Details Matter When Tackling the Public-Health Crisis of Maternal Mortality

By shaunesse’ a. jacobs

Giving birth is often one of the most transformative experiences in a person’s life. Communities shift in the most beautiful ways: families expand, individuals assume communal roles, and investing in the future becomes increasingly important. Yet, the beauty of birth becomes challenging in the United States. The country ranks 55th in the world based on the maternal care our healthcare system offers. These rates are even more staggering for Black communities, as Black women in the United States are three to four times more likely to die from pregnancy-related complications than white women. In fact, following the CDC’s Pregnancy Mortality Surveillance System, Black women experienced the highest number of pregnancy-related deaths compared to all other racial/ethnic groups in 2011-2016.

These statistics inspire my research and the work I have been privileged to pursue through IHSIP this summer. I began the research process wanting to acquire medical records to determine if there were differences in care over the course of a person’s pregnancy that differed across racial/ethnic groups in a Boston hospital. Narratives in the medical records could reveal disparities in care and practices, which might offer health system design and implementation improvements that could be applied across the Boston area and the wider region. Later, the data findings and ideas for improvement could be used to build a computational policy simulation to demonstrate the impact of novel policy ideas both on health outcomes and on healthcare costs.

I assumed the trends in care would be apparent through the way notes were documented by clinicians and the number of follow-up visits a patient scheduled from awareness of conception through six weeks post-partum. While this was a sensible hunch based on the many news reports, social media posts, and CDC reports I had read on this topic, I discovered that the question was far more complex and the nuances matter.

Through meetings with experts in the field—Dr. Eugene Declercq, Dr. Brian Jack, and Dr. Michael Kogan—my faculty advisor Dr. Wildman and I came to understand the variety of public-health and clinical terms used to address maternal morbidity. To begin with, maternal mortality, severe maternal morbidity, and pregnancy-related death are distinct categories in medical records and measured differently. Social factors and health prior to pregnancy are factors. Age and education play important roles. Most importantly, post-natal and preventative care inform how a birthing person’s death is understood. My research expanded to incorporate different measurements and clinical terms. I also had to account for the ways these measures are articulated in national and state datasets. Individual narratives made me aware of the public health crisis, but the subtleties of definition, measurement, and reporting made me aware of the ways the issues swirling around maternal care and morbidity should be communicated with patients, clinicians, public health professionals, and the public.

While our research still seeks to understand the differences in how care is reported across racial/ethnic groups, we have also become aware of the ways that medical records and state and national datasets must be in conversation with one another. These conversations have the potential to improve health system design, public health engagement, and even computational policy simulations that might be used to guide policy decisions. With the right kinds of conversations and public communication, the delivery of care improves, the public’s support of relevant policy measures strengthens, and Black birthing people increase their chances of surviving and flourishing as parents of young children.

We hope our research contributes to the work of shedding light on the dearth of policy initiatives directed towards maternal care. By means of a better understanding of preventable problems that lead to negative birthing outcomes for mothers, especially Black mothers in the United States, we hope to support the development of new policies that directly improve maternal care practices, the reporting of maternal health statistics, and the experience of families..

About the Author

shaunesse’a. jacobs is a third year PhD student on the Constructive Theology and Ethics track at Boston University’s School of Theology. She is a recipient of the 2020 IHSIP Summer Student Research Award in collaboration with advising faculty member, Wesley J. Wildman, PhD. Her research broadly examines the ways communities use religious practices to cope with the injustices of the healthcare system, with special focus on the healthcare injustice of severe maternal morbidity for Black birthing people.

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