002114. 
  13. Diguisto, Caroline, Pierre-Marie Choinier, Monica Saucedo, Marie Bruyere, Eric Verspyck, Estelle Morau, Marie-Pierre Bonnet, and Catherine Deneux-Tharaux. “Timing and Preventability of Cardiovascular-Related Maternal Death.” Obstetrics & Gynecology 141, no. 6 (May 3, 2023): 1190–98. https://doi.org/10.1097/aog.0000000000005176. 
  14. Estriplet, Tracey, Isabel Morgan, Kelly Davis, Joia Crear Perry, and Kay Matthews. “Black Perinatal Mental Health: Prioritizing Maternal Mental Health to Optimize Infant Health and Wellness.” Frontiers in Psychiatry 13 (April 29, 2022). https://doi.org/10.3389/fpsyt.2022.807235. 
  15. Grasser, Lana Ruvolo, and Tanja Jovanovic. “Neural Impacts of Stigma, Racism, and Discrimination.” Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 7, no. 12 (December 2022): 1225–34. https://doi.org/10.1016/j.bpsc.2022.06.012.
  16. Hall, William J., Mimi V. Chapman, Kent M. Lee, Yesenia M. Merino, Tainayah W. Thomas, B. Keith Payne, Eugenia Eng, Steven H. Day, and Tamera Coyne-Beasley. “Implicit Racial/Ethnic Bias among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.” American Journal of Public Health 105, no. 12 (December 2015). https://doi.org/10.2105/ajph.2015.302903. 
  17. Hirshberg, Adi, and Sindhu K. Srinivas. “Epidemiology of Maternal Morbidity and Mortality.” Seminars in Perinatology41, no. 6 (October 2017): 332–37. https://doi.org/10.1053/j.semperi.2017.07.007. 
  18. Horrom, Tristan. “Gestational Diabetes and Preeclampsia Rates Higher in Women with PTSD.” US Department of Veteran Affairs, April 26, 2017. https://www.research.va.gov/currents/0417-pregnancy.cfm. 
  19. Jang, Caleb, and Henry Lee. “A Review of Racial Disparities in Infant Mortality in the US.” Children 9, no. 2 (February 14, 2022): 257. https://doi.org/10.3390/children9020257. 
  20. Kozhimannil, Katy B., Julia D. Interrante, Alena N. Tofte, and Lindsay K. Admon. “Severe Maternal Morbidity and Mortality among Indigenous Women in the United States.” Obstetrics & Gynecology 135, no. 2 (February 2020): 294–300. https://doi.org/10.1097/aog.0000000000003647. 
  21. Kozhimannil, Katy, Viengneesee Thao, Peiyin Hung, Ellen Tilden, Aaron Caughey, and Jonathan Snowden. “Association between Hospital Birth Volume and Maternal Morbidity among Low-Risk Pregnancies in Rural, Urban, and Teaching Hospitals in the United States.” American Journal of Perinatology 33, no. 06 (January 5, 2016): 590–99. https://doi.org/10.1055/s-0035-1570380. 
  22. Kyere, Eric, and Sadaaki Fukui. “Structural Racism, Workforce Diversity, and Mental Health Disparities: A Critical Review.” Journal of Racial and Ethnic Health Disparities 10, no. 4 (August 5, 2022): 1985–96. https://doi.org/10.1007/s40615-022-01380-w. 
  23. Lee, Aiden, Joel Ruhter, Christie Peters, Nancy De Lew, and Benjamin D Sommers. “National Uninsured Rate Reaches All-Time Low in Early 2022.” Assistant Secretary for Planning and Evaluation, 2022. https://aspe.hhs.gov/sites/default/files/documents/15c1f9899b3f203887deba90e3005f5a/Uninsured-Q1-2022-Data-Point-HP-2022-23-08.pdf.
  24. Levinson, Zachary, Jamie Godwin, and Scott Hulver. “Rural Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid.” KFF, February 23, 2023. https://www.kff.org/health-costs/issue-brief/rural-hospitals-face-renewed-financial-challenges-especially-in-states-that-have-not-expanded-medicaid/#:~:text=Among%20other%20challenges%2C%20rural%20hospitals,facilities%20to%20offer%20specialized%20services.
  25. Lingras, Katherine A., M. Elizabeth Alexander, and Danielle M. Vrieze. “Diversity, Equity, and Inclusion Efforts at a Departmental Level: Building a Committee as a Vehicle for Advancing Progress.” Journal of Clinical Psychology in Medical Settings 30, no. 2 (September 16, 2021): 356–79. https://doi.org/10.1007/s10880-021-09809-w.
  26.  Liu, Katherine A., and Natalie A. DiPietro Mager. “Women’s Involvement in Clinical Trials: Historical Perspective and Future Implications.” Pharmacy Practice 14, no. 1 (March 6, 2016): 708–708. https://doi.org/10.18549/pharmpract.2016.01.708
  27. MarchofDimes. “2023 March of Dimes Report Card for United States.” March of Dimes, 2023. https://www.marchofdimes.org/peristats/reports/united-states/report-card. 
  28. “Maternal Health.” World Health Organization, 2023. https://www.who.int/health-topics/maternal-health#tab=tab_1. 
  29. McGregor, Alyson. Sex matters: How male-centric medicine endangers women’s health and what we can do about it. London: Quercus, 2021. 
  30. Mughal, Saba, Yusra Azhar, and Waquar Siddiqui. “Postpartum Depression.” National Center of Biotechnology Information, October 7, 2022. https://www.ncbi.nlm.nih.gov/books/NBK519070/. 
  31. Nielson, Marci, Darrin D’Agostino, and Paula Gregory. “Addressing Rural Health Challenges Head On.” Missouri Medicine 114, no. Sept/Oct 2017 (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140198/ 
  32. Owens, Deirdre Cooper, and Sharla M. Fett. “Black Maternal and Infant Health: Historical Legacies of Slavery.” American Journal of Public Health 109, no. 10 (October 2019): 1342–45. https://doi.org/10.2105/ajph.2019.305243. 
  33. Pierce, Matthias, Holly F. Hope, Adekeye Kolade, Judith Gellatly, Cemre Su Osam, Reena Perchard, Kyriaki Kosidou, et al. “Effects of Parental Mental Illness on Children’s Physical Health: Systematic Review and Meta-Analysis.” The British Journal of Psychiatry 217, no. 1 (October 15, 2019): 354–63. https://doi.org/10.1192/bjp.2019.216. 
  34. Powers, Abigail, Briana Woods-Jaeger, Jennifer S. Stevens, Bekh Bradley, Misti B. Patel, Andrea Joyner, Alicia K. Smith, Denise J. Jamieson, Nadine Kaslow, and Vasiliki Michopoulos. “Trauma, Psychiatric Disorders, and Treatment History among Pregnant African American Women.” Psychological Trauma: Theory, Research, Practice, and Policy 12, no. 2 (February 2020): 138–46. https://doi.org/10.1037/tra0000507. 
  35. Rae, Matthew, Cynthia Cox, and Hanna Dingel. “Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care.” KFF, July 12, 2022. https://www.kff.org/health-costs/issue-brief/health-costs-associated-with-pregnancy-childbirth-and-postpartum-care/#:~:text=It%20finds%20that%20health%20costs,by%20the%20type%20of%20delivery. 
  36. Roberts, A. L., S. E. Gilman, J. Breslau, N. Breslau, and K. C. Koenen. “Race/Ethnic Differences in Exposure to Traumatic Events, Development of Post-Traumatic Stress Disorder, and Treatment-Seeking for Post-Traumatic Stress Disorder in the United States.” Psychological Medicine 41, no. 1 (March 29, 2010): 71–83. https://doi.org/10.1017/s0033291710000401. 
  37. Saluja, Bani, and Zenobia Bryant. “How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States.” Journal of Women’s Health 30, no. 2 (February 1, 2021): 270–73. https://doi.org/10.1089/jwh.2020.8874. 
  38. Singh, Gopal K. “Trends and Social Inequalities in Maternal Mortality in the United States, 1969-2018.” International Journal of Maternal and Child Health and AIDS (IJMA) 10, no. 1 (December 30, 2020): 29–42.  https://doi.org/10.21106/ijma.444. 
  39. Snyder, Cyndy R, and Anjali R Truitt. “Exploring the Provider Preferences of Multiracial Patients.” Journal of Patient Experience 7, no. 4 (May 27, 2019): 479–83. https://doi.org/10.1177/2374373519851694. 
  40. Steenland, Maria W., Rachel E. Fabi, Meghan Bellerose, Arielle Desir, Maggie S. White, and Laura R. Wherry. “State Public Insurance Coverage Policies and Postpartum Care among Immigrants.” JAMA 330, no. 3 (July 18, 2023): 238. https://doi.org/10.1001/jama.2023.10249. 
  41. Taylor, Jamila K. “Structural Racism and Maternal Health among Black Women.” Journal of Law, Medicine & Ethics 48, no. 3 (2020): 506–17. https://doi.org/10.1177/1073110520958875.  
  42. Wallace, L. S. “A View of Health Care around the World.” The Annals of Family Medicine 11, no. 1 (January 1, 2013): 84–84. https://doi.org/10.1370/afm.1484. 
  43. Wang, Eileen, Kimberly B. Glazer, Elizabeth A. Howell, and Teresa M. Janevic. “Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States.” Obstetrics & Gynecology 135, no. 4 (April 2020): 896–915. https://doi.org/10.1097/aog.0000000000003762.
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