Maternal Health Disparities Need Data-Driven, Community-Based Approach

March 20, 2023 - For the folks working on the front lines of health equity, the question of Black maternal health disparities isn’t a new one. But as the public health data outlining inequities continues to mount, more data-driven and community-based strategies are coming forward.

To be clear, that public health data only illustrates what communities of color already knew to be true: that Black women are more likely to die from childbirth-related causes than their White counterparts. The nation has a troubling history of mistreating Black and Brown bodies, and all the way from the J. Marion Sims operating on Black enslaved people without anesthesia through eugenics, we get to today’s maternal health disparities.

In what some view as a hopeful turn, the mounting data about these maternal health inequities makes this pattern nearly impossible to ignore.

According to Irogue Igbinosa, MD, a maternal-fetal medicine specialist at Stanford Medicine Children’s Health and women’s reproductive health research instructor at the Stanford School of Medicine, that data has been essential to the work of the many healthcare experts who have been trying to sound the alarm on health inequities for decades.

"Using the data to show outcomes by race and ethnicity has helped objectively reveal how communities receive different obstetric care and birth-related outcomes,” Igbinosa said in a video interview with PatientEngagementHIT. “This has pushed the conversation forward and demonstrated that the disparities by race and ethnicity are not just hearsay.”

Racial maternal health disparities became a common discussion point in the healthcare industry, particularly after a 2019 report from the Centers for Disease Control and Prevention (CDC) stated that Black women are nearly three times more likely to die from childbirth than their White peers. That finding persists even after controlling for social determinants of health and other factors.

That report was far from the first detailing birth inequities, but it sparked a conversation that reached into the deepest corners of the healthcare profession.

That’s been a good thing, Igbinosa said, because it corroborates the anecdotal evidence that has long surrounded the topic of birth outcomes for Black and Brown people and which has been amplified by way of social media.

“We have data moving the needle on one side. On the other side, and arguably equally if not more important, patients' stories are being heard and amplified through social media and other modern platforms,” Igbinosa explained.

"People are finding out that a poor outcome didn't happen in isolation, that similar stories were happening around our country,” she continued. “This galvanized people to say, ‘Well, why is this collectively happening? This is not just something that happened in my neighborhood or to my family. These are happening to other people who look like me, and why is that?’”

Researchers like Igbinosa are capitalizing on this opportunity to move the ball forward on maternal health equity, and part of that is going to require a continued data-driven approach. Data is what helps prove that a problem exists, and by asking the right questions, scientists can outline an entire narrative of the patient experience.

That means putting the patient into context, Igbinosa asserted.

"Our responsibility to data, especially as a health disparities researcher, is how much of the story can we fill in?” she explained. “So instead of analyzing a pregnant person's birth in isolation, we are investigating the system in which this person received care and how it impacts their pregnancy and birth."

Those external influences—the non-clinical factors influencing patient outcomes—have proven to be varied.

One 2022 Annals of Family Medicine study indicated that insurance type, educational attainment, and income can influence birth outcomes for Black and Hispanic patients. In 2020, experts from the National Academies of Sciences, Engineering, and Medicine published a list of social determinants of health associated with pregnancy and birth outcomes disparities, ranging from access to transportation to the racism that is implicit in the healthcare experience.

According to Igbinosa, collecting information about that context is integral to solving inequities.

"If we do not account for where our patients live, their access to nutrition, the type of jobs they have, and their ability to get those jobs, then we're missing pieces of the story, and you can make incomplete assumptions,” she added.

That context is important as healthcare researchers continue to debunk the notion that race is a biological construct. Black birthing people don’t experience worse birth outcomes simply because they’re Black; it’s because interpersonal and institutional racism influence health outcomes. Research needs to account for and reinforce that.

"Race is social, not genetic,” Igbinosa stressed. “Our focus is how race, the way that the world sees you, informs one's lived experience. We aim to capture how historical inequities shape the healthcare a birthing person receives during pregnancy."

Researching and creating that context means that scientists can’t go at it alone. Although scientists have a wealth of knowledge, everyone had blind spots, and it’s important that researchers enlist community health partners to help inform scientific questions and policy interventions.

"The onus is not on one person; it's on all of us,” Igbinosa said. “As researchers, clinicians, and physicians, we're learners too."

In addition to her scientific study, Igbinosa works closely with SMCH’s community health partners to apply a community-driven lens to solving the maternal health equity problem. That means that sometimes she takes a back seat in planning, instead allowing for community partners to not just have a seat at the table, but also have a comfortable seat as active contributors.

For example, community health partners have proven to be instrumental in crafting research questions. These folks know exactly what patients experience, so they can use that perspective to ask the right kinds of questions that will ultimately move the needle on maternal health outcomes.

“We had initial ideas, but our community partners encouraged us to think of our hypotheses differently,” Igbinosa explained. “And our collaboration informs the greater work. I've been excited about that because it enriches what we can accomplish. I'm thankful to our community partners for being collaborators and thought partners in this work."

Igbinosa has taken on the role of a physician-researcher because it helps her to channel her insights into policies that can affect change, she explained.

“We can demonstrate, for example, by this zip code in this area, there are fewer resources and a higher concentration of poor birth-related outcomes,” she said. “Thus, this community can benefit from health policies that increase resources.”

That’s in contrast to the work she did as a practicing clinician. To be sure, there is a lot that healthcare providers can do one-on-one to help support health equity and contribute to better care outcomes for a population, but it takes time and patience.

“And that's one of the more considerable barriers in healthcare; you're only allocated so much time for a patient visit,” Igbinosa said.

Those time constraints can get in the way of uncovering that context and those social determinants of health affecting birthing outcomes. According to March 2022 surveying from the Physicians Foundation, most providers want to learn more about a patient’s SDOH, but they don’t have the time or the resources to do so.

Clinicians come up against demands to document clinical quality measures, plus following general clinical best practice, and that can be in tension with what patients want and need to discuss during encounters.

“There are things we want to address because this is what we've trained on, but then there are things the patients want to address that only sometimes fall on that list,” Igbinosa noted. “Finding the time and space to meet everyone's goals warrants reevaluating the status quo."

But until then, healthcare providers need to identify strategies to fill both buckets: the clinical guidelines plus patient needs. Some practicing clinicians are dipping into advocacy, Igbinosa said, finding committees within or outside of their hospital to speak up for patient rights and needs.

Other physicians are leading the way in partnering with community organizations to help funnel clinic support and resources to individuals who are traditionally underserved. This level of community-based healthcare has proven effective for meeting patients who otherwise may not trust healthcare or be able to access it.

Even still, clinicians have their own lives that should not need to be consumed with advocacy. Igbinosa encouraged her peers to evaluate how they can make a difference right during the patient encounter.

"The one thing that anyone can do—is in that moment with a patient—ask yourself if you are providing respectful care,” she concluded. “A lot of patient-oriented research says patients understand physicians and providers are busy. Still, there is value in patients knowing they will be heard and there's a follow-up to their concerns. At the end of the day, we have shared goals - healthy moms and babies."

Correction 03/20/2023: A previous version of this artcle stated that Dr. Igbinosa is a a women’s reproductive health research scholar and maternal-fetal medicine instructor at Stanford Medicine Health Care. Her correct title is maternal-fetal medicine specialist at Stanford Medicine Children’s Health and women’s reproductive health research instructor at the Stanford School of Medicine.