issue Community Health 2024

‘Unacceptable Disparities’ Challenges in Addressing Maternal Mortality

By Dan Moran
Symposium participants included Myrtis Sullivan, MD, MPH, assistant dean for Diversity, Equity and Inclusion; Damaris Montano, MPH, BSN, RN, from the Lake County Health Department and Community Health Center; Dr. Bergo; moderator Kimberley Darey, MD ’04, CPE, FACOG; Dr. Emory; Dr. Borders; and Brenda Reyes, RN, CLC, from HealthConnect One.
Photo by Michael R. Schmidt

Before presenting a series of slides detailing maternal mortality and morbidity and their relation to systemic inequities, Cara Bergo, PhD, MPH, sought to frame the issue in starkly human terms.

Dr. Bergo clicked on a video documenting the final days of Shalon Irving, PhD, MPH, MS, CHES, a CDC epidemiologist who died in 2017 from postpartum complications of high blood pressure.

“Why are women dying? What can we do better?”

The 鶹Ӱ Centennial Room audience at “Maternal Mortality: A Nation in Crisis” heard Dr. Irving’s mother share how “I lost my vibrant, beautiful, intelligent best friend and daughter because she wasn’t heard” by physicians providing treatment in the days after Dr. Irving gave birth.

“I just want to really make note of how truly important it is to center this conversation on stories like Shalon’s,” said Dr. Bergo, a maternal mortality epidemiologist with the Illinois Department of Public Health. “Sadly, there are many more out there — women, moms, daughters who lost their lives to this crisis of maternal mortality.

“Each number I present today represents a real woman who has lost their life, and their families are grieving them. It is them who we do this work for, and hopefully strive to fight this crisis and identify opportunities to prevent future deaths.”

The Sept. 20 Symposium on Race in Medicine event, sponsored by Chicago Medical School and 鶹Ӱ’s Office of Excellence in Diversity and Inclusion, focused on higher rates of pregnancy-related deaths among women of color in the United States, particularly Black women like Dr. Irving.

“Why are women dying? What can we do better?” said Anne Borders, MD, MSc, MPH, executive director of the Illinois Perinatal Quality Collaborative, who described “unacceptable disparities” that include Black maternal mortality rates running more than 2.5 times higher than the U.S. average.

Dr. Bergo told the audience that pregnancy related deaths increased in Illinois “in all geographic areas” between 2018 and 2020.

“If we think about the way our system is set up — the structural and systemic racism that has led to bias, and discrimination in health care that’s led to bias, and discrimination in our communities that’s led to generational economic oppression — we know that this impacts the quality of our care and the chronic stress that our patients are coming to pregnancy carrying,” Dr. Borders added.

Asked about what systemic changes would improve maternal outcomes for Black patients, coordination of care was a unanimous recommendation among the symposium panelists, with Dr. Bergo saying that “sometimes deaths occur in patients that are getting care in six different places, and no one’s talking to each other.”

Along the same lines, panelist Lakshmi Emory, MD, MPH, chief medical officer for Aetna Better Health of Illinois, advocated for electronic health records. “I think that would go a long way toward bridging the gap,” she said, “not only for maternal health, but for health care in general.”

“It’s going to take ongoing intentional change, and continuing to get folks to move toward change and take action — not just talk about it.”

Other recommendations included increased screening for severe maternal hypertension and use of opioids; increased connection to treatment for opioid-use disorder; implicit-bias training for doctors, nurses and staff; and empowering pregnant women from communities of color to make their medical choices.

“It’s going to take ongoing intentional change, and continuing to get folks to move toward change and take action — not just talk about it,” Dr. Borders said. “But I do believe that we can make change happen.”

Dan Moran is the communications director in 鶹Ӱ’s Division of Marketing and Brand Management.