Addressing Systemic Racism in Healthcare: Initiatives to Improve Maternal Health Outcomes for Black Mothers

Many studies show that Black mothers face more health problems during pregnancy compared to others. The Centers for Disease Control and Prevention (CDC) says Black women die from pregnancy-related causes two to three times more often than white women. A study found even rich Black women have a higher chance of dying during pregnancy than poor white women. This means that money or education doesn’t solve the problem. The issue comes from racism and unfairness in healthcare.

Diseases like preeclampsia, heavy bleeding after birth, and blood clots happen more often in Black mothers. Almost half of the mothers who die do so within the first year after giving birth, which shows support is needed for a long time after delivery. Black women also have more preterm births and babies with low birth weights. These show worse health for both mothers and babies.

Another problem is that many Black mothers rely on Medicaid to pay for care during and after pregnancy. About 65% of Black mothers use Medicaid, while only 42% of all mothers do. Medicaid often stops paying after 60 days after birth, but many problems can happen after that. Some states that let Medicaid pay for a whole year after birth have seen better health results for Black mothers.

Structural Racism and Historical Context

Racism in healthcare has been a part of the system for a long time. In 1910, a report called the Flexner Report caused many Black medical schools to close and hurt the role of Black midwives. This lowered the number of healthcare workers who understand Black culture and caused distrust in the health system. Discrimination still happens today. For example, Black women are tested for drugs more often during labor, even though they test positive less often.

Black women are also less likely to get paid family leave. Only 13 states plus Washington D.C. have paid leave laws. Without paid leave, many Black mothers must go back to work early, which can raise stress and health risks.

Community and Healthcare System Initiatives

Many healthcare groups and community teams have started programs to fix the problems Black mothers face. They try to work together with the community and medical staff to make better care.

Summa Health in Akron, Ohio, changed a program called CenteringPregnancy and worked with groups like Project Ujima and the Minority Behavioral Health Group. Their program offers Black OB/GYN care, help from community health workers, mental health support, and breastfeeding help. This led to more mothers breastfeeding, more check-ups after birth, fewer early births, and fewer baby deaths. This shows working with communities can improve health.

Cedars-Sinai in Los Angeles uses doulas and birth helpers to build trust and help mothers understand medical terms and services. Doulas also help mothers and doctors talk better, which reduces stress and helps make better choices. Good communication is important because many Black mothers feel ignored, which can cause worse outcomes.

The Memorial Healthcare System in Florida uses teal bracelets to mark patients at high risk, like those with preeclampsia. This helps staff pay attention quickly. They also teach emergency and hospital workers about these risks. Working with local partners helps them respond better to risks.

Policy Efforts and State-Level Actions

Many state governments have started new rules to fight racism in healthcare and improve care for Black mothers. In New York, data shows Black pregnant people die at five times the rate of white people. From 2018 to 2020, 54.7 out of 100,000 Black mothers died, compared to 11.2 out of 100,000 white mothers. Deaths from cesarean births are three times higher than vaginal births, which shows where care could improve.

The state’s Maternal Mortality and Morbidity Advisory Council says 73.6% of pregnancy-related deaths could have been stopped. They suggest teamwork at many levels to fix the problem. The governor signed a law creating a state doula directory and gave $4.5 million to Regional Perinatal Centers. Starting January 2024, New York Medicaid will cover doula services fully, helping Black mothers get more support.

At the national level, the Black Maternal Health Momnibus Act contains twelve bills to improve social factors, workforce diversity, and data collection. This law shows that solving these health gaps needs money and changes in social and health systems, along with fighting racism.

The Role of Provider Diversity and Training

Having more health workers from different backgrounds helps make care better for Black mothers. Studies show that when patients see providers who look like them or understand their culture, patients trust the care more and communicate better. Doulas, midwives, nurse practitioners, and community workers of similar backgrounds can give care that fits cultural needs, which helps health.

Medical schools are also changing. They want to teach students about hidden biases, anti-racism, and fairness in health. People are becoming more aware that unconscious bias affects decisions during labor and delivery. Changing the lessons taught is an important step in stopping unfair treatment of Black mothers.

Technology and Automation in Maternal Care: A New Avenue for Equity

New technologies like artificial intelligence (AI) and automation are helping reduce health gaps. Medical managers and IT leaders can use these tools to improve patient communication, accuracy, and care coordination.

For example, electronic medical records (EMRs) with AI alerts can identify patients with higher risks based on race, medical history, and social factors. Cedars-Sinai used EMR reminders to increase the use of low-dose aspirin for Black pregnant patients at risk of preeclampsia from 25% to 80%. This kind of tool helps doctors follow proven treatments and avoids missing important care steps.

Simbo AI offers phone systems that use AI to help patients make appointments and get reminders. Black mothers often have trouble navigating health systems or making appointments. AI phone systems work all day and night to make scheduling easier. This helps prevent missed visits and keeps care going, especially for Medicaid patients who face added challenges like transportation or work schedules.

AI virtual helpers can also answer common questions about pregnancy care, warning signs after birth, and support services. This constant information helps mothers make better choices and ask for help on time.

Using automation for routine tasks frees staff to spend more time with patients and learn about cultural needs. AI can also find patterns in health data, which helps improve care quality and fairness.

Practical Steps for Medical Practices in the U.S.

• Enhance Data Collection and Reporting: Use EMR systems to gather race and ethnicity information along with social factors. Analyze this data carefully and protect patient privacy. Track differences and improvements in health outcomes over time.

• Invest in Cultural Competency Training: Make sure all staff, including doctors and office workers, get training to reduce hidden bias and understand the social issues that affect Black mothers.

• Leverage AI for Patient Engagement: Use AI phone systems for appointments, reminders, and follow-ups. This lowers missed visits and helps mothers stick with prenatal and postpartum care plans.

• Expand Access to Birth Advocates: Support doulas, midwives, and community health workers in clinics. Work with community groups to offer full support.

• Collaborate with Community Organizations: Work with local groups involved in Black maternal health to design services and create referral networks. Services like home visits, breastfeeding support, and mental health help are important.

• Monitor Clinical Protocols: Use AI alerts to make sure staff follow proven treatments like low-dose aspirin to prevent preeclampsia or treat high blood pressure on time.

• Advocate for Policy Change: Support expanding Medicaid coverage for postpartum care and full payment for doula services in your area.

Black maternal health problems come from many layers of racism and inequality. Still, clinical programs, community work, technology, and policy changes can help close the gaps. Healthcare leaders like administrators, owners, and IT managers have an important role in shaping better care systems. Improving communication, hiring diverse providers, and offering more support will help Black mothers have safer pregnancies and healthier families.