Redefining Maternal Health: Innovations and Equity for Birthing People
September 27, 2024
On Friday, September 27, the Boston Foundation kicked off the Early Childhood Coffee and Conversations series for 2024-2025 with a discussion of how we can nurture strong beginnings by improving maternal health, with a particular focus on reducing disparities by race and ethnicity.
After a welcome from Danubia Camargos Silva, Senior Program Officer for Child Well-being at the Boston Foundation, Kelly Harrington of Boston Indicators began the event with a data presentation on maternal health. While noting that some of what has been seen as an alarming spike in maternal morbidity and mortality has been triggered by changes in how data is reported, Harrington noted there is no questioning data that show maternal risk is unacceptably high in the United States and that there are serious racial health gaps in maternal health, particularly for Black birthing people.
After the data presentation, Camargos Silva brought together a panel of experienced workers in maternal health and child well-being. They included Emily Anesta, President of the Bay State Birth Coalition, Renée Boynton-Jarrett, MD, ScD, Founding Director of Vital Village Networks and Hafsatou Diop, MD, MPH, Assistant Commissioner for Health Equity, Office of the Commissioner, Massachusetts Department of Public Health.
During the discussion, the three panelists and Harrington reacted to the data and what they have been seeing in their own work. All highlighted the importance of broadening the conversation around maternal health, not just to a wider range of birthing people (although that, too, is critical) but to fathers and others to ensure that we are developing more effective systems of care that support the health and well-being of the family and improve access and support for all parents, regardless of race and socioeconomic factors.
The panel also discussed the importance of using data in a way that illustrates issues and keeps a focus on root causes, without laying blame at the feet of those most impacted. Panelists noted research can sometimes frame issues facing Black birthing people without recognizing the inequitable access to resources and opportunities they have endured for generations.
Beyond that, they also highlighted one of the harshest data points – that 84% of maternal deaths were preventable, underscoring repeated failures to listen to birthing people and or respect their knowledge of their own bodies. Changing that – by simply listening – can both save lives and empower patients. Too often, it was noted that women, especially women of color, feel discriminated against in their own birth process and that a new generation of systems of care can and should start with an eye toward equitable partnerships in their design. There must also be room for other critical voices and alternative birthing options that meet the needs of every person. Panelists highlighted the need for greater recognition of and respect for doulas, who are often much more able to advocate for patients and offer patient-centered care that other medical professionals cannot.
Another area of acknowledgment was around the need to recognize the trauma that has resulted from either substandard care or unexpected complications around birth. Panelists called for a recognition of the need for trauma-informed care and a proactive approach to birth trauma rather than a purely reactive one.
The path to a better, more equitable system of care and support for birthing people should be grounded in intentional cross-sector partnerships, such as the Commission on Racial Inequities in Maternal Health that generated the successful push for the recent maternal health legislation. By providing a broader system of care options, focused on the needs and desires of birthing people, including birth centers with welcoming home-like environments, community-based midwifery, and better integration of doulas, it is hoped that the Commonwealth can build on recent legislative victories to ensure birth is a beautiful, healthy, safe and joyful experience for everyone, regardless of their racial or socioeconomic background.