Black maternal health: Health equity begins before birth

The statistics are sobering: Black women in the U.S. are three times more likely to die from pregnancy than White women. Here in North Carolina, 27.6 women die per every 100,000 births. For Black women, the death rate number is more than double. These disparities persist across education, income, and age levels.

Driven by our mission to improve health and well-being for all, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) recognizes that a healthier North Carolina begins with healthier pregnancies – and healthier pregnancies depend on equitable access to resources, support and maternal care. We also must acknowledge the role that race continues to play in the delivery of patient care.

To tackle this challenge, we have pursued a multi-pronged strategy of community investments, research and evaluation, and innovation in our own product offerings to improve maternal health and address disparities and inequity.

First, we support community-based organizations that are on the front lines working to improve maternal health outcomes and promote equity. In 2018 alone, Blue Cross NC invested nearly $2 million to support local organizations that help women before, during, and after delivery.  That support continues today.

These investments have helped sponsor a UNC School of Global Public Health initiative that supports North Carolina hospitals as they pursue designation as a Baby-Friendly Hospital. Prior to our investment, only 14 hospitals in the state had achieved this status. Our investment has helped 41 hospitals – many of them located in historically underserved and marginalized communities – engage in the rigorous certification process with Baby-Friendly USA, the accrediting body and national authority for the Baby-Friendly Hospital Initiative (BFHI) in the United States.  Other funds have helped educate new mothers how to care for their infants.

Just recently, we announced our investment in a March of Dimes educational program designed to reduce implicit bias among health care professionals working in maternity care settings. The course helps doctors, nurses, maternal care providers, and doulas recognize how stereotypes can unconsciously impact decisions. Changing these behaviors will improve patient-provider communication practices and enhance quality of care.

Furthermore, the Blue Cross and Blue Shield of North Carolina Foundation has long been a champion of efforts to support doulas in our state. It has provided ongoing support to a program called Mothering Asheville. Using the community-centered health approach, Mothering Asheville is working to reduce, and ultimately eliminate, racial disparities in infant mortality by changing institutional policies to address structural racism and increase access to preventive services in community-based settings. The collaborative, working in partnership with a safety-net obstetrical practice, developed a doula program that employs women from the community most impacted by infant mortality in the Buncombe County area.

In addition to our community investments, Blue Cross NC has been active in thought leadership, helping our state tackle disparities in pregnancy outcomes. We are an ongoing strategic partner to the North Carolina Institute of Medicine Task Force on Maternal Health, collaborating with other stakeholders to identify evidence-based solutions to improve the state’s maternal health outcomes. We’ve also contributed to the North Carolina Department of Health and Human Services Perinatal Health Strategic Plan Team. Working with more than 125 maternal and child health experts from across North Carolina, Blue Cross NC has been engaged in the development of action steps designed to address infant mortality, maternal health, maternal morbidity, and the health of individuals of childbearing age.

Finally, we have incorporated pre-natal care initiatives throughout our lines of business. Our Healthy Blue Medicaid plan offers breastfeeding and safe sleep support kits, in addition to providing members with free rides to doctor visits and support to help establish housing security. It also targets the care of populations with social risk factors by offering unique benefits (“value-added services”) that promote access to doulas, non-clinical support services delivered through community-based organizations, and case management teams that help integrate services for pregnant members. Given that Medicaid covers nearly half of the births in North Carolina, the impact of these services will be significant.

In addition, Blue Cross NC’s My Pregnancy mobile app provides free member support during pregnancy and after delivery. The app features vetted educational materials related to breastfeeding, labor and delivery; tools for identifying potential risks; pregnancy trackers; and more.

Blue Cross NC is guided by a central purpose: to improve the health and well-being of our customers and communities – we won’t stop until health care is better for all.  And when it comes to improving maternal health in our state, we all have more to do to reverse these poor outcomes and persistent disparities.