Being Black and pregnant too often comes at a deadly cost. Black women are six times more likely to die during pregnancy or shortly after childbirth than white women in Chicago and about three times more likely statewide.
“You have to look at what’s going on and find out why we are failing Black women,” says Cynthia Jacinthe, owner and founder of Dr. Jacynia Women's Care Consulting, and one of Chicago’s Black certified midwives. “We have to change things around.”
Research by the Centers for Disease Control and Prevention suggests 3 in 5 pregnancy-related deaths among all women are preventable — and the potential to prevent these deaths doesn’t vary by race or ethnicity.
But experts say solving the disparities experienced by Black mothers demands addressing a complex set of other challenges. They include limited communication and support during and after pregnancy, access to quality health care coverage and care, and implicit bias in the health care system.
Dr. Jacynia Women’s Care Consulting is among the recipients of a recent round of grants from Blue Cross and Blue Shield of Illinois supporting organizations and providers dedicated to improving maternal health outcomes. The grant initiative is one way BCBSIL is reinvesting payments from the Illinois Department of Healthcare and Family Services for providing Medicaid members quality care.
Jacinthe is using the grant to provide pregnancy and postpartum telehealth counseling and services to low-income women. Periodic postpartum check-ins may help identify and help women with medical complications or mental health issues, she says, or assist new mothers struggling with breastfeeding.
The community grants are part of BCBSIL’s broader commitment to confronting the problem. The insurer also is partnering with Illinois health systems to improve health care quality in minority groups, increase physician workforce diversity and cultural competency and address unconscious biases and stereotypes that influence behavior.
“We are working to help create an environment that fosters access to affordable benefits, better health outcomes and care that is collaborative and compassionate."
Under its Health Equity program, BCBSIL is increasing the number of providers who receive value-based payments and including health equity as a core component of the quality program. It also will examine disparities in maternal care and telehealth services.
“We are working to help create an environment that fosters access to affordable benefits, better health outcomes and care that is collaborative and compassionate,” says BCBSIL medical director Dr. Anita Stewart.
That depends on insurers, clinicians, health educators and social service providers working together to better serve mothers during and after their pregnancies. For BCBSIL, that includes establishing care protocols and rewarding doctors for adhering to them.
“We have to figure out how to transition patients so they are never caught in the middle,” she says. “If we can help give patients better care and services, we can help reduce some of their stressors and give them a little bit of a greater chance to improve outcomes.”
Many new moms, however, don’t have health care coverage. Illinois recently moved to extend full Medicaid benefits for a full year after mothers give birth. Women with incomes up to 208% of the federal poverty level are eligible under the new policy, which was supported by BCBSIL and made possible by the American Rescue Plan Act.
“It will make a big difference,” Stewart says. The extended coverage may lead to better diagnosis and treatment of physical and mental health disorders and help identify and meet women’s social service needs.
Experts say solving the maternal health crisis also requires confronting bias in the health care system.
American College of Obstetricians and Gynecologists, the country’s leading professional organization for OB-GYNs, has recognized in a policy statement that explicit and implicit bias in health care contributes to worse outcomes for minority women.
“Racial disparities in maternal morbidity and mortality transcend income and education levels,” says Dr. Derek J. Robinson, BCBSIL vice president and chief medical officer.
“While the pregnancy-related mortality rate for Black women of all ages is more than three times that of white women, Black women with at least a college education die at a rate 5.2 times that of their white counterparts, according to the CDC. Additionally, bleeding and high blood pressure are among the leading cause of pregnancy-related death in the U.S.”
He adds that the pregnancy-related mortality rate for Black women who have completed college or achieved a higher degree level still is 1.6 times higher than the rate for white women with less than a high school diploma.
“While our grants may support the underserved, we have a concurrent focus on improving the quality of care,” Robinson says. “In our new hospital equity program, we are incentivizing a focus on improving outcomes and eliminating racial disparities in hospital care for pregnant moms with high blood pressure and bleeding problems.”