As Maternal & Infant Health Falter, Advocacy Is Key to Progress

November 16, 2023 - As it continues to pave the road to progress with data, March of Dimes is using its advocacy prowess to also call for policy and medical device solutions to the nation’s growing maternal and infant health crisis.

Paired with a new report giving the United States a D+ for pre-term birthrates, the 85-year-old advocacy organization is also outlining the policy solutions that can promote maternal and infant health, plus putting its money where its mouth is in medical device investment.

“As an industrialized nation, it's mortifying. It's embarrassing, right?” Elizabeth Cherot, MD, the president and CEO of March of Dimes, remarked in a call with PatientEngagementHIT. “About our outcomes being worse for Native American population as well as Black, both women and babies.”

The report, obtained via email, is another in a long line that paints a dark picture of maternal and infant health in the US. The US is home to the worst maternal health outcomes and disparities in the developed nation, while fetal and infant health both also falter. Earlier this month, the Centers for Disease Control and Prevention showed that even preventable problems like congenital syphilis are on the rise in the US.

This newest report from March of Dimes adds to that data by looking into the preterm birthrate, defined as a baby being born before 37 weeks gestation. Preterm birthrates are poor in the US, coming in at 10.4 percent in 2022, the report showed.

Preterm birthrate is a key metric for looking at maternal and infant health, according to Cherot, because of the health consequences that can affect a premature baby.

“Having a premature infant before 37 weeks of gestation, and the more premature, the harder the recovery or resilience a baby needs to have,” Cherot explained.

Extremely premature babies have a higher risk of infant mortality, she added. And for babies who do survive past infancy, some health impacts could be seen down the line.

The whole US isn’t doing great in preterm birthrate, the report showed, but there are clear regional disparities at play. Although 32 states have yielded modest improvements in preterm birthrate, the nation’s average is being pulled down by the 14 that have seen increases in preterm birthrates.

“There's a demarcation line when you look at the Southeast; that's where the worst preterm rates are,” Cherot explained.

That single data insight—the regional disparity in preterm birthrate in the US—is a catalyst for Cherot and March of Dimes to examine how policy and shape a better future. Take, for example, the extension of Medicaid for postpartum people. What is the rate of extension in those Southeastern states that have higher preterm birthrates? Are these states home to maternity care deserts?

Cherot said similar questions arise when looking at racial disparities in preterm birthrate and other metrics related to maternal and infant health. In the report, March of Dimes said the preterm birthrate for babies born to Black birthing people is 1.5 times greater than for White birthing people. That racial and ethnic disparity is similar to other metrics, like maternal and infant mortality.

“We know that Black babies are two times more likely to die before their first birthday compared to their white counterparts,” Cherot offered as an example. “Those disparities for preterm birth exist just as the maternal mortality, just as infant mortality does.”

“That is a crushing statistic in my mind,” she added.

But again, the data has Cherot pulling at threads about how care access can influence the outcomes of these babies and mothers.

Preterm birth, which can influence other birthing outcomes, has clear risk factors: smoking, hypertension, unhealthy weight, diabetes, a previous preterm birth, and carrying multiple babies.

Most of these are chronic diseases or public health issues commonly addressed in the doctor’s office. But the nation is rife with maternity care deserts and poor access to care in many places. According to one report, maternity care deserts affect 5.6 million birthing people. Given that reality, Cherot pointed out that it’s not easy to stem these risk factors.

That’s what’s led March of Dimes to much of its mission. The maternal and infant health crisis isn’t just a problem to be observed, Cherot indicated. Rather, it’s up to policymakers, healthcare experts, and advocacy groups like March of Dimes to dig into the solutions to turn that data around.

“We obviously do a ton of advocacy. We do the research, and then we produce all this data to fight for that for moms and babies who can’t on their own,” Cherot said.

Right now, March of Dimes is zeroing in on policies that make it easier for birthing people to access healthcare both during pregnancy and postpartum.

According to the March of Dimes report, states are making serious headway in these areas. Thirty-seven states plus DC have fully extended Medicaid healthcare benefits for a year after birth of a child for both mother and child, which is complemented by Medicaid expansion adopted in 39 states plus DC.

“I get really excited about the extension of postpartum care. You get that into fairness for moms in the workspace. Those are all things that we have been working on state by state,” Cherot said.

Additionally, 11 states reimburse doula care, 44 states have federally funded maternal mortality review committees, and 28 states plus DC have fetal and infant mortality review committees. Meanwhile, ten states and DC provide 12 weeks of paid family leave, and 36 states have federally funded perinatal quality collaboratives.

And for its part, March of Dimes is also working to get different point solutions to market to help moms and other birthing people through its Innovation Fund. Using its donor dollars, March of Dimes identifies and invests in new inventions with its $10 million fund.

As of right now, March of Dimes has funded three companies: one that provides continuous blood pressure monitoring on babies, one that builds a fetal heart rate monitor to reduce unnecessary C-sections, and one that provides wraparound services for postpartum people with high-risk chronic conditions.

“We're not here to make huge money like venture capital. We're really about taking new inventions from start to commercialization and get it into the hands of moms sooner,” Cherot explained. “These companies, we think, can make a big difference.”