Creating Partnerships to Improve Maternity Care in NYC Hospitals

Maternal deaths worldwide have decreased over the last century, but pregnancy-related deaths in the United States continue to rise. The U.S. is the only developed country that’s seen an increase in maternal mortality, from 17.5 deaths per 100,000 live births in 2000 to 26.4 in 2015. Disturbingly, there are significant racial and ethnic disparities in maternal morbidity and mortality across the U.S. ¬†In 2018, non-Hispanic Black women were found to be three times more likely to die from pregnancy-related causes than non-Hispanic White women. These disparities are worse in New York City, where Black women are eight times more likely than White women to die from pregnancy-related causes.

Recognizing inequities in maternal health

Structural racism and gender oppression are root causes of inequities in maternal outcomes. Research shows that experiences of racism (and often, relatedly, not being believed or having pain taken seriously), takes a toll on bodies, especially during pregnancy and birth. The chronic stress of racism increases the risk of diseases like high blood pressure and diabetes, which also increase the risk of maternal morbidity and mortality.

After FPHNYC received a grant from Merck for Mothers in 2013, NYC became the first local jurisdiction in the United States to design a citywide Severe Maternal Morbidity (SMM) surveillance system. Analysis of these data indicated that occurrences of SMM had increased by 28% from 2008 to 2012, and that about 2,500 women experienced SMM each year. Furthermore, the analysis showed that Black women were three times more likely than White non-Latina women to have a near death experience related to pregnancy.

A new path forward

In response to these alarming findings, in July 2018 New York City announced an investment of $12.8 million over three years to support a comprehensive plan to reduce maternal deaths and life-threatening childbirth complications among women of color. This plan, known as the Maternity Hospital Quality Improvement Network (the Network) is supported by the leadership of the Bureau of Maternal, Infant, and Reproductive Health at the Health Department. Additionally, it builds upon projects made possible by the Merck for Mothers grants as well as work implemented by the Sexual and Reproductive Justice Community Engagement Group.

The Network will 1) develop hospital quality improvement committees to review SMM cases, 2) conduct trauma-informed  trainings to support systems and address implicit bias, 3) foster best health care practices through ongoing medical simulation trainings, 4) support hospital driven quality improvement projects, 5) support the implementation of the NYC Standards for Respectful Care at Birth, and 6) support resources and technical assistance for community engagement.

To address these disparities and ensure respectful care for pregnant and parenting mothers in New York City, The Fund for Public Health in (FPHNYC), in collaboration with the New York City Department of Health and Mental Hygiene (DOHMH), was recently awarded a $300,000 grant from The New York Community Trust to support the Maternity Hospital Quality Improvement Network over two years. The New York Community Trust grant allows DOHMH to supplement the above initiatives with trainings to support both trauma- and resilience-informed care and address implicit biases that can lead to poorer health outcomes for people of color.

Living with the daily experience of racism takes a physical toll on the body that increases the risk of hypertension, diabetes, toxic stress, and trauma, which all contributing factors to SMM. The Health Department has adopted a comprehensive approach to address racial and ethnic inequities in maternal mortality and SMM.

FPHNYC and the Health Department have a history of implementing successful programs in partnership with The New York Community Trust, including the Pharmacy to Farms Prescription program which works to provide SNAP participants with high blood pressure $30 per month to spend on fresh produce, increasing their access to healthy foods. In addition to these projects, the Maternity Hospital Quality Improvement Network award will allow the Health Department to improve upon its already robust public health quality improvement systems to enhance delivery of healthcare to the mothers and babies across New York City, and across racial and ethnic lines.

For more information about this project and others to protect the rights of pregnant and parenting people in NYC, please contact us.