Despite tremendous health advances, the United States has the highest maternal death rate of any developed country. And while most of the world has drastically reduced rates of maternal mortality over the past several decades, the U.S. is one of a handful of countries where the problem has not only worsened, but worsened significantly. A substantial racial disparity exists as well, with black women nearly three times more likely to die during childbirth than white women.
It’s not just deaths on the rise. So are complications that result in near deaths, with more than 50,000 a year across the country, resulting in serious–and sometimes debilitating–injury.
Research suggests that nearly 60 percent of maternal deaths are preventable and linked to complications like infections, severe bleeding, high blood pressure and heart disease. A rise in the rate of C-section deliveries is also a contributing factor to maternal mortality, despite the fact that many of these surgical deliveries are medically unnecessary. Like any surgery, C-sections significantly increase the likelihood of life-threatening hemorrhage, blood clots and infections.
The growing prevalence of chronic disease among women of child-bearing age is worsening the problem. According to the Centers for Disease Control and Prevention, roughly half of pregnancies in the U.S. are unplanned, so chronic health issues like obesity, diabetes and cardiovascular disease aren’t fully addressed before pregnancy, putting women at much greater risk of complications. And many women are having children later in life and thus have more complex medical histories.
Maternity care deserts are also threatening women’s access to necessary care before, during and after pregnancy. Five million women live in counties considered maternity care deserts, according to a recent March of Dimes report, with no hospital offering obstetric care and no obstetric providers.
Together with physician, hospital and community partners, Blue Cross and Blue Shield companies are leading initiatives to make childbirth safer, address disparities and close critical access gaps.
In Mississippi, a state with one of the highest maternal mortality rates in the country, Blue Cross & Blue Shield of Mississippi (BCBSMS) supports hospitals in improving health outcomes through the BCBSMS Maternity Quality Model. There are three main focuses: the 39 weeks Initiative, a partnership with network clinicians which reduces the number of medically unnecessary early term deliveries, lowering the risk of complications during birth; Baby Friendly, which enhances the mother/baby experience through training and education; and Maternal Safety Bundles, a partnership with Mississippi Perinatal Quality Collaborative (MSPQC) focusing on education and training for improving maternal care.
As part of Maternity Safety Bundles, BCBSMS is training healthcare professionals in hospitals throughout the state to better identify and respond to complications – including severe bleeding and high blood pressure – which are two of the most preventable causes of pregnancy-related deaths that are often undetected, misdiagnosed or ignored. They are also working towards safely reducing unnecessary C-sections.
Finally, as part of the Blue Primary Care Women’s Wellness Home initiative, primary care physicians are helping to meet women’s OBGYN and other healthcare needs, resulting in more coordinated care and lower risk pregnancies. This is helping to close a critical access gap in rural Mississippi, where the maternal mortality rate is highest.
In Tennessee, BlueCross BlueShield of Tennessee has helped establish an extensive network of telemedicine sites in rural communities–called the Solutions to Obstetrics in Rural Communities (STORC)–to improve access to specialty care for women with high-risk pregnancies. To avoid having a woman travel to one of the state’s major cities for care, STORC sites are staffed with an ultrasound technician and an advanced practice nurse who can video conference with a specialist. Currently, there are STORC sites in 13 rural Tennessee communities, many with no obstetrical specialists or women’s healthcare professionals at all. The program, which began in 2009 with 134 visits has now grown to 3,953 in 2018. More than 90 percent of women in the program have delivered healthy babies.
CareFirst BlueCross BlueShield (CareFirst) is awarding $2 million over the next two years to programs seeking to improve birth outcomes, maternal health and lower infant mortality rates in Maryland, Virginia and Washington, D.C. CareFirst has already contributed more than $18 million to address these problems since 2007. The investments are paying off. From 2009 to 2018, Baltimore City, whose residents often have significant unmet maternal and child health needs, saw a 38 percent decrease in the black-white disparity in infant mortality.
And in Louisiana, Blue Cross and Blue Shield of Louisiana offers the maternity support program Healthy Blue Beginnings for mothers with high-risk pregnancies. The program identifies at-risk women and offers expectant mothers confidential nursing support specific to their individual needs. Expectant mothers are also encouraged to sign up for text4baby, which sends free health and safety tips via text message. Each message is tailored to the mother’s due date.
Healthy Blue, a Louisiana Medicaid health plan, takes a proactive approach to maternal and infant health offering expectant mothers the comprehensive program, New Baby, New Life℠. Pregnant women undergo risk assessments to determine the level support they'll need throughout pregnancy. The program provides the women with enhanced case management, care coordination and education.
Recently, a package of new legislative proposals aimed at improving health outcomes for pregnant women and mothers, particularly vulnerable populations including black, Native American and incarcerated women, as well as female veterans, was introduced in Congress. BCBSA supports the “Black Maternal Health Caucus Momnibus” as an important step in improving health outcomes for pregnant women and mothers.