Michael Dowling: Maternal mortality isn't changing, so Northwell will

Maternal health outcomes for women of color are moving in the wrong direction.

 

Healthcare has not treated women's health equitably. Most healthcare delivery has used the male model of medicine. Cardiac health was primarily seen as a men's issue versus women's issue, for instance. Most medical research has been done on men, not women.

These troubling inequities drove Northwell in 2007 to create its Katz Institute for Women's Health, a comprehensive network of experts devoted to every aspect of women's health. Today I am excited to announce that Northwell is building upon the commitment to women's health equity with the launch of our Center for Maternal Health. This is the linchpin in our plan to reduce the rate of maternal mortality in the United States — the highest among industrialized nations — and to specifically address health risks facing Black women, who are three times more likely to die from pregnancy-related causes than their white counterparts in the U.S.

Maternal health outcomes for women of color are moving in the wrong direction. Long-standing disparities in healthcare and outcomes for people of color were laid bare throughout the COVID-19 pandemic, with racial disparities for maternal and infant health worsening. In 2019, the maternal mortality rate for Black women was 44 deaths per 100,000 live births. In 2020, the maternal mortality rate increased to 55.3 deaths per 100,000 live births.

It is appropriate to state that Black mothers are not equitably treated by the U.S. health system. Their voices too often go unheard compared to their white counterparts. For instance, medical records of women undergoing C-sections showed that black and Hispanic women reported higher pain scores than white and Asian women, yet received fewer pain assessments and lower doses of all pain medication, according to research out of UNC-Chapel Hill. 

This is unacceptable.

Nearly 4 million women give birth in the U.S. every year. Northwell delivers more babies in New York than any single entity. The Center for Maternal Health brings a 360-degree approach to improving maternal health by working throughout the continuum of care. It extends our reach to Black mothers in the community to address health conditions that can occur from pre-conception through the first year after delivery. It considers social determinants that raise the risk of pregnancy problems among Black women.

By focusing on the health and outcomes of Black women, we'll help everybody. 

The center launches with short-term goals to reduce C-section rates, track any complications at delivery, and reduce readmission rates for maternity patients. Long term, we want to dramatically reduce the rate of maternal mortality.

To accomplish this, the center, working with the Katz Institute for Women's Health, will offer a range of programs and targeted solutions to move the needle in the right direction on maternal morbidity among Black women. For instance, the program uses objective, data-driven measures to automatically identify obstetric patients who are at increased risk of complications — a move that helps prevent lower referral rates for Black women. 

Our  Maternal Outcomes Navigation program ensures high-risk women have support outside of the healthcare setting, whether that be between prenatal appointments or in the postpartum period at home. A 20-month pilot program at three of Northwell's largest facilities showed this navigation reduced hospitalizations caused by pregnancy-related, life-threatening problems by 47 percent among participating women — and by 69 percent among participating Black women. 

Planning and development for the Center for Maternal Health took about a year. Physicians have led the effort, encouraged in seeing Northwell treat racial disparities in maternal health as a major priority. The center involves several key stakeholders across our integrated system, including Northwell's departments of medicine, community health, obstetrics and gynecology, behavioral health services, population health and care management. The center pulls together robust resources from across the system and begins the fight against threats to maternal and infant health further upstream.

Overall, too many women confront high levels of risk during pregnancy and childbirth in the United States, and the danger facing Black women is a national crisis. We must do better, and we can do better. Northwell has the structure, strategy, support and scope to drive holistic and inclusive change. Now we need to achieve it, with immediate and long-term outcomes that demonstrate success and move the needle in the right direction for women and their babies.

 

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