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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Advancing Maternal Health
Equity and Reducing Maternal
Morbidity and Mortality

PROCEEDINGS OF A WORKSHOP

Joe Alper, Rose Marie Martinez, and Kelly McHugh, Rapporteurs

Board on Population Health and Public Health Practice

Health and Medicine Division

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by the March of Dimes, Merck & Co., Ronald McDonald House Charities Global, and the National Academy of Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-09354-5
International Standard Book Number-10: 0-309-09354-6
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Advancing maternal health equity and reducing maternal morbidity and mortality: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26307.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×

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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×

PLANNING COMMITTEE FOR A WORKSHOP ON ADVANCING MATERNAL HEALTH EQUITY AND REDUCING MATERNAL MORTALITY1

CLAIRE BRINDIS (Chair), Distinguished Emerita Professor of Pediatrics and Health Policy and Emerita Director, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, School of Medicine

ELENA FUENTES-AFFLICK, Professor and Vice Chair of Pediatrics and Vice Dean for Academic Affairs, University of California, San Francisco, School of Medicine, and Chief of Pediatrics, Zuckerberg San Francisco General Hospital

MELISSA A. SIMON, George H. Gardner, MD, Professor of Clinical Gynecology, Vice Chair of Research in the Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, and Founder and Director, Center for Health Equity Transformation

BROWNSYNE TUCKER EDMONDS, Assistant Dean for Faculty Affairs, Professional Development, and Diversity, and Associate Professor of Obstetrics and Gynecology and Pediatrics, Indiana University School of Medicine

Project Staff

ROSE MARIE MARTINEZ, Study Director and Senior Board Director, Board on Population Health and Public Health Practice

KELLY McHUGH, Research Associate

Y. CRYSTI PARK, Administrative Assistant

Consultant

JOE ALPER, Consulting Writer

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by MAXINE HAYES, University of Washington School of Medicine and School of Public Health. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×

Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Board on Population Health and Public Health Practice wishes to express its sincere gratitude to planning committee chair Claire Brindis for her valuable contributions to the development and orchestration of this workshop. The board also wishes to thank the other members of the planning committee—Elena Fuentes-Afflick, Melissa Simon, and Brownsyne Tucker Edmonds—for collaborating to ensure a workshop complete with informative presentations and rich discussions. Finally, the board would like to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants.

Support from the many annual sponsors of the Board on Population Health and Public Health Practice is critical to the board’s work. The sponsors include the March of Dimes, Merck & Co., Ronald McDonald House Charities Global, and the National Academy of Medicine.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×

Centering Lived Experience and Expertise: Health Equity and Measurement

Maternal Mortality and Medical Misogynoir

Birthing Experiences in Care Settings: Pregnant People Experiencing Incarceration

MATERNAL HEALTH AND COVID-19: EXACERBATING VULNERABILITIES AND USE OF TECHNOLOGY

Maternal Morbidity with COVID-19 in Pregnancy and the PRIORITY Study

Maternal Health Inequities: Lessons Learned (and Re-Learned) from the COVID-19 Pandemic

Disconnects and Digital Divides: Black Women and Birthing People’s Maternal Telehealth Experiences During the COVID-19 Pandemic

Discussion

MATERNAL HEALTH ISSUES RELATED TO THE FOURTH TRIMESTER

Establishing the Fourth Trimester

Post-Birth Warning Signs and Exploring Concepts of Implicit Bias Among Obstetric Nurses

Perinatal Mental Health: The Role of the Fourth Trimester

Improving Maternal Mental Health Outcomes for Women of Color

Discussion

STATE EFFORTS TO REDESIGN MATERNAL HEALTH CARE

North Carolina’s Pregnancy Medical Home

Support Community-Based Doula Organizations Working Toward Bridging Racial Inequities in Maternal Mortality Rates

Perinatal Quality Collaboratives

IMPLEMENTATION OF STATEWIDE POLICIES AND MANDATES TO ADVANCE MATERNAL HEALTH EQUITY

Birthing People and Newborns Affected by Opioids: Universal Screening for Opiate Use Disorder with a Validated Tool Strategy

Building Capacity to Address Maternal Health Equity

California’s Dignity in Pregnancy and Childbirth Act and Maternal Health Policy

Discussion

PROMISING STRATEGIES USING A REPRODUCTIVE WELL-BEING APPROACH TO ADVANCE MATERNAL HEALTH

Mamatoto Village

Reproductive Justice Influence in Community Health: Midwifery Model in a Federally Qualified Health Center Birth Center

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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11 Incarcerated pregnant people in a 12-month period, 2016–2017

12 COVID-19 has a prolonged course of symptoms in 25 percent of pregnant patients

13 Black people as a share of COVID-19 vaccinations, cases, deaths, and total population, May 24, 2021

14 Large majorities of both Black and white seniors are eager to get vaccinated

15 Medicaid eligibility is much more restrictive for parents than pregnant women, particularly in states that have not expanded Medicaid

16 The factors influencing maternal health in the year following birth

17 North Carolina’s birth hospitals and urban and rural counties, 2019

18 Percentage of births born weighing less than 5 pounds 8 ounces, by state, 2019

19 The North Carolina Pregnancy Medical Home provider network

20 Entry to care rates in the first trimester among non-emergency Medicaid, Pregnancy Medical Home–attributed pregnancy

21 Rate of unintended pregnancy based on the initial risk screening among non-emergency Medicaid, Pregnancy Medical Home–attributed pregnancy

22 ImpactabilityTM score for pregnant people for a patient-centered task

23 Medication for opioid use disorder works to decrease overdoses in pregnant and postpartum patients

24 Challenges impacting maternal health outcomes and inequities in the District of Columbia

25 The percentage of U.S. births attended by certified nurse-midwives

26 Pregnancy-related mortality by race and Hispanic origin, 2014–2017

27 Leading causes of pregnancy-related mortality, 2014–2017

28 An expansive model reflecting the gaps, opportunities, and interconnectedness of issues along the research continuum

TABLES

1 Maternal Outcomes for Pregnant Women Who Develop COVID-19

2 Perinatal Outcomes for Pregnant Women Who Develop COVID-19

3 Risk Factors for Severe COVID-19 Illness

4 Descriptives for Mothers and Nurses

Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Acronyms and Abbreviations

ACA Patient Protection and Affordable Care Act
ACOG American College of Obstetricians and Gynecologists
AWHONN Association of Women’s Health, Obstetric and Neonatal Nurses
CDC Centers for Disease Control and Prevention
CMS Centers for Medicare & Medicaid Services
FQHC federally qualified health center
HHS Department of Health and Human Services
ICU intensive care unit
IHS Indian Health Service
IMI Institute for Medicaid Innovation
MADM Mother’s Autonomy in Decision Making
MMRC Maternal Mortality Review Committee
MMRIA Maternal Mortality Review Information Application
MORi Mothers on Respect Index
MOUD medication for opioid use disorder
NASDOH National Alliance to Impact the Social Determinants of Health
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×
NBEC National Birth Equity Collaborative
NCHS National Center for Health Statistics
NICHD National Institute of Child Health and Human Development
NICU neonatal intensive care unit
NIH National Institutes of Health
NVSS National Vital Statistics System
OUD opioid use disorder
PHQ-9 Patient Health Questionnaire-9
PMSS Pregnancy Mortality Surveillance System
PQC Perinatal Quality Collaborative
PREM-OB Scale Patient-Reported Experience Measure of Obstetric RacismTM
PRIORITY Pregnancy Coronavirus Outcomes Registry
PRMR pregnancy-related mortality ratio
RWJF Robert Wood Johnson Foundation
SDOH social determinants of health
SWHR Society for Women’s Health Research
USPSTF United States Preventive Services Task Force
V-QPAC Virtual Quality Improvement Prioritization by Affected Communities
WHO World Health Organization
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×
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Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
×
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Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Advancing Maternal Health Equity and Reducing Maternal Morbidity and Mortality: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26307.
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The United States faces an alarmingly high rate of maternal morbidity and mortality, distinguishing it from other high-income countries that have achieved decreases in these rates in recent years. U.S. maternal morbidity and mortality rates are disproportionate across racial, ethnic, socioeconomic, and geographic groups. Statistics on maternal health outcomes reveal that there are challenges to protecting both the lives and future health of birthing people and their children.

Recognizing the urgency of this growing problem, the National Academies Board on Population Health and Public Health Practice convened a 2-day virtual workshop, Advancing Maternal Health Equity and Reducing Maternal Mortality. The workshop examined the current state of maternal health in the United States and explored the factors needed to help communities and health care systems become more effective in reducing maternal morbidity and mortality and improving health outcomes through the fourth trimester. This publication summarizes the presentations and discussions of the workshop.

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