Why we need to achieve a full continuum of care in maternal and infant health
Through my ongoing collaboration with Medicaid and commercial health plans, as well as hospital NICU teams across the country, I am fortunate to witness the tremendous ongoing passion for improving maternal and infant health and health equity.
However, passion alone will not propel us forward to the type of progress that women, their children, and their families so rightfully deserve. Today, what is truly needed is a greater continuum of care that holistically supports mothers and their newborns from conception through the first year after birth.
Support for this full continuum of care is based upon decades of global evidence that suggests a fully integrated care delivery program provides baseline levels of routine monitoring and consistent opportunity for critical intervention, when needed, through pregnancy, in the critical months post delivery, and throughout the entire postnatal period. Colloquially known as the “fourth trimester,” this cardinal healing, recovery and bonding window is essential for the long-term health of both mother and baby.
Regrettably, today, the United States has the highest maternal mortality rate of all developed countries and experiences substantial disparities in maternal health outcomes, particularly when broken down by race and ethnicity. For 2020, the CDC released data revealing our nation’s maternal mortality rate again increased, this time by 14% from 2019 to 2020. And for these reasons the expansion of maternal care is pertinent.
While this annual data continues to paint a very bleak picture, I believe that there remains a significant opportunity to drive change and improvement within our healthcare system. This opportunity is for us to embrace a more holistic view of maternal and infant healthcare.
New policies are beginning to lay the groundwork for true systemic change as 19 states, plus the District of Columbia, are now leveraging funds from the American Rescue Plan Act to extend postpartum Medicaid coverage from 60 days to a full year following delivery. Under the current program, this expansion of care is slated to run for five years, an inspiring step forward towards more holistic maternal and infant care for all. This brings the total number of states to adopt Medicaid expansion to 39. For the more than 42% of women covered by Medicaid, this guarantees access to vital healthcare services, including lactation support, chronic condition management, postpartum mental health screenings, home visits, community education measures, and other services.
In more ways than one, achieving a full continuum of care empowers us to create better standards for all. Regardless of method, we want to achieve quality outcomes that protect our mothers and the most vulnerable among us, our newborns. By applying a more comprehensive maternity journey, we are able to address social determinants of health that vary by population, geography, and community – and are estimated to impact 80% of an individual’s overall, long-term health. We can tailor outreach by circumstance, and ensure all mothers and newborns have a safety net for care and community.
Leveraging this framework and a contextual, community-based understanding will be crucial to ensure that our continuums of care are not designed as “one size fits all.” What is likely to work in New York City may not likely work in rural Louisiana. Factors such as limited public transportation, or a lack of trust in the healthcare system, greatly impact whether or not new mothers are likely to follow their care plan and attend follow-up appointments. Additional proactive outreach methods, appointment reminders, and home-care visits can make a bigger impact in these areas.
When we begin reaching women earlier, and providing more – and more relevant – interactions throughout pregnancy and beyond, our actions will have an impact. Driving towards a comprehensive, community-based care approach that focuses on improving quality outcomes will finally help us move the needle on our maternal and infant health metrics. Finally, we will begin to see healthier, happier, and more empowered mothers and infants.
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