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Maternal Health Equity: Scale of Impact

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5 MIN. READ
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MATERNAL HEALTH EQUITY: scale of impact

In the developed world, the United States is the most dangerous place to give birth—especially for women of color.1 Grasping the extent of maternal health disparities is the first step in being able to provide support to expectant mothers in your workforce. 85% The vast majority of women in the workplace (85%) will become mothers during their careers.2 50K Each year, 50,000 women suffer from life-threatening pregnancy complications.3 63% Women in majority Black communities face 63 percent higher rates of severe maternal morbidity (SMM) than women in majority white communities.*4 *Among women with employer-sponsored health insurance. Take a closer look at maternal health disparities before, during and after pregnancy. PRECONCEPTION - Women in majority Black communities have up to 2x the prevalence of risk factors for SMM,* such as hypertension or anemia, as women in majority white communities.5 - Women in majority Hispanic communities have up to 33% higher prevalence rates of some risk factors for SMM,* such as prior cesarean birth and pre-existing diabetes, compared to women in majority white communities.6 - Rates of severe illness are higher among pregnant women in the Northeast and South, those from lower-income communities and those giving birth in public hospitals.7 *Among women with employer-sponsored health insurance. PREGNANCY - A review by the American Diabetes Association reported that Asian/Pacific Islander women exhibit the highest prevalence of gestational diabetes (14.8%), which can increase pregnancy complications.8 - Native Hawaiian and other Pacific Islander women are five times more likely than white women to not begin receiving prenatal care until the third trimester or to receive any prenatal care at all. Hispanic women are twice as likely compared to white women to have a birth with late or no prenatal care.9 - The risk for miscarriage is roughly 43% higher for Black women compared to white women.10 LABOR & DELIVERY - Black women have pregnancy-related mortality rates that are over 3x higher compared to the rate for white women.11 And pregnant Black women are 45% more likely to die in the hospital.12 - Prevalence of delivery complications is 46% higher among Black mothers versus white mothers.13 Even after adjusting for socioeconomic status, access to healthcare and other medical conditions, researchers found that compared to white women, pregnant Black women were: 57% more likely to have a stroke; 42% more likely to develop a blood clot in the lungs; and 71% more likely to develop heart muscle weakness.14 These outcomes are more likely to occur at or near the time of labor and delivery. POSTPARTUM - Early and consistent screening combined with the context of known risk factors has been found to help detect and treat postpartum depression.15 But according to a recent survey from Blue Cross Blue Shield (BCBS), 34% of Black women and 38% of Hispanic women said they were not screened for postpartum depression or did not know if they were screened.16 - Based on BCBS claims data for women with employer-sponsored health insurance, nearly half (45%) of women diagnosed with postpartum depression went untreated during the 2019-2020 time period. Among those who received treatment, only 52% of Black women and 49% of Hispanic women were treated compared to 57% of white women. These gaps in treatment are due, for the most part, to disparities in the adoption of prescription treatment, which was 39% for white women, but only 28% for Black and Hispanic women.17 Impact on employers With women accounting for nearly half the American workforce,18 maternal health disparities can have a huge impact on the health and overall well-being of your employees, their families and your business. To help advance maternal health equity, employers can support improving access to quality care. 1.9M DELIVERIES EACH YEAR OVER $1B IN SAVINGS Advancing maternal health equity takes all of us. There’s much more to learn about the diverse populations affected by maternal health disparities, key contributing factors and actionable strategies for employers to advance maternal health equity. Download our latest Health Equity mini-eMagazine and join the charge to change the tide at smarterbetterhealthcare.com.

Maternal health equity: scale of impact

In the developed world, the United States is the most dangerous place to give birth—especially for women of color.1 Grasping the extent of maternal health disparities is the first step in being able to provide support to expectant mothers in your workforce.

  • 85%

    The vast majority of women in the workplace (85%) will become mothers during their careers.2

  • 50K

    Each year, 50,000 women suffer from life-threatening pregnancy complications.3

  • 63%

    Women in majority Black communities face 63 percent higher rates of severe maternal morbidity (SMM) than women in majority white communities.*4

*Among women with employer-sponsored health insurance.

Take a closer look at maternal health disparities before, during and after pregnancy.
Preconception
- Women in majority Black communities have up to 2x the prevalence of risk factors for SMM,* such as hypertension or anemia, as women in majority white communities.5
- Women in majority Hispanic communities have up to 33% higher prevalence rates of some risk factors for SMM,* such as prior cesarean birth and pre-existing diabetes, compared to women in majority white communities.6
- Rates of severe illness are higher among pregnant women in the Northeast and South, those from lower-income communities and those giving birth in public hospitals.7
*Among women with employer-sponsored health insurance.
Pregnancy
- A review by the American Diabetes Association reported that Asian/Pacific Islander women exhibit the highest prevalence of gestational diabetes (14.8%), which can increase pregnancy complications.8
- Native Hawaiian and other Pacific Islander women are five times more likely than white women to not begin receiving prenatal care until the third trimester or to receive any prenatal care at all. Hispanic women are twice as likely compared to white women to have a birth with late or no prenatal care.9
- The risk for miscarriage is roughly 43% higher for Black women compared to white women.10
Labor & Delivery
- Black women have pregnancy-related mortality rates that are over 3x higher compared to the rate for white women.11 And pregnant Black women are 45% more likely to die in the hospital.12
- Prevalence of delivery complications is 46% higher among Black mothers versus white mothers.13 Even after adjusting for socioeconomic status, access to healthcare and other medical conditions, researchers found that compared to white women, pregnant Black women were: 57% more likely to have a stroke; 42% more likely to develop a blood clot in the lungs; and 71% more likely to develop heart muscle weakness.14 These outcomes are more likely to occur at or near the time of labor and delivery.
Postpartum
- Early and consistent screening combined with the context of known risk factors has been found to help detect and treat postpartum depression.15 But according to a recent survey from Blue Cross Blue Shield (BCBS), 34% of Black women and 38% of Hispanic women said they were not screened for postpartum depression or did not know if they were screened.16
- Based on BCBS claims data for women with employer-sponsored health insurance, nearly half (45%) of women diagnosed with postpartum depression went untreated during the 2019-2020 time period. Among those who received treatment, only 52% of Black women and 49% of Hispanic women were treated compared to 57% of white women. These gaps in treatment are due, for the most part, to disparities in the adoption of prescription treatment, which was 39% for white women, but only 28% for Black and Hispanic women.17

Impact on employers

With women accounting for nearly half the American workforce,18 maternal health disparities can have a huge impact on the health and overall well-being of your employees, their families and your business.

To help advance maternal health equity, employers can support improving access to quality care.

Read More
A significant amount of women undergo cesarean sections unnecessarily, for reasons which cannot be medically justified. But many women require the potentially life-saving procedure, and those with limited or no access to medically necessary cesarean sections are at higher risk for short- and long-term impacts on their health.19
1.9M
Deliveries
each year
Employer-sponsored health plans cover 1.9 million deliveries each year, 32% of which are cesarean. This surgery may be associated with increased maternal and neonatal complications and costs an employer, on average, $5,100 more than a vaginal delivery. Specifically, women of color are disproportionately impacted by these higher-cost, higher-risk deliveries as evidenced by 36% of Black mothers delivering via cesarean, versus 30.9% of white mothers. In addition, once a woman has a cesarean, it significantly increases her chances to have future cesarean deliveries.20
over
$1B
in savings
Cesarean sections carry added risks of complications and can be costly for employers. They are also frequently performed unnecessarily. If we were to reduce the rate of employer-sponsored cesareans in the U.S. from 32% to 31% (a decrease of just 1%), we would see about $97 million in savings. A further decrease to 23% (a 9% drop from 32%) would achieve over $1 billion in savings.21

Advancing maternal health equity takes all of us.

There’s much more to learn about the diverse populations affected by maternal health disparities, key contributing factors and actionable strategies for employers to advance maternal health equity. Download our latest Health Equity mini-eMagazine and join the charge to change the tide at smarterbetterhealthcare.com.

Learn More
eMagazine cover for Maternal Health Equity Crisis on iPad Mini

1 Roosa Tikkanen, et al., Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries, The Commonwealth Fund, Nov. 18, 2020.

2, 18 Bryan Robinson, “Pregnancy Discrimination In The Workplace Affects Mother And Baby Health,” Forbes, July 11, 2020.

3, 20, 21 Suzanne Delbanco, et al., “The Rising U.S. Maternal Mortality Rate Demands Action from Employers,” Harvard Business Review, June 28, 2019.

4, 5, 6 Blue Cross Blue Shield Association, The Health of America Report, “Racial Disparities in Maternal Health,” May 20, 2021.

7 Eugene Declercq and Laurie Zephyrn, Severe Maternal Morbidity in the United States: A Primer, The Commonwealth Fund, Oct. 28, 2021.

8 Gianna Melillo, “Racial Disparities Persist in Maternal Morbidity, Mortality and Infant Health,” AJMC, June 13, 2020.

9, 11 Samantha Artiga, et al., Racial Disparities in Maternal and Infant Health: An Overview, KFF, Nov. 10, 2020.

10 Tori B. Powell, “Black Women Are at Higher Risk for Miscarriage, Study Finds,” CBSN, Apr. 29, 2021.

12, 14 “Black Women Have the Highest Risk of Pregnancy-Related Heart Problems in the US,” American Heart Association, Dec. 16, 2020.

13 Blue Cross Blue Shield Association. Health of America, Maternal Health Data. 2020.

15 Zoleykha Asgarlou, Mohammad Arzanlou, and Mohammad Mohseni, “The Importance of Screening in Prevention of Postpartum Depression,” Iranian Journal of Public Health, May 2021, 1072–1073, cited in National Center for Biotechnology Information/US National Library of Medicine, National Institutes of Health.

16 Blue Cross Blue Shield Association, Maternal Health Survey. 2020.

17 Blue Cross Blue Shield Association, Analysis on Postpartum Depression. 2022.

19 New WHO Guidance on Non-clinical Interventions Specifically Designed to Reduce Unnecessary Caesarean Sections, World Health Organization (WHO), 2018.

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