Improving Maternal Health in the United States: Incorporating Our Primary Stakeholders
This post is part of “Inequities in Maternal Mortality in the U.S.,” a blog series hosted by the MHTF.
As a maternal health provider, I would love to know what women think about the care my colleagues and I provide. I need more comprehensive, high quality information about the patient experience in the maternal health care system than my online reviews or the latest discussion about home birth vs facility birth on a pregnancy help website.
Projects in low-income countries are engaging patients in the conversation on how to improve safe and respectful care in maternity centers worldwide[i],[ii]. Through a quick PubMed search, I can read about what women in Tanzania think of the quality of obstetric care they receive, yet I can’t find a systematic, large-scale effort to understand patient perceptions of quality and satisfaction with maternal care in the U.S.[iii] I understand that maternal health outcomes are vastly different in Tanzania and the U.S., but I think that we can learn from efforts in low-income countries to better engage primary stakeholders (women) in research and quality improvement initiatives to help improve maternal health outcomes in the U.S.
The U.S. ranks low in maternal health outcomes as compared to other high-income countries. Vast disparities in maternal mortality exist within the country. According to the CDC, 42.8 black women died from pregnancy-related causes per 100,000 live births in 2011 as compared to 12.5 white women[iv]. There are number of factors related to socio-economic status and health care access that may be contributing to the marked disparity in maternal deaths between black women and white women. The disparity in maternal deaths between white and black women has continued to widen since 2008. In order to address the U.S. disparities problem in maternal health we need more rigorous quality improvement research that engages our patient population. The California Maternal Quality Care Collaborative is an example of a cohesive effort of over 40 multidisciplinary organizations, the result of which was the successful reduction of maternal mortality in California through a focus on quality and safety[v].
Maternal mortality and morbidity reviews can identify gaps and fuel systems improvement. Checklists and protocols help improve quality and safety in maternal health facilities. These strategies help address the problem of substandard care that has so often been identified as the root cause of death in maternal mortality cases[vi].
While checklists and protocols can standardize and equalize care within facilities, developing innovative ways to engage patients in research and quality improvement can further improve maternal mortality and close the gap in disparities. While it is difficult to recruit patients and administer surveys through traditional research methods, mHealth technology offers an exciting opportunity to engage our population in quality and disparities research in a way that is easily accessible, anonymous and potentially linked with powerful tools for patient education.
[i] Abuya T, Warren CE, Miller N, et al. Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PLoS One. United States; 2015;10(4):e0123606.
[ii] Vogel JP, Bohren MA, Tunçalp Ö, et al. WHO Research Group on the Treatment of Women During Childbirth. How women are treated during facility-based childbirth: development and validation of measurement tools in four countries – phase 1 formative research study protocol. Reprod Health. 2015 Jul 22;12:60.
[iii] Larson E, Hermosilla S, Kimweri A, Mbaruku GM, Kruk ME. Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study. BMC Health Serv Res. 2014 Oct 18;14:483.
[iv] CDC. Pregnancy Mortality Surveillance System. 16 Sept 2015. Accessed 28 Oct 2015. <http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html>.
[v] California Maternal Quality Care Collaborative. Accessed 28 Oct 2015. <https://www.cmqcc.org/about-us>.
[vi] Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A,Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O’Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011 Mar;118 Suppl 1:1-203.