America leads wealthy countries in maternal deaths. Our local data could change that.
Everything contributes to America’s maternal health crisis: geography, social factors, racial inequality, internalized racism.
Opinion piece by Sema Sgaier and Mary-Ann Etiebet, originally published in USA Today on January 18, 2022.
The recent Biden-Harris Maternal Health Day of Action focused the nation’s attention on shameful and inexcusable facts about the health and survival of our mothers. Not only is America’s overall maternal mortality rate the highest among wealthy nations, death occurs more than twice as often for Black, American Indian and Alaska Native women.
The day saw dozens of organizations, including ours, make significant commitments to act, but how do we increase the chances that these actions will help reverse decades-long trends of worsening health inequities?
On health, it’s time to go hyperlocal
We need to go local — hyperlocal. To solve the crisis, we must understand the interplay of local factors contributing to maternal deaths and use that precise knowledge to target local action.
We know that social and environmental factors play a significant role. Black women are 1.6 times more likely than white women, and American Indian and Alaska Native women are 2.6 times more likely, to live in conditions that are not conducive to optimal maternal health.
But what exactly are those conditions, how do they differ across regions and communities, and how important are they for moving the needle?
Answering these questions holds the key to unlocking the full potential of policy and programmatic solutions.
And it will require a revolution in the use of data to better understand local factors. It is time to move beyond averages and aggregates and into more detailed, disaggregated insights that use all the tools necessary to increase precision and more effectively allocate scarce resources.
In support of these aims, Surgo Ventures recently launched a new data tool, the Maternal Vulnerability Index (MVI), that provides county-level data on social, structural and environmental factors behind maternal mortality. It ranks every U.S. county and state on overall vulnerability as well as six vulnerability “themes.”
Understanding racial disparities was a central goal in our development of the MVI. There are multiple forms of racism — structural, systemic, interpersonal and internalized — and different regions manifest them in different ways. The MVI allows us to better understand in each geography not only what drives how women fare in their pregnancies, but also what is driving vulnerability for each racial and ethnic group.
For example, the MVI showed that contextual factors such as the environment in which a woman lives, her socioeconomic status and the local resources available to her explain some of the disparity in vulnerability between Black and white women, but they do not explain the full problem.
Also present are systemic and interpersonal racism, such as biases in clinical care affecting women of color and the chronic stress these biases cause.
Addressing the crisis is feasible
As distressing as these realities are, we should take comfort in what else the data shows: Rather than being unsolvable, the problems are modifiable. Local data allows us to home in on changeable factors, track how they evolve and hold ourselves accountable for solving them. These data systems are most powerful when in the hands of local leaders and community members because data itself must be contextualized — married with personal insights and lived experiences
We’ve seen examples of this in action. Through the Merck for Mothers’ Safer Childbirth Cities initiative launched in 2018, community-based coalitions across 20 cities are tackling racial inequities in maternal health by addressing local factors, incorporating local strengths and tracking the outcomes that matter most in their communities.
At Surgo, we’re exploring ways to partner with the private sector to solve local health access challenges. For example, our partnership with Uber pairs pregnant women in Washington, D.C., with free transportation to their medical appointments at qualified health centers.
America’s maternal mortality crisis is a multifaceted problem, but it’s time to embrace this as an opportunity. The variety of unique factors at play means that each of us — policymakers, funders, community health organizations, researchers, advocates and the general public — can help contribute to whole-of-society solutions. We owe it to every mother to reverse the dangerous trends in maternal mortality and ensure that each pregnant woman has the right to safe, healthy and respectful maternal care.
Dr. Mary-Ann Etiebet is assistant vice president for Health Equity at Merck and is the lead of Merck for Mothers, Merck’s global health initiative helping to create a world where no woman has to die while giving life. Sema Sgaier, co-founder and CEO of Surgo Ventures, is an affiliate assistant professor of Global Health at the University of Washington.