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Black Maternal Mortality Rates are Soaring in the U.S.: Could a Navigator Model Policy Help?

By Guest contributor, shree govani

An ever-pressing issue that often gets overlooked by the community is maternal mortality. Compared to other countries with similar resources to the U.S., we have a shockingly high rate of maternal mortality. Despite having the latest updated technology, the U.S. is one of only two countries that shows a significant increase in its maternal mortality ratio since 2000, according to a 2016 study published by the National Library of Medicine. This difference is exasperated when looked at from the lens of race, especially individuals who identify as Latinx/Hispanic and Black/African American. 

While volunteering in health care settings, I witnessed the ways health disparities present in medicine, hurting Black female patients especially; in many cases, Black mothers would not receive pain medications despite voicing their concerns. Through my public health coursework and as a future health care professional, I wanted to help change this broken health care system and eliminate the racial inequity Black women experience. The priority for reducing maternal mortality in Black women is ensuring their voices are present and heard in health care settings. Often, the perspectives of people of color are ignored in medicine. 

Is anything currently being done?

With current policies in place, there was an expanded eligibility for Medicaid that allowed low-income women to stay on Medicaid 60 days after their postpartum period. However, not every state has adopted this policy; thus, those women must re-apply for Medicaid—but this time around, with different eligibility levels as a parent—making it harder for them to get insurance. Hence, many women become uninsured after pregnancy because even though they are poor, their income is still too high to qualify for Medicaid as parents, according to a 2021 study published in the Journal of the American Heart Association. This often causes various women to fall through the cracks and creates many post-pregnancy complications such as infection, postpartum depression and sepsis as they are not able to get those check-ups with health care providers. In 2018, the Preventing Maternal Deaths Act was passed to establish a program that puts funds towards reviewing maternal deaths; sustaining a Maternal Mortality Review Committee (MMRC) in every state; developing for every state a plan for ongoing health care provider education to improve the quality of maternal care; distributing maternal mortality review information applications to every state; and providing public disclosure of what was found. Despite each of these proposed health policies, current maternal mortality rates are still on the rise. 

How do we fix this?

A way to solve this issue is through the implementation of a navigator model policy for the city of St. Louis, with the help of a database that offers a one-stop support system in the form of a website for the pregnant population in the community. Implementation of a pilot navigator model would give us a chance to test this policy and see if it might overcome what has been done in the past; this would allow someone to be there for the patient each step of the way, according to a 2020 study published in the journal “Public Health.” Through the mandatory establishment of a database for clinics, doctors and public places, this policy is empowering women to seek resources already available in their communities. The database should be present in all clinics and made available in public places for easy accessibility for individuals who might not have a mobile phone or access to the internet. The goal is to provide support to Black women while making sure to be culturally and economically sensitive. 

Additionally, there needs to be an establishment of trust within the community, which can best be achieved through participating in community events and promotion of educational content. There are already organizations, such as Almost Home, that are working to resolve this issue in St. Louis, and the policy is not hoping to overshadow them. Instead, the policy hopes to shine light on the work of the organization’s by integration of resources into a “one-stop shop” for the purpose of heightened accessibility. This policy hopes to bridge the gap between what Black mothers need and what providers must do to aid them. For this policy to come true, there is need for funding from the state or city government to create the website and have it placed in various locations throughout the city. This funding can be used for legal services, providing a website domain, technological equipment, campaigns going out into health fairs/communities/churches to distribute marketing materials, transportation fees for patients to make use of these resources and printing supplies for those without access to the internet.

but will it actually work?

Implementation of this policy first and foremost gives patients full access to a “one-stop shop” for each of their needs, whether it be mental health resources, food banks or diaper banks. The database hits on resources in relation to pregnancy that are often overlooked, such as transportation services to and from doctor’s visits. Furthermore, this policy will implement a database that has questionnaires that will generate individualized recommendations for resources, making it easier to navigate and access the resources they need. To check up on the mothers, surveys and feedback forms will be sent out followed by a personal phone call to ensure that they have used the services and or to help them with anything else they might need. This policy makes sure that the patients are cared for each step of the way—especially through human connection with the help of a follow up. 

Additionally, the policy is not overstepping; in fact, it aims to work with established community organizations to further show their appeal to others. There would be advantages in both a short- and long-term manner. Black women would be given a voice at the table, as this would allow them to take the matter of their health care into their own hands. Moreover, they would be presented with  choices: which physicians they want to see, where they want food from, if they desire mental health care. This gives them the choice to take care of and inform themselves as they please. A long-term advantage of this policy would be the creation of collaboration between city government and community organizations, creating more established and trusting relations between the two: thereby decreasing the disparities present when it comes to Black maternal health. 

However, I do understand that there are counter arguments against the passing of this policy that must be acknowledged if implemented in the city of St. Louis. It would be remiss to assume that there would be immediate cooperation between the city government and the Black community, as there is a long history between the two. Having individuals in the community oversee the creation and implementation of the database will help increase trust in this policy. 

Another argument against this policy is that people question if this would actually help lower maternal mortality in Black women in St. Louis. A huge problem that this policy will need to overcome is gauging if the community even wants something like this, or if there would be any use of this database present in all public places and or clinics. One option would be a community needs assessment, as well as focus groups, where individuals who would help establish this policy would go out to the community and talk with pregnant Black women to understand what resources they want. 

Would this policy potentially harm or single out individuals who might not have access to the internet? Does it make the disparities more present, which in turn negatively impacts those individuals and creates further mistrust and miscommunication? A potential way to resolve this issue would be through implementation of the pilot database in printed form at local shops and spots. However, this would require more funding and or permission from the organizations. 

How would this impact individuals that might not have the means to get to a community health center or a clinic? A disadvantage is how long the creation and implementation of this policy would take. Would other organizations or clinics be okay with having such a database as part of their life? To some, this pilot policy might seem more of a hassle then a benefit of any sort. 

Through the implementation of any policy, it is important to understand and discuss the benefits of having it in place. With the creation of a new policy where many are already in place, the social cost of this policy is something that must be addressed. The government would be creating and funding the project for the creation and implementation of the database. However, one would have to figure out if the database would be present for free in all these locations or if users would have to pay for use of the database, which in turn would be another barrier. If the policy made sure that individuals wanting to use the database did not have to pay for it, would that be acceptable for the government—and where would the money for funding the website domain come from? (Though, the overall cost of the website domain by itself is not as expensive as other measures have been.)

The policy provides the community with a more holistic approach to maternal care; through this policy, an individual is cared for each step of the way and presented with the choice of handling their own health care. This policy is needed now more than ever as, due to COVID-19, many individuals have become disconnected in the sense of health care. This policy provides them with a way to connect to professionals to get the help they need and deserve. A prominent reason for the continuing increase in the maternal mortality crisis is due to racism in medicine, which is present through health care disparities. A way to overcome this is through changing policy directly to implement change and bring about a way to empower women.

Saint Louis University is a Jesuit institution located in St. Louis City, Missouri.
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