MetroPlusHealth: Maternal care, mental health & race

Pregnancy should be a time of hope and excitement, but for women of colour the experience is often marred by disparities in maternal healthcare that put their lives at risk.

In a recent survey conducted by MetroPlusHealth, 50% of the 1,000 respondents believed that Black pregnant women die at the same rate as White women during childbirth. In fact, the risk of maternal death among Black women is nearly three times higher. 

“People are unaware of how vast the problem is and the challenges that these individuals face,” says Starlette Johnson, Vice President, Quality Management at MetroPlusHealth. 

Here, she tells us more.

Health inequalities in maternal healthcare

As a Black woman and mother of three, Starlette has witnessed first-hand the inequalities that exist in maternal care and the need for clinicians to rethink the way they treat patients.

“These deep-rooted inequalities extend far beyond infant mortality and they won’t be solved overnight,” she says. “Today, there are far more resources available for pregnant people than in years past. In many cases, however, women of colour are not informed of what they need care for. For example, expectations for postpartum care vary by race, with 50% of Black and Hispanic women agreeing they needed more care than expected, compared to 28% of white women. This discrepancy raises the likelihood that different racial groups may not be equally aware of prenatal care options available to them.”

Starlette advises health systems to take steps now to:

• Close the knowledge gap
• Prioritise mental health
• Ensure pregnant women have access to the care and support they deserve at every stage of their pregnancy.

To restore parity, she suggests that healthcare providers should not only provide their members with more information, but also educate caregivers around the best practices and workflows that will help marginalised members navigate the healthcare ecosystem. “This is why training clinicians on how to cultivate relationships is essential. For many women of colour, learning they are pregnant often means scheduling an appointment with a new doctor. Encountering a caregiver with personal biases can discourage them from seeking the care they need early in their pregnancy and establishing trusted relationships with the people they rely on most.

“During my pregnancies, I’ve seen the importance of doctors that treat their patients’ concerns with respect and listen to their unique needs – an experience that may be less common among women of colour given the survey results. I still remember the feeling of joy and excitement when I learned I was pregnant with my last child. As I had recently moved into a different neighbourhood, I quickly made an appointment with a new doctor to confirm my pregnancy.”

But Starlette’s happiness turned to fear and confusion upon reaching the office. After conducting blood tests and a sonogram, her doctor believed a miscarriage was likely and immediately recommended that she terminate the pregnancy.

“This was such an extreme position that was dismissive of my point of view and my feelings at the time,” she explains. “When I pushed back, the doctor even became cold and argued with me.”

Fortunately, Starlette trusted her gut and sought a second opinion.

“Today, my three-year-old is healthy and thriving,” she beams. 

Black mothers must be able to access maternal mental health support

Experiences such as these illustrate the challenges that women of colour face during pregnancy and the importance of providing them with accessible mental health programmes. 

“70% of women say they wished they knew more about mental health challenges after giving birth. This figure is higher for minority communities, with 76% of Hispanic women and 81% of Black women agreeing.

“Many members of the black community have been told that mental illness is not real, and that they simply need to work through it and be strong. As a result, health systems must be more active in getting the word about their mental health services, and train clinicians to discuss mental health needs in maternal care – especially when certain populations may not always be honest about what they’re going through.”

One solution is the use of mail, live calls, text message campaigns and community events to educate women about the importance of prenatal and postpartum care, including mental health and the disparities that exist in maternal care. 

“These include targeted texting campaigns and personalised phone calls that begin when providers find out that a member is pregnant. From here, take a hands-on approach, helping them to schedule appointments and get the care they need.”

If providers and health systems want to close the racial disparities in maternal care, they must take a more active role in disseminating information to their caregivers and communities. 

“Healthcare leaders must begin to prioritise improvement of patient outcomes for long suffering groups. This doesn’t mean prioritising one person over another but making provider and patient education and resources a hallmark of healthcare strategy.”

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