Improving maternal and perinatal health equity in North Carolina and beyond

In the United States, nearly four million women give birth each year, and the majority do so without any complications. But even with the health advances in the U.S., our country still has the highest maternal death rate compared to any other developed nation.

Over the past several decades, in much of the world, the maternal mortality rate has declined. But in the U.S. the problem has only worsened.

While health outcomes need to be addressed across all demographics, women and infants of color are much more likely to have worse outcomes. The pregnancy-related mortality rates for Black women are three times higher than for White women. For American Indian and Alaska Native (AIAN) women, that number is twice as high (PDF) as the rate for White women.

The disparities are complex and often a result of drivers of health factors faced by communities of color. These factors include barriers to accessing quality health care, food security, social support, education, and safe neighborhoods. For these reasons and many more, the health care industry and government agencies alike have put maternal and perinatal health care equity high on their priority lists.

In the U.S., on average, there are about 700 maternal deaths and more than 50,000 serious pregnancy-related complications per year. More than half of these deaths and complications are preventable.

The ability to access quality health care plays a significant role in maternal and perinatal health outcomes. Areas called maternity care deserts are becoming a significant threat to the overall health and well-being of pregnant women across the country. A recent report by the March of Dimes found that five million women in the U.S. live in counties that are considered maternity care deserts, meaning there is no hospital that offers obstetric care and no obstetric providers.

By not receiving pregnancy-related care until the third trimester, or not receiving care at all, women run the risk of complications. Early prenatal care is critical to monitoring overall health and managing medical conditions. But this can often be a challenge for women of color.

Studies have found that implicit bias in the health care setting may prevent women of color, particularly Black women, from seeking out or receiving prenatal health care. Additionally, women of color are more likely to live in communities with fewer pregnancy-related resources such as childbirth education and breastfeeding support.

While infant mortality has slowly improved in North Carolina over the last two decades, our state still ranks 42nd in the U.S.

• Currently only 68% of pregnant women in North Carolina receive the necessary prenatal care. This puts us far behind the national average of 77% (PDF).
• Depression is the most common mental health need during the perinatal period. Ten to 20% of pregnant women are affected by prenatal and/or postpartum depression.
• In 2018, the total infant death rate in North Carolina was 7.2 per 1,000 live births. The infant death rate is higher among American Indians and African Americans.

These are statistics we simply cannot ignore.

Together with North Carolina providers, hospitals, local and state governments, and community partners, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is helping lead the charge to address disparities within maternal and perinatal health.

We’ve collaborated with the March of Dimes to launch its Breaking Through Bias in Maternity Care program in North Carolina. It provides access to maternal care providers free of charge. The program’s curriculum covers structural racism in the United States and works to reduce bias in maternity care.

Our Healthy Blue Medicaid Program offers breastfeeding and safe sleep support kits. It also works to address transportation barriers and provides support for establishing housing security. Healthy Blue also addresses social risk factors by supporting access to community health workers, doulas, and community-based services. And Healthy Blue’s New Baby, New Life℠ program helps connect members to an OB care manager, as needed, based on risk assessment.

The Affordable Care Act (ACA), passed in 2010, expanded coverage for many maternal health benefits under all ACA-compliant policies including breastfeeding support, counseling and equipment for the duration of breastfeeding. This includes the cost of a breast pump and lactation counseling support. In addition to the core set of benefits, Blue Cross NC includes maternal depression screening, prevention of perinatal depression and gestational diabetes screening.  These services are provided at no additional cost when performed by an in-network provider.

Other work is underway to address these issues as well:

• The North Carolina Institute of Medicine (NCIOM) Taskforce on Maternal Health – To improve maternal health outcomes in North Carolina, the NCIOM in partnership with the North Carolina Department of Health and Human Services (NC DHHS) established the Task Force on Maternal Health to bring together stakeholders and experts from across North Carolina to identify evidence-based solutions to best improve maternal health outcomes and to guide and develop a Maternal Health Strategic Plan for the state.
• NCIOM Taskforce on Developing a Perinatal System of Care. In April 2020, the taskforce published Healthy Moms, Healthy Babies, which provides recommendations on how to improve health outcomes form women and infants in North Carolina.
• Healthy North Carolinians 2030. The Healthy North Carolinians 2030 project led by the NCIOM has created a set of public health indicators and goals for our state to achieve over the next 10 years. Goals include addressing early prenatal care and decreasing infant mortality.
• NC Perinatal Health Strategic Plan: 2016-2020+. This plan, developed by NC DHHS, was created based on a framework of closing the Black-White disparity gap in birth outcomes across our state. There are three main goals – 1) Improving health, 2) Strengthening families and communities, 3) Addressing social and economic inequalities – which have helped guide various statewide initiatives, policies, and legislative focuses over the past several years.

At Blue Cross NC, our mission is to improve the health and well-being for all North Carolinians. That includes helping provide quality maternal and perinatal health care.