August 2019

Addressing the Maternal and Infant Health Crisis Through A Health Equity Lens

By: Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Illinois (BCBSIL)

In November 2018, I wrote a column discussing the imperative to help find solutions to eliminate maternal health inequities and combat rising mortality rates. While pregnancy is a significant and happy life event for expecting parents, the risk some women face during pregnancy and after giving birth is magnified. Racial and ethnic disparities exist in both obstetric outcomes and health care quality. These disparities are not simple differences but rather inequities that systematically and negatively impact less advantaged groups. Minority women suffer a disproportionate number of maternal deaths, pregnancy complications, comorbid illnesses, and adverse obstetric outcomes and have been shown to receive obstetric care that differs by race and ethnicity.¹

Compared to all other racial/ethnic groups, African American women have three to four times more maternal deaths.¹ Similarly, adverse perinatal outcomes, including infant death, are more common among black women than white women. In fact, in a study including over 100,000 women, racial and ethnic disparities were documented in frequency of labor induction, episiotomy and cesarean delivery. The authors of the study, Byrne and Tanesini, suggest that there appears to be a fundamental inconsistency between research which shows that some minority groups consistently receive lower quality healthcare and the literature indicating that healthcare workers appear to hold equality as a core personal value.²  

Premature births and their complications are the greatest contributor of infant mortality within the first year of life. The U.S. preterm birth rate is among the worst of high-resource nations. About 380,000 babies are born prematurely in the U.S. each year.³

According to the Centers for Disease Control and Prevention (CDC), the preterm birth rate rose for the third year in a row in 2017, and racial and ethnic differences in preterm birth rates remain.⁴ In 2017, the national average for premature birth rate in the U.S. was 9.93%. This means one in 10 babies is born too soon.³ In Illinois, the 2017 premature birth rate was above the national average at 10.4%, but for black women in Illinois it’s 14.2%, which is 53% higher than the rate among all other ethnical groups of women in Illinois.⁵

Why is this important at BCBSIL?
Previously, I noted the importance of patient-centric factors, like language proficiency, cultural beliefs and/or socioeconomic factors. It’s these factors that may impact patient understanding, access and adherence to care plans during pregnancy. BCBSIL has several initiatives underway to help address these factors and to provide vital member education that will have long-lasting impact on the communities we serve.

BCBSIL is standing by its members and providing access to information, care and other resources to support a healthy pregnancy, including the recovery period immediately following delivery, and beyond. Our Special Beginnings^® program provides expectant mothers with access to articles, videos and information needed to care for themselves and their baby during pregnancy and up to six weeks after giving birth. Going forward, we want to expand our disparity-reducing efforts to various vulnerable populations within the state of Illinois. 

Our fall Blue University^SM event will continue this conversation on addressing the maternal and infant health crisis through a health equity lens. How can BCBSIL work with providers to help tackle this issue? Please share your ideas with us by emailing the Blue Review editor and look for Blue University registration information in the coming months.

Learn more about Dr. Derek J. Robinson

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

¹ U.S. National Library of Medicine, NIH, Improving hospital quality to reduce disparities in severe maternal morbidity and mortality, August 2017. https://www.ncbi.nlm.nih.gov/pubmed/28735811

² U.S. National Library of Medicine, NIH, Instilling new habits: Addressing implicit bias in healthcare professionals, December 2015. https://www.ncbi.nlm.nih.gov/pubmed/25771742

³ March of Dimes, Fighting Premature Birth: The Prematurity Campaign, https://www.marchofdimes.org/mission/prematurity-campaign.aspx

⁴ CDC, Premature Birth, June 2019. https://www.cdc.gov/reproductivehealth/features/premature-birth/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffeatures%2Fprematurebirth%2Findex.html,%20accessed%207/2019

⁵ March of Dimes, 2018 Premature Birth Report Card, 2019. https://www.marchofdimes.org/peristats/tools/reportcard.aspx?frmodrc=1&reg=17