Ethnic Disparities in Maternity Care in the US - Can Technology Help?

Could technology be used to narrow the gap in maternal outcomes?

Tori Bowie, source unknown

Trigger warning — this post discusses racial inequalities in the US healthcare system and death in childbirth

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In the United States, a country known for its technological advancements and economic prowess, the state of maternity care presents a paradox. Despite the nation’s wealth and resources, it has one of the highest maternal mortality rates among developed countries. This issue becomes even more alarming when we consider the racial and ethnic disparities that exist within these statistics.

The story of Tori Bowie, a three-time Olympic medallist who tragically died from childbirth complications at the age of 32, has brought the maternal mortality crisis in the US into sharp focus. Bowie was eight months pregnant and in labour at her Florida home at the time of her death. The New York Times reported an autopsy shared with them listed respiratory distress and eclampsia as possible complications. The baby she was carrying, a girl, was stillborn. This terrible event underscores the urgent need to address the maternal health crisis in the US.

A Sorry Story

According to a 2016 analysis published in The Lancet, the maternal mortality ratio in the United States stood at 26.4 per 100,000 live births. This alarming figure places the US among the worst-performing countries in the industrialised world, with a rate three times higher than that of England. Remarkably, this occurs in the context of the US boasting the highest per capita healthcare expenditure globally, with only Switzerland coming close. Furthermore, the situation appears to be deteriorating. Data from the Pregnancy Mortality Surveillance System, a study organised by the US-based CDC, indicates that maternal deaths have more than doubled over the past 30 years.

“It’s basically a public health and human rights emergency because it’s been estimated that a significant portion of these deaths could be prevented,” — Dr. Ana Langer

Delving deeper into these statistics reveals a distressing disparity in healthcare outcomes. The Centers for Disease Control and Prevention report that Black women face a risk nearly three times higher of dying from pregnancy-related causes compared to white women. Similarly, American Indian or Alaska Native women have over double the risk, while for Native Hawaiian and Other Pacific Islanders, the risk escalates to more than four times. “It’s basically a public health and human rights emergency because it’s been estimated that a significant portion of these deaths could be prevented,” said Dr. Ana Langer, director of the Women and Health Initiative at the Harvard T.H. Chan School of Public Health in Boston.

Source: CDC

Causes of Disparity

The reasons behind these disparities are complex and multifaceted, encompassing socioeconomic factors, access to quality healthcare and implicit bias within the healthcare system itself.

The National Academies of Sciences, Engineering, and Medicine (NASEM) and research done by the Centers for Disease Control and Prevention (CDC) suggest the following contributing factors to ethnic disparities in maternal health outcomes:

1. Implicit bias and discrimination: Implicit bias and discrimination exists within the healthcare system and leads to poorer health outcomes for ethnic minority groups. Sadly, this can manifest as healthcare providers not taking patients’ concerns seriously, providing substandard care or making assumptions based on a patient’s race or ethnicity.
2. Chronic stress and weathering: The concept of “weathering” refers to the cumulative impact of chronic stress, often related to racism and discrimination, on an individual’s health. This chronic stress can lead to premature ageing and poorer health outcomes, including in maternal health.
3. Socioeconomic factors: These include elements such as unstable housing and limited access to transportation, which can make it difficult for women to access healthcare services or maintain regular check-ups during pregnancy. Financial insecurity, often associated with lower socioeconomic status, can also contribute to stress and negatively impact health outcomes.
4. Healthcare access and quality: This encompasses several factors that can affect the quality of care a woman receives. System-level issues such as inadequate access to care and poor case coordination can also lead to gaps in care and poor health management. Additionally, women living in medically underserved areas or facing language or cultural barriers in healthcare settings may have less access to quality healthcare.
5. Provider factors: The quality of care provided by healthcare providers can significantly impact maternal health outcomes. Missed or delayed diagnoses and a lack of continuity of care (meaning the woman sees the same healthcare provider throughout her pregnancy) can lead to poor management of the woman’s health.
6. Patient knowledge and behaviour: A woman’s knowledge can also impact her health outcomes. For instance, a lack of knowledge of warning signs of complications or non-adherence to medical regimens can lead to uncontrolled health conditions that can affect her and her baby’s health.
7. Underlying health conditions: Ethnic minority groups often have higher rates of certain health conditions, such as hypertension and diabetes, which can complicate pregnancy and lead to poorer maternal health outcomes.

The Maternal Mortality Review Committees (MMRC) data suggest the majority of deaths — 60% or more — could have been prevented by addressing these factors at multiple levels.

Can Tech Play a Role?

Tech solutions cannot erase systemic issues such as bias and discrimination and the biological consequences this stress has on a woman’s body, nor other social determinant of health. That requires a comprehensive, systemic approach that likely includes policy changes, education and a commitment to addressing the root causes of these issues.

However, some of the contributing factors to health inequality could be amenable to technology solutions.

Increasing Access

Millions of women in the US live in areas with geographical barriers to maternity care, either as they are in rural areas, urban deserts or due to transportation challenges. When we consider a healthy pregnancy requires 13 prenatal visits and many women won’t have access to paid leave, attending appointments becomes costly in both time and money.

By allowing patients to consult with healthcare professionals remotely, telemedicine can help to overcome geographic barriers to care. This could be a game-changer for hundreds of thousands of women, making it easier for them to access prenatal and postnatal care. To date the uptake of telemedicine for prenatal care has been low, likely in part due to the involved nature of these appointments. However, these challenges may be surmountable by advances in technology, which we will cover next.

Real Time Delivery of Care

Over the past decade, diagnostic tools and remote patient monitoring systems have seen remarkable advancements, facilitating real-time care delivery. This proves particularly beneficial for pregnancies deemed high-risk, where frequent clinic visits become the norm. Utilising FDA-approved connected devices, these platforms can remotely track vital metrics like weight, blood glucose levels, blood pressure and foetal heart rate. Abnormal results trigger real-time alerts to patients and providers allowing the real time delivery of care and faster interventions when needed.

Patient Empowerment

Technology can help to provide women with the knowledge they need to make informed decisions about their health and pregnancy journey. Digital platforms and apps can offer evidence-based educational content, tailored to each stage of pregnancy, ensuring women are well-informed about potential risks, warning signs and best practices.

Moreover, remote monitoring devices can give women a sense of control and engagement in their care, allowing them to actively participate in tracking their health metrics and understanding their significance. This empowerment not only fosters a sense of ownership over one’s health but also bridges the communication gap between patients and providers. By being more informed and engaged, women can have more meaningful conversations with their healthcare providers, leading to personalised care plans and better health outcomes.

Companies Addressing the Issue

Several companies are stepping up to tackle these pressing challenges in maternity care, and venture capitalists are paying attention. This heightened interest from the investment community is hardly surprising, given the vast size of the US maternity care market.

1. Metronomic: Their product Materno specialises in remote patient monitoring, offering solutions that allow healthcare providers to keep track of vital metrics in real-time. Their tools are especially beneficial for high-risk pregnancies, ensuring timely interventions when needed.
2. Aster Care: This company aims to enhance the delivery, management, and payment processes for pre and post-natal care, including monitoring and clinical content.
3. Pomelo Care: A platform that connects patients with healthcare providers for remote consultations, with a particular emphasis on maternity care. Their services aim to bridge the gap between patients and providers, ensuring continuous care even from a distance.
4. Babyscripts: This app offers remote monitoring for pregnant women, allowing healthcare providers to keep track of their patients’ health and well-being throughout pregnancy.
5. Lucina Health: This company uses data analytics to identify at-risk pregnancies and then engages with both the mother and her care team to reduce the risk of preterm birth.

The Road Ahead

The story of Tori Bowie is a tragic reminder of the urgent need to address the maternal health crisis in the US. From telemedicine and remote monitoring, to digital maternity platforms, these technologies offer promising solutions to improve maternity care. However, clearly technology alone is not enough. We must also address the systemic issues that contribute to these disparities, from socioeconomic factors to implicit bias in the healthcare system. Only then can we hope to ensure that every woman has access to the quality maternity care she deserves.

References

1. CDC — Pregnancy Mortality Surveillance System. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
2. CDC — National Vital Statistics Reports. https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69-02-508.pdf
3. National Survey of Children’s Health (NSCH). https://mchb.hrsa.gov/data-research/chartbooks
4. CDC Newsroom — Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html
5. Institute of Medicine — Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. https://doi.org/10.17226/12875