Lack of health care coordination and inadequate treatment of chronic conditions contribute to pregnancy-related deaths, which in Virginia disproportionately affect African American women, according to the Virginia Department of Health.
Overall maternal deaths in the state have fluctuated significantly since 2014, showing no clear pattern, according to a VDH presentation to the Joint Commission on Health Care this week.
But African American mothers have consistently died at a much higher rate than white mothers, a disparity that Gov. Ralph Northam has pledged to eliminate by 2025 through the work of a Maternal Mortality Review Team established to look into causes and solutions. African American maternal death rates were two-to-three times the rates of maternal death rates among white women from 2009 to 2013, with rates ranging from 60 to 105 deaths per every 100,000 live births compared with 27 to 35 per 100,000.
The review team concluded that chronic conditions, including substance abuse and mental illness, are not adequately addressed before, during and after pregnancy and that a lack of coordinated care leaves many women to navigate the health care system on their own.
It was this lack of attention to African American women in particular that prompted a group of birth workers, also known as doulas, to start Birth in Color RVA, a community of pregnancy and birth professionals dedicated to helping women of color navigate healthy pregnancy and motherhood.
“We saw that a change needed to be made of how women (of color) are treated during childbirth,” said Kenda Sutton-EL, a birth worker with Birth in Color RVA. “They’re not being listened to.”
Sutton-EL said that many of the women that she works with have faced challenges of being dismissed by medical professionals, looked down upon in childbirth classes and left with little follow-up after giving birth.
Birth in Color RVA hosts mothering circles so moms of color can have a supportive place to share their experiences, provides information on childbirth, breastfeeding and parenting and connects women with birth workers who can help them throughout the pregnancy and afterward.
“A lot of people are afraid,” Sutton-EL said. “We’re saying, ‘Don’t be afraid to have children.’ ”
But even as national and state statistics show the racial disparity in maternal deaths, there is a lack of data to guide policy responses, particularly on the local level.
In Richmond City, 36 women died either during or within a year after pregnancy between 1999 and 2013, according to the Richmond City Health Department. Because the number is so low, the health department can’t identify any meaningful trends.
Dr. Danny Avula, director of the Richmond and Henrico Health Districts, said that he is focusing on infant mortality, as well as maternal mortality, in an effort to improve health outcomes for families.
This month, the health department began transitioning out of offering direct prenatal care to women and is instead shifting resources to help them navigate the health care system and is also rolling out an infant mortality task force, Avula said.
The health districts are working with the city and other regional entities to develop a strategy that would build up more supportive systems, including case management, prenatal care, social services and nutritional services.
Over the next few months, the state will be looking into best practices and program models within Virginia as well as in other states that might move the needle on maternal mortality and plans to present a strategic plan by the end of this year, according to Gena Boyle Berger, deputy secretary of health and human resources.
Sen. Siobhan Dunnavant, R-Henrico, an OB-GYN and member of the Joint Commission on Health Care, said she would like to see more specific and complete data from VDH, including infant death data, so the governing body can make more informed decisions on how to address the issues.
“We’re starting with a premise here,” Dunnavant said during the commission meeting Monday. “I think we really need to build out the data and figure out what opportunities that we have.”
The commission voted unanimously to direct its staff to compile and analyze additional data that might guide the commission on whether it should request additional funding for specific programs focused on maternal mortality.