Addressing maternal and infant health inequities

Maternal health outcomes in the United States have reached crisis levels compared with the rest of the world, and they’re getting worse. Preterm birth rates have increased in the U.S. for the past 5 years, and the number of birthing people who experience Severe Maternal Morbidity (SMM) has also continued to grow. These poor outcomes, however, impact some more than others. Black birthing people experience preterm birth rates that are 49% higher than for all other birthing people, and they are 3 to 4 times more likely to die from childbirth than White birthing people.

As Medicaid covers nearly half of all births in the U.S., and 65% of Black births, Medicaid agencies are uniquely positioned to make an impact on improving this public health crisis. At UnitedHealthcare Community & State, we are committed to working to address these stark and persistent racial inequities in maternal and infant health outcomes. The factors contributing to these inequities are complex and rooted in both historical and present-day systems of racism and discrimination. We recognize that we can’t solve these complex factors alone or with just one program. Instead, we are working with our state, provider and community partners to deploy a multi-faceted approach aimed to: (1) empower birthing people; (2) evolve the care system; and (3) engage communities — all with an enhanced focus on supporting birthing people of color.

Today, Medicaid funds:

43% of all births

67% of all American Indian and Alaska Native births

65% of Black births

Empower birthing people

We aim to educate and empower birthing people in their care journey by providing social supports and leveraging evidence-based interventions to help educate and uplift the voices of birthing people.

For example, our Healthy First Steps (HFS) program provides care management services to high-risk moms who may need extra support and services. Our local care teams seek to engage and empower moms by providing education; supporting them in their care plan; removing barriers to prenatal and postpartum care; and linking them to resources to support healthy pregnancies, deliveries, and early childhood and family planning. Additionally, given the evidence around group prenatal care and its potential to reduce racial inequities, we have supported the development and launch of in-person group prenatal care models and are currently piloting a virtual group prenatal education model to educate and empower our members throughout their care journey. 

Evolve care

Given deficiencies in care during both prenatal care and hospital delivery have been linked to inequities in maternal and infant outcomes, we also partner with providers to evolve the health system and drive more equitable outcomes. This includes investing in multiple approaches to improve the consistency and quality of care that is delivered to Medicaid members.

For example, we provided $2.85M to the March of Dimes to fund hospital quality improvement initiatives as part of a public-private partnership to address Black maternal health. In addition to the partnership, we are testing remote patient monitoring (RPM) to understand how digital technology can impact the ability for providers to engage patients and monitor conditions such as chronic hypertension, which disproportionately impacts people of color. We are also testing several alternative payment models to drive greater provider accountability for health outcomes and are deploying provider trainings to increase provider understanding of the role of implicit bias on maternal outcomes.  

Engage communities

We know that unmet social and safety needs can contribute to poor outcomes. Community-based organizations (CBOs) often provide critical services and supports to our moms and their families. We aim to expand community capacity to support the complex social needs of our Medicaid population by partnering with CBOs and other vendors serving our member needs.

We’ve provided over $1M in grants to CBOs serving the needs of birthing people and families. For example, in Mississippi we invested $40,000 in the Delta Health Alliance and their work in supplying baby items and creating a women’s advisory council. In Ohio,we provided a $28,000 grant to Black Lactation Circle, serving greater Columbus to expand breastfeeding support programs and provide resources to address social drivers of health. In Tennessee, we invested $75,000 in SisterReach to support housing, food, clothing, domestic violence prevention, utility assistance and doula services.

Our experience has shown that no single innovation can address the complexity of racial inequities in maternal and infant outcomes. However, we believe the collective impact from a multi-faceted, evidence-informed approach with intentional collaboration with our members, providers, and community and state partners will help improve maternal and infant morbidity and mortality and reduce racial inequities. We will continue to learn, partner and assess our efforts with the goal to reduce racial inequities in maternal and infant outcomes in the U.S. 

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