Health Equity Critical to Reducing Maternal and Infant Mortality
The U.S. could avoid about 40% of maternal deaths if all women had access to quality health care. The key to helping resolve this issue is to focus on maternal and infant equity in order to foster healthy moms and babies. That was the resounding message at the 2019 Institute for Public Health 12th Annual Conference, held on Oct. 30th.
More than 400 students, faculty scholars, staff, local and national infant and maternal health experts, and St. Louis community members packed the Eric P. Newman Education Center on the Medical Campus for the day-long event entitled, Healthy Moms and Babies: Paving the Path to Reproductive Equity.
With an introduction by William G. Powderly, MD, the Larry J. Shapiro Director of the Institute for Public Health, and additional opening remarks from Debra Haire-Joshu, PhD and the Joyce Wood Professor of the Brown School and School of Medicine, the popular event featured two renowned keynote speakers, panel discussions, networking opportunities, lunch with panelists and speakers, and a poster session.
Keynote speaker, Haywood Brown, MD, FACOG, professor of Obstetrics and Gynecology; associate dean of Diversity at Morsani College of Medicine, and vice president of Institutional Equity at University of South Florida discussed maternal and infant health disparities. He said the U.S. currently experiences higher infant and maternal mortality rates than any other wealthy country ranking 19th of 20 in child morality and 21st in maternal mortality. He noted that among “health deserts” in the U.S., more than half of rural women live more than thirty minutes away from OB-GYN or maternal services. Motor vehicle accidents, homicide and suicide rank as the top three “hidden causes” of maternal mortality, according to Dr. Haywood’s research.
Panel I: State of Regional Affairs: Data, Programs and Policy
Dr. Cynthia Rogers, MD agreed with Dr. Haywood’s perspective on disparities in maternal health saying, “A concerted effort focused on maternal mental health is necessary to move the needle in this issue for healthy moms and infants.” Dr. Rogers directs the Washington University Perinatal Behavioral Health Service, a clinical service that provides screening, care coordination, and treatment for perinatal women with psychiatric and substance use disorders.
Dr. Nhial Tutlam, PhD, MPH, program manager with the St. Louis County Department of Public Health debuted the county’s first report on maternal and infant health: The Maternal and Child Health Profile, highlights of which show decreasing infant mortality in the St. Louis region and a narrowing of racial disparities. Still, the report shows that black infants die at more than twice the rate of white infants primarily due to premature birth and low birth weight, followed by birth defects and accidental injuries. Nearly 10% of infant deaths in 2018 occurred in areas of St. Louis County with high rates of poverty, down from 18% in 2014, the report states.
Ebony Carter, MD, MPH who specializes in evidence-based prenatal care and community-based participatory research to reduce economic and racial health disparities, said, “It’s not a lack of prenatal care that’s putting mothers at risk, but the fact that many low-income women in Missouri lose their insurance after giving birth.” Currently Medicaid for pregnant women ends 60 days, post-delivery. There is currently a strong movement to extend Medicaid for families past the 60 days. Read her blog.
Cora Faith Walker, JD, MPH, director of policy for the St. Louis County Executive’s office, said while she was a member of the House of Representatives, Missouri became the first state in the country to extend Medicare coverage to postpartum moms dealing with substance abuse.
Dean McKay discussed how the Brown School collaborates often with the Institute to help create projects, implement research, and find solutions to real-world problems such as maternal and infant mortality. Convening experts and the community to discuss the issues and answers surrounding topics such as this one, in a forum such as the annual conference is what makes Washington University a world-class institution, she added.
Chancellor Martin remarked that infant and maternal health is a “critical topic” and applauded the Institute for a “truly impressive event”. He added that it is important for Washington University to continue to identify “scientific-based interventions” which can be implemented around the world. “Institute for Public Health leaders have bridged the community and Washington University and we will have greater impact working together,” he concluded.
The second keynote speaker, James M. Greenberg, MD, executive co-director of the Prenatal Institute of Cincinnati Children’s Hospital Medical Center reviewed an effective collective impact collaborative he co-founded called “Cradle Cincinnati”, which helps eliminate infant mortality in Hamilton County, Ohio. Infant mortality rates there were a big problem driven by congenital malformations, sleep-related deaths and extreme preterm birth. The collaborative found that the death rates were concentrated in defined geographies and disproportionately experienced by black families. The group found success in lowering mortality rates through constant communication with community partners, a shared system of data, a menu of services that filled gaps in the system with interventions that attempted to reach every mom and baby in a defined area. Read more about Cradle Cincinnati.
Panel II – A Closer Look: Interventions, Support and Opportunities
Rose Anderson-Rice, MPA is deputy director of Generate Health, a St. Louis organization which helps advance racial equity in pregnancy outcomes, family well-being, and community health. She concurred with Dr. Greenberg’s point about enabling the community to understand the social determinants of maternal and infant mortality and committing to interventions that help eliminate the problem.
Panelist Brittany “Tru” Kellman, CPM, CD, CLC agreed with Dr. Greenberg’s assessment that race plays a large role in maternal and infant health inequity. She began an organization called Jamaa Birth Village in St. Louis, which has trained 75 doulas since 2016 and in 2019, was herself named Missouri’s first black Certified Professional Midwife in Missouri.
Read a blog on the topic of racial inequities in women’s health.
Allison Kemner, MPH, Parents as Teachers (PAT) vice president of Research and Quality, agreed that direct community support goes far in helping reduce postpartum mortality rates. She remarked that 80% of moms who receive PAT’s at-home visits have experienced severe stresses such as housing instability, which can potentially lead to dangerous outcomes for moms and babies.
Cynthia Herrick, MD, who works with moms with gestational diabetes, added that many gestational diabetes patients often don’t receive postpartum screenings because of a lack of transportation or other stressful issues. She added that extending Medicaid benefits past the first year after birth can help eliminate issues leading to postpartum infant and maternal mortality. Read her blog.
2019 Annual Conference Poster Session:
The conference concluded with a judged poster session featuring posters from the Washington University and St. Louis communities, which focused on a host of important public health topics. Poster session participants were tasked with illustrating the significance of their research question or topic and clearly explaining its relevance to public health, their approach and methods used, and subsequent results and conclusions.
The 2019 Institute for Public Health Annual Conference is co-sponsored by Institute for Public Health, Center for Diabetes Translation Research, St. Louis Children’s Hospital, and the Department of Obstetrics and Gynecology at the School of Medicine at Washington University in St. Louis.