Recent data shows sobering statistics of increased rates of maternal mortality and persisting racial disparities nationwide. This data reminds us that we have so much more work to do to improve equity to access and care for moms, birthing people, and their babies across our country and in our state. CPCQC is coming to the table with the NAACP to talk about maternal health and to find new ways to connect and align our work in ending racial disparities in maternal and infant health outcomes.
The data has also given us more insight into the depth of the disparities in maternal health outcomes across communities of color in Colorado. Given so many have come together across our state to make meaningful change, sometimes disheartening data, such as this, can be hard to accept. However, we can and we must accept what the data tells us and use it to continue to improve how we care for all moms, birthing people, and their babies throughout the perinatal period.
This week we anticipate the release of the Colorado Department of Health Care Policy and Financing’s Maternal Health Equity report and all that it will reveal on the health and well-being of Black mothers and birthing people in Colorado who are covered under public health insurance for maternity care. However, we know that much of what the CDC reports on racial disparities in maternal outcomes nationally is also playing out in Colorado. And, new data from the Colorado Department of Public Health and Environment reports that Maternal Mortality Review Commission (MMRC) data between 2014–2018 showed that the pregnancy-associated mortality ratio was disproportionately high for Native Americans in Colorado (233.4 compared to the average of 46.6), and the pregnancy-related mortality ratio for Black Coloradans was significantly higher than the average (52.0 compared to 19.7). Starting with maternal deaths in 2017, the MMRC assessed whether discrimination—through implicit bias, structural racism, or interpersonal racism—was a contributing factor. To date, it has been found that discrimination contributed to 39.6% of all maternal deaths. A 2019 Medicaid report also showed that Native American and Black patients were less likely to receive timely prenatal care (72.1% and 73.0% respectively, compared to 77.1% of all Medicaid patients).
Using newly analyzed discharge data provided by Colorado Hospital Association for 2022, Black mothers are 53% more likely to experience severe maternal morbidity than their white counterparts which is only surpassed by Native American mothers who are twice as likely (98%). Hispanic mothers are 28% more likely to experience severe maternal morbidity and Asian mothers—20% more likely.
Severe maternal morbidity (SMM) is a measure of unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a birthing person’s health. While maternal mortality rates reflect the worst possible outcome of a pregnancy, because SMM includes patients whose health was severely impacted by birth but did not die as a result of their pregnancy, SMM rates reflect negative outcomes that occur in a larger population of patients, and include “near-misses.”
Simply pointing out these facts is not enough. We must effect change and inspire action on new approaches to care that specifically address the very real experiences of moms and birthing people that lead to the disparities born out in the data. Here are some actions already underway:
- Between 2020 and 2022, CPCQC trained over 325 perinatal healthcare stakeholders through the March of Dimes-facilitated Breaking Through Bias in Maternity Care Training, which covers topics of stigma and bias related to patients of marginalized racial/ethnic backgrounds or those suffering from behavioral health conditions. Trainees represented multisectoral backgrounds, including physicians, registered nurses, community public health practitioners, community health workers, childbirth educators, doulas, and mental health practitioners, from inpatient, outpatient, safety-net clinic, and community settings.
- CPCQC will be implementing recommendations from the upcoming MMRC legislative report that relate to quality improvement and continuing to enhance the data and centering lived experience in all of our work.
- The NAACP is contributing to the work of Children Colorado’s Black Health Initiative which is committed to improving maternal and infant health outcomes in the African American/Black community
- The NAACP is educating the African American/Black community about the African American maternal and infant health crises in Colorado.
- The NAACP is sharing culturally responsive health-related resources with birthing people in Colorado.
- Together, we are continuing to strengthen the Colorado Maternal Mental Health Collaborative—with CPCQC serving as the backbone support—to ensure that Black mothers who are more likely to suffer from Perinatal Mood and Anxiety Disorders (PMADs) like postpartum depression, do not do so in silence and without clinical help.
- Together, we are encouraged by the development of the Hear Her campaign by the CDC and support the campaign’s adoption across the state of Colorado.
- Together, we are following the development of more robust doula programs with reimbursement through Medicaid and the growth in peer support specialists from communities that live and breathe alongside those experiencing unequal perinatal outcomes.
- Together, we will encourage BIPOC organizations working to improve maternal and infant health outcomes to collaborate with the CPCQC.
Black Maternal Health Week, April 11–17, 2023, is a reminder of our call to action. Our vision is that EVERY pregnant and postpartum person, infant, and their families in Colorado have access to and receive safe, equitable, high quality care.