Tuesday, July 23, 2019
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How data and evidence can help us solve the problem of African American maternal mortality
By Elaine Batchlor, MD, MPH
Published April 18, 2019

Dr. Elaine Batchlor (Courtesy photo)

I’m a doctor and a scientist.  When we’re looking to solve a problem, we’re a lot like detectives. We follow the evidence.

It stands to reason then that when it comes to the problems we have with racial bias and disparities in American health care, I’m interested in solutions that are grounded in data and evidence.

Take pregnancy. Data shows us that the U.S. is the only nation in the developed world in which the number of pregnancy-related deaths is rising—the number has more than doubled in the past 20 years.

Data also shows us that California has reversed that trend. While the rest of the country’s outcomes have worsened, California has cut maternal mortality in half.

Yet even in California we still haven’t adequately addressed one shocking statistic: African-American women are three to four times more likely to die from pregnancy than women of other races. It’s one of the widest disparities in women’s health.

This is a serious public health problem. I believe the most effective way to tackle it is using data and evidence to improve outcomes.

Research has already established a set of best practices for maternal care. Data on the causes of maternal mortality can help us pinpoint where those practices will have the most impact on improved outcomes. Data can also help us develop new practices to target causes. Finally, publicly sharing data can motivate providers to change. Reporting outcomes by race in a visible way will help hold them accountable.

I’m encouraged to hear about the new Maternal Black Health Caucus, created this month by more than 50 Congress members to elevate black maternal health as a national priority and seek culturally competent, evidence-based solutions. I’m also glad to see that U.S. Senator and presidential candidate Kamala Harris and California State Senator Holly Mitchell have each introduced bills that emphasize the training of health care professionals on implicit bias.

Implicit bias is when a health care provider does not listen, discounts what a patient says, or provides different treatment based on a conscious or unconscious attitude about a characteristic like race. As I’ve written before, this is also personal for me; I believe I didn’t get the level of prenatal care I should have received when I was pregnant with my sons, and I still have a nagging suspicion that my race might have had something to do with it. Other African-American women have shared similar stories over the past year, including Beyoncé and Serena Williams.

Sen. Harris’s bill would provide funding for implicit bias training and for a pregnancy home health model. Sen. Mitchell’s bill does two things: it requires implicit bias training for all hospitals and it requires collection and reporting of data on maternal mortality by race and ethnic group.

There’s no question that race plays a role in most aspects of American society and health care is no exception. But for me the most interesting part of Sen. Mitchell’s bill is the data-reporting requirement; it’s also why I’m encouraged by the Congressional caucus seeking evidence-based solutions.

We know this works: Data and evidence-based approaches have helped California reduce its overall maternal mortality rate. The result: maternal deaths in this state have fallen 55% since 2006.

The data we have, according to a new report by the California Maternal Quality Care Collaborative, indicates improving outcomes for African-American women will include heightened vigilance from health care providers about factors that increase risk for this group, including chronic conditions such as obesity and heart disease. It will also include attention to communication, collaboration and quality care at hospitals—including a reduction in cesarean sections, which increase the chances of infection and bleeding from deliveries.

Many of the recommended obstetrical best practices are now more common in California hospitals and we use them at my hospital, Martin Luther King, Jr. Community Hospital. For example, we have laborists (obstetricians who work full-time treating women in labor) and midwives present in the hospital 24/7 so that problems can be quickly addressed by a team of providers and no mother is pressured to deliver sooner because her doctor wants to go home. And our staff are largely from the surrounding community, culturally attuned to our patients. It’s no surprise that MLKCH has one of the lowest Cesarean section rates in the state.

I want to see this approach that has worked to reduce overall maternal deaths applied to address disparities in outcomes for African-American mothers. I want to see data-driven quality improvement and evidence-based best practices adopted to improve outcomes for this group. And I want hospitals and providers, including my own, to be held accountable for their performance.

The truth is, mindsets are hard to change.  But performance less so.  If a doctor –

even a doctor with implicit bias – is expected to produce good outcomes for all of his or her patients and has the data and practices to do it, things will get better.

Not all health disparities can be solved by changes in how we practice medicine; about 60% of maternal deaths are considered preventable by medical care. There are other factors outside the control of hospitals, such as increasing levels of obesity and heart disease and social disparities. We must use data to drive solutions to those public health challenges in our communities, too.

 

Let’s use the evidence we have to change what we can. Generations of new mothers and children are depending on us.

Dr. Elaine Batchlor is the chief executive officer of Martin Luther King, Jr. Community Hospital in Watts.

Share your feedback, questions, comments and stories with Dr. Batchlor at DrB@mlkch.org.

 

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