“We're Not in the Business of Just Doing the Research. We are Taking Action”: A Conversation About Maternal Health

What do we mean by maternal health? What are some trends impacting people who are pregnant and their babies today? And what are some of the factors that lead to inequities in maternal health outcomes?

These are all topics that Dr. Darrell Gray, president of Elevance Health's affiliate health plan in Maryland, and Dr. Tiffany Inglis, Carelon Health's national medical director for women’s and children's health, discussed in this recent conversation.

Elevance Health is focused on improving outcomes for mothers and babies in this country. The Elevance Health Foundation has committed $30 million over the next three years toward programs that support maternal and infant health, and the company is researching strategies that can produce healthier outcomes — like the promising role of doula care.

Listen to find out how these two leaders are working to support healthy pregnancies and babies — and why even more support is needed.
 

Full Transcript:

INTRO

Welcome to Elevance Health. Today we're talking to visionary changemakers about how they're contributing to healthier communities and connecting people to the care and support they need to lead healthier lives.

Dr. Darrell Gray

Good morning, good afternoon, good evening, depending on where you are listening. My name is Dr. Darrell Gray, and I have the pleasure of serving as chief health equity officer for Elevance Health. I'm here with Dr. Tiffany Inglis, who is medical director of clinical programming and population health here at Elevance Health. Today we're going be talking about some new research that has come out about maternal health in the United States, and Dr. Inglis has a special focus on maternal health here at Elevance Health.

Dr. Tiffany Inglis

Hi, Darrell. Thanks so much for having me. We've been working really hard to understand our moms and babies better and really look at the national research and local understanding and our own membership data and really know who's pregnant, when are they pregnant, and understanding their needs. The focus of maternal health right now is really acknowledging and understanding that health is more than just: Do I have diabetes? Do I have hypertension? Those things are very important and we know that, but it's also about understanding the behavioral health needs of the people we serve, their social dynamics: Where do they live, and then how do they identify, where do they come from? All those different things that impact health so much impact moms and babies dramatically. And as we learn more and more, we realize just how important those are.

Dr. Darrell Gray

I love that you pointed out how critically important it is to meet people where they are with what they need. And as we think about maternal health, some may think of maternal health as what happens during pregnancy and delivery, and that's it, but I know you have a broader view of what maternal health is. Can you dig into that a little bit more?

Dr. Tiffany Inglis

It's such a great question. We often think of maternal care or maternity care as pregnancy and childbirth. It's so much more than that. It's the process leading up to how we decide when and where, and if we want to be pregnant, does that include a fertility journey or not? Which is very different based on your needs. That fertility journey can be so different for so many people. And then that pregnancy journey is so different. The childbirth and labor and delivery experience is so much a key portion of that. But then also it's that postpartum period, and that's more than just a few weeks. It's months, it's a year plus, right? Supporting that family unit is how we think about it. And then it's also getting back to the behavioral, social, physical inputs that have the impact on the family in that space and really the whole health of the people. And it's not just a person, it's the people and how they share that space. And we know when our birthing mom is healthier, the baby tends to be healthier, and how do we take that through those first early years of childhood development and then the impacts that early childhood development has on future health when that child becomes the adult. And really, I would say, threading that needle all the way through and recognizing how much they all impact one another.

Dr. Darrell Gray

I really like how you're digging in here. I'd like to bring one thing to the attention of our listeners. It's probably no mystery to them that we are living amidst a maternal health crisis. The disparities are stark, particularly when we look across different populations, whether it be based on where people live, whether it's based on their race or ethnicity, whether it's based on disability comorbidity, the list goes on, but there are stark disparities in outcomes amongst birthing people. Can you shed a little bit more light on this as to what we're seeing?

Dr. Tiffany Inglis

The United States has some of the worst maternal mortality rates in the developed world, and we have for a long time, and they're not improving. They're actually getting worse. And the newest CDC study showed 80% of pregnancy related deaths in the years 2017 to 2019 were potentially preventable. And then you break that down further, Black women are three times more likely to die before, during, and after childbirth than a white woman is. The maternal mortality rate for Hispanic women increased 44% in 2020—44%. That's a huge number. We know that Black women are more likely to die from cardiovascular causes of death. Non-Hispanic white women are more likely to have mental health conditions that lead to the pregnancy-related causes of death. And I think when we start thinking about that, that gets back to a little bit of what we talked about before, is just understanding the person and trying to figure out how do we know what their risk is?

How do we know it early? And then how do we wrap them around with those supports? And I think that's what our goals have been, and really trying to make sure that we address where are the barriers to care, how do they impact that pregnant person, that birthing person, and then how do we act those action points. How do we help? Because as you point out in those studies’ statistics show we're not meeting people where they need us to meet them and we're not getting them the care that they need to help prevent those risks.

Dr. Darrell Gray

I definitely appreciate all of that. I think you touched on several critical things. Access is one thing, ensuring that you have a high-quality birthing center that is in proximity to those who need it most. And we know that access is an issue and there are other issues outside of access, other issues outside of where people can go to receive care that they deserve. And we know that also, some of the disparities we see are a reflection of discriminatory practices and certainly there's much literature around the impact of implicit bias and frankly, racism on outcomes among certain populations. That's another area of ongoing work for all of us. And what I'm really excited about, Tiffany, is that we're not in the business of just observing a problem, right? We're not in the business of just doing the research, but really taking action. Can you tell us a little bit around strategies that are working to improve health outcomes for our birthing parents?

Dr. Tiffany Inglis

What we do know is that if I'm the pregnant person and you are taking care of me and I identify with you on a more personal level, I'm so much more likely to get my care and to be present and to feel heard and to feel understood, and to feel bought in, or just really believe in what you're saying to me and feel like I'm a part of the process. And I think that's what we hear so much from our pregnant people is I didn't feel heard. And I think we hear it even more from our women of color, from our women who have potential disabilities or these other areas where we see these disparities. When they can identify with their care provider, it really, really positively impacts their feeling of connectedness, which impacts their outcomes, and it makes their experience better, and it makes their long-term potential outcome better.

We've tried to think about how can we diversify in many different directions? Who's at the table talking about the problem? Who's creating solutions? Because that's all very important in the background, but then also, who are they seeing when they get their care delivered, whether that's a doctor, a midwife, a doula, community health worker, peer advocate and how does that person connect better with them, creating and building in those connection points so that it's more personal but then also making sure that we are working to diversify the care providers within communities so that people can find someone that they can connect with and they can feel heard by, and that they can understand their care better and feel supported.

Dr. Darrell Gray

One key word that you said multiple times that I think can't be said enough is connections. Just to build upon what you said, for some that meaningful connection is made in an in-person interaction, but for others, they may prefer a more digital or virtual solution. And I think that's also where we come in solutioning and meeting people where they are with what they need and what they want to have the optimal outcome. Any feedback or comments on that?

Dr. Tiffany Inglis

A hundred percent agree with you. Overall, this is a younger skewed, healthier population. They don't want to talk to me on the phone, they want to connect with us when and how and where it works for their lifestyle. And so those digital solutions are hugely impactful, but I have an alternative learner in my home and talking on the phone, getting a list of things to do, and then turning around, signing off that checklist and finishing that doesn't work for him. That's not the way he intakes, processes, and turns around information. So when we move to some of these digital resources being more available, what we're also providing is that equity component, that health literacy component we talk about so much in healthcare. It's really the ability to give people information in the way that they like to receive it, the way they learn, the way they process, and the way they can understand better.

Dr. Darrell Gray

Tiffany, I am convinced that we could talk about this all day, but I know our listeners probably can't listen to us all day and we have to also do the work right that we're talking about today. So Tiffany, thank you so much for your time today.

Dr. Tiffany Inglis

Thank you so much. This is great. I agree we could go on and on, but it's really been lovely to talk about it and hopefully the listeners have enjoyed what we've had to say. Thank you.