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America is trying to fix its maternal mortality crisis with federal, state and local programs

Maternal Mortality-Government Programs
September 04, 2024

TULSA, Okla. (AP) โ€” At the site of a race massacre that reduced neighborhoods to ashes a century ago, where murals memorialize a once-thriving โ€œ Black Wall Street,โ€ one African American mother strives to keep others from dying as they try to bring new life into the world.

Black women are more than three times as likely to die from pregnancy or childbirth as white women in Oklahoma, which consistently ranks among the worst states in the nation for maternal mortality.

โ€œTulsa is suffering,โ€ said Corrina Jackson, who heads up a local version of the federal Healthy Start program, coordinating needed care and helping women through their pregnancies. โ€œWeโ€™re talking about lives here.โ€

Across the nation, programs at all levels of government โ€” federal, state and local โ€” have the same goals to reduce maternal mortality and erase the race gap. None has all the answers, but many are making headway in their communities and paving the way for other places.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

Jacksonโ€™s project is one of more than 100 funded through Healthy Start, which gave out $105 million nationally in grants this year. Officials call Healthy Start an essential part of the Biden administrationโ€™s plan for addressing maternal health.

Other approaches to the crisis include California halving its maternal mortality rate through an organization that shares the best ways to treat common causes of maternal death and New York City expanding access to midwives and doulas two years ago. Several states passed laws this year aiming to improve maternal health, including a sweeping measure in Massachusetts. And last week, the U.S. Department of Health and Human Services announced more than $568 million in funding to improve maternal health through efforts such as home visiting services and better identifying and preventing pregnancy-related deaths.

Locally and nationally, "we need to really identify the birthing people who are at potentially the greatest risk," New York City health commissioner Dr. Ashwin Vasan said, "and then wrap our arms around them throughout their pregnancies.โ€

A Healthy Start in Tulsa

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

Besides coordinating prenatal and postpartum care โ€” which experts say is crucial for keeping moms alive โ€” local Healthy Start projects provide pregnancy and parenting education and referrals to services for things like depression or domestic violence. The local efforts also involve womenโ€™s partners and kids up to 18 months. And they focus on issues that influence health, such as getting transportation to appointments.

โ€œYou try to get them in their first trimester and then work with them to delivery day, and then we also work with the babies to make sure that they reach their milestones," Jackson said.

Jackson got help from the local Urban League as a single mom, and felt called to give back to her community. She's been with Healthy Start for more than 25 years, first through Tulsaโ€™s health department and recently through a nonprofit she started that received about $1 million in federal funds this fiscal year.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

โ€œIโ€™m just like a mom to this program,โ€ Jackson said.

Oklahoma overall has a maternal mortality rate of about 30 per 100,000 live births, significantly higher than the national average of about 23. But in Jackson's quarter-century tenure, she said, there have been no maternal deaths among clients.

Pivotal to Healthy Startโ€™s success are care coordinators like Krystal Keener, a social worker based at Oklahoma State University's obstetrics and gynecology clinic, where clients get prenatal care. One of her responsibilities is to educate clients about health issues, like how to spot the signs of preeclampsia or how much bleeding is too much after delivery.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

She also helps with practical matters: Many clients donโ€™t have cars, so they call Keener when they need a ride to a prenatal visit, and she assists in scheduling one.

With doctors, Keener serves as a patient advocate. On a recent afternoon, Keener sat in on a prenatal appointment for Areana Coles. A single mom, Coles was joined by her 5-year-old daughter, who was born prematurely and spent time in intensive care.

Coles, 25, said Healthy Start is โ€œprobably the best thing thatโ€™s happened in this pregnancy.โ€ She called Keener โ€œan angel.โ€

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

Together they navigated several recent medical concerns, including dehydration and low potassium levels that put Coles in the hospital.

With Coles' due date approaching, Keener talked about what to watch for around delivery and shortly after, like blood clots and postpartum depression. She advised Coles to take care of herself and โ€œgive yourself credit for small things you do.โ€

During an ultrasound a few minutes later, Coles watched Dr. Jacob Lenz point to her unborn babyโ€™s eyes, mouth, hand and heart. He printed an image of the scan, which Coles immediately showed her daughter.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

Keener said she's gratified that Coles would not be giving birth prematurely this time.

โ€œYou made it to term โ€“ yay!โ€ she told her client.

Coles smiled. โ€œMy body can do it!โ€

Improving medical care

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

While programs like Healthy Start focus on individual patient needs, other efforts manage the overall quality of medical care.

California has the lowest maternal mortality in the nation โ€” 10.5 per 100,000 live births, less than half the national rate. But that wasn't the case before it created a โ€œmaternal quality care collaborative" in 2006.

Founded at Stanford Universityโ€™s medical school in partnership with the state, it brings together people from every hospital with a maternity unit to share best practices on how to deal with issues that could lead to maternal injury or death, like high blood pressure, cardiovascular disease and sepsis.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

โ€œWhen you look at the rate of maternal death in the United States compared to California, they basically ran neck-and-neck until it was established,โ€ said Dr. Amanda Williams, clinical innovation adviser for the collaborative. โ€œAt that time they totally separated and California started going down. The rest of the country started going up.โ€

In the collaborative, hospitals get toolkits full of materials such as care guidelines in multiple formats, articles on best practices and slide sets that spell out what to do in medical emergencies, how to set up medical teams and what supplies to keep on the unit. The collaborative also tackles issues such as improving obstetric care by integrating midwives and doulas โ€“ whose services are covered by the stateโ€™s Medicaid program.

At first, some doctors resisted the effort, figuring they knew best, Williams said, but thereโ€™s much less pushback now that the collaborative has proven its value.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

MemorialCare Miller Childrenโ€™s & Womenโ€™s Hospital Long Beach started participating around 2010. The collaborative helps โ€œvet through all the research that's out there,โ€ said Shari Kelly, executive director of perinatal services. โ€œItโ€™s just so important to really understand how we as health care providers can make a difference."

For example, if a woman loses a certain amount of blood after a vaginal delivery, โ€œwe know to activate what we call here a โ€˜code crimson,โ€™ which brings blood to the bedside,โ€ Kelly said. โ€œWe can act fast and stop any potential hemorrhage.โ€

She said the collaborative has also helped reduce racial inequities โ€” bringing down the rate of cesarean sections among Black moms, for example.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

In July, U.S. Centers for Medicare & Medicaid Services proposed a similar initiative to California's, focused on the quality of maternal care nationwide: the first baseline health and safety requirements for maternal emergency and obstetric services in hospitals.

A community perspective

Experts said getting maternal mortality under control at a national level requires tailoring solutions to individual communities, which is easier when programs are locally run.

New York City has a goal of reducing maternal mortality overall โ€” and specifically achieving a 10% drop in Black maternal mortality by 2030. Statewide, Black residents are about four times more likely to die from pregnancy or childbirth than white residents.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

The city is starting with, among others, low-income residents and those living in public housing. The New Family Home Visits Initiative gives pregnant people and those who've given birth visits from professionals such as nurses, midwives, doulas and lactation consultants. Vasan said more than 12,000 families have gotten visits since 2022.

Nurse Shinda Cover-Bowen works for the initiativeโ€™s Nurse Family Partnership, which has her visiting some families for 2 1/2 years, well beyond the pregnancy and birth. She said โ€œthat consistency of someone being there for you and listening to you and guiding you on your motherโ€™s journey is priceless.โ€

Being grounded in the local community โ€” and its history โ€” is also crucial for Healthy Start projects. The lingering effects of racism are evident in Tulsa, where in 1921, white residents are estimated to have killed 100-300 Black people and destroyed homes, churches, schools and businesses in the Greenwood section. That's where Jackson lives now, and where health disparities persist.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

Being relatable is valuable for Black women, who may distrust the health care system, Jackson said. Plus, knowing the community makes it possible to work closely with other local agencies to meet people's needs.

Denise Jones, who enrolled in Healthy Start in February, has struggled with anxiety, depression and drug addiction, but has been sober since April.

In mid-July, baby items filled her room โ€” a crib, a bassinet, tiny clothes hanging neatly in a closet โ€” in anticipation of her childโ€™s arrival. Jones, 32, flipped through a baby book, pointing to a sonogram of her son Levi, who would be born within a couple of weeks.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

She said she feels healthy and blessed by the help she's gotten from Healthy Start and Madonna House, a transitional living program run by Catholic Charities of Eastern Oklahoma.

โ€œI have professionals that are working with me and give me support. I didnโ€™t have that with my other pregnancies,โ€ she said. โ€œIโ€™m at one with my baby and Iโ€™m able to focus.โ€

___

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

Associated Press data journalist Nicky Forster in New York contributed to this report.

___

This is the second story in a two-part series examining how the United States could curb deaths from pregnancy and childbirth.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Instituteโ€™s Science and Educational Media Group. The AP is solely responsible for all content.

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

America is trying to fix its maternal mortality crisis with federal, state and local programs
Maternal Mortality-Government Programs

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