MATERNAL & INFANT HEALTH

Despite decades of effort, the rate of maternal mortality and severe maternal morbidity (SMM) in the United States continues to rise. A recent Centers for Disease Control and Prevention (CDC) Vital Signs reported an estimated 700 women die annually in the United States from pregnancy-related causes, 60% of which are preventable. This analysis revealed that Black and Native American women die at rates 3.3 and 2.5 times greater than their white counterparts. Severe Maternal Morbidity (SMM) defined as “any physical or mental illness or disability directly related to pregnancy and/or childbirth” and also referred to as “near-misses” are even more prevalent – and more than 50,000 women in the US are estimated to be impacted each year. 

The impacts of maternal mortality and SMM spread beyond the individual and ripple to their children, families, and greater community. While the source of these rising rates and disparities continue to be misunderstood, scholarship from communities most impacted — Black and Indigenous women and birthing people — point to the systemic and institutional nature of racism, sexism, classism, ableism and their intersections as a major source of the rising rate. 

AMCHP continues to lead and partner in major national initiatives to improve maternal health and prevent maternal mortality and SMM. For nearly two decades, we have partnered with the CDC and ACOG to assist states in establishing or sustaining maternal mortality review committees (MMRCs) and to highlight unique and expert knowledge in the challenges translating maternal health surveillance findings, including maternal mortality review data, into population action. As we continue to grow and expand our equity lens, we have also pivoted to listen acutely to community organizations and thought leaders who have been working to address maternal mortality and SMM in their communities for generations. In addition to partnership with national organizations and traditional public health institutions, we understand the importance of listening to individuals with lived experience and community organizations, and work to uplift their interventions and scholarship as we continue to work collectively to reverse the rising trends in maternal mortality and SMM.

Significant racial and ethnic disparities continue to persist within maternal and infant health. Despite various programs and initiatives to address, communities of color continue to be disproportionately at risk for a multitude of negative health outcomes. Not only are Black and Native American people disproportionately at risk for infant and maternal mortality, preterm birth and low birthweight, they are disproportionately impacted by the comorbidities associated with these outcomes and the physical and social environments that do not support optimal health.

In our analysis of these disparities, we counter the narrative that they are individual-level issues requiring solely individual-level intervention. In contrast, on the Women and Infant Health team, we understand systemic racism to be the root cause and engine of racial disparities in maternal health. Embedded into institutional histories and policies, racist practices continue to live on in present day, often without challenge or the realization of how the practice was built on a racist foundation. To address these disparities, and to reach true health equity, we understand racial equity to be the starting point. In our work, we see achieving racial equity as reaching a reality in which race no longer determines, impacts, and influences one’s health outcomes. Humbly listening to leaders in the field, who profess that there is “no answer that Black women do not already possess” we:

• Aim for transparent and honest community engagement in our work. We know that not all community engagement equates with equity work. We aim for transparent, compensated partnership for community engagement 
• Strive to uplift evidence-based practices and innovations. “Evidence” has historically been held hostage by academics and academic institutions. We approach “evidence” by prioritizing lived experience and cultural rigor in ways not previously done. 
• Understand that we cannot do this work alone. We need partnership across sectors that allows for accountability and honesty in how we have previously enabled these poor outcomes to persist. 

In our work to advance racial equity in our portfolio, the following trainings and resources aided the development of our analysis:

• Racial Equity Institute’s Anti-Racism Training
• Interaction Institute for Social Change’s Fundamentals of Facilitation for Racial Justice Work
• An inconvenient truth: You have no answer that Black women don’t already possess – Scott, KA, Bray, SRM, Asiodu, IV, McLemore, MR
• “How the Bad Blood Started” episode of the 1619 Project podcast
• “Roots of the Black Birthing Crisis” episode of NATAL podcast

People who identify as LGBQT+ and desire to be or are parents often face discrimination due to misinformation, bias and ignorance. Stigma and erasure remain barriers to perinatal care that is gender-affirming and welcoming of all family forms. In our American society, life events such as pregnancy and childbirth are deeply associated with cultural constructions of womanhood. As such, motherhood is often regarded as an exclusively feminine experience. These heteronormative and cis-gendered assumptions lead to non-binary and transgender individuals from being excluded and dismissed. 

Data shows that LGBQT+ individuals are more likely to delay care and more likely to receive care in emergency rooms. These health disparities continue into reproductive and birthing spaces where non-binary and transgender individuals may come across providers who are unable to provide proper respectful care due to ignorance or even clear discrimination. 

While there is surmounting data on health disparities of LGBTQ+ populations, there is not enough data for us to have a clear picture about birth outcomes because most health information systems can only register perinatal and birth services to a patient who is female. It is important to note that BIPOC individuals who are queer or trans face the double oppression of racism and the challenges noted above and experience more exposure to discrimination, hate and violence in health care and birthing spaces. 

In our maternal and infant health work and advocacy, we value all family forms and gender expressions. We strive for inclusion and to encourage our partners to be thoughtful about embracing all birthing people, whether cis-gender, trans, or non-binary, and their families. 

Human milk is the most biologically appropriate first food for human babies, but human milk feeding requires consistent, compassionate support. Human milk provides babies with important nutrients, bioactive substances, and immunologic properties that adapt to meet the growing child’s needs from the time of birth through the first year, and beyond. Human milk feeding is an important public health focus, because it strengthens the baby’s immune system and reduces the risk for SIDS, respiratory infections, and gastrointestinal illnesses. Benefits to the lactating parent include reduced postpartum blood loss and a potentially reduced risk for breast and ovarian cancer.

Disparities in rates of human milk feeding can be traced to systemic issues like racism and poverty. Kimberly Seals Allers describes first food deserts as “communities with minimal to nonexistent breastfeeding resources and support mechanisms.” Providing targeted, affirming, culturally reflective support for human milk feeding especially in communities of color is necessary for increasing the reach of human milk feeding. For families unable or choosing not to feed human milk, access to infant formula and education on safe formula feeding should be easily available and families should be wholly supported in their infant feeding choices.