Addressing social determinants of health to advance maternal health equity

The U.S. is embroiled in a maternal health crisis–American women have the highest maternal mortality rate of any high-income country in the world. What’s more, deeply entrenched inequities mean that parents and families from historically marginalized communities are experiencing significantly worse pregnancy outcomes. Maternal mortality among Black mothers is three times higher than their white counterparts, and rates of preterm birth and low birthweight are higher among Black, Hispanic, and American Indian & Alaska Native women when compared to white women.

Health inequities run deep in the U.S., and social determinants of health (SDOH)—like housing, education, and racism—are playing a huge role in the negative pregnancy outcomes experienced by birthing parents across the country. The COVID-19 pandemic starkly highlighted the effects of inequitable care, especially as it relates to parents and families. Health plans must take actionable steps now to address the SDOH that are causing negative health outcomes for birthing parents.

What are social determinants of health?

Health inequities are caused by the structural and systemic mechanisms that cause unequal distribution of resources among groups of people, and SDOH are influenced by those inequities. At their core, SDOH recognize the fact that health (and sickness) do not exist in a vacuum—instead, a person’s health is affected by many external forces in their lives and society. Transportation, education, housing, job opportunities, income, water pollution, racism, and violence, for example, can all affect an individual’s health and well-being.

Social determinants of health are one of the primary drivers of the systemic health inequities facing our society today. According to a report by the American Action Forum, clinical care is estimated to account for just 10%-20% of health outcomes, genetics are estimated to account for 30% of health outcomes, and social determinants of health for 60% of health outcomes.

Upstream challenges in the conditions of people’s lives lead to myriad downstream health issues and poor health outcomes for birthing parents and their families:

• People living in rural areas often don’t receive the care they need because there are too few facilities and providers, or the services they need are not available. Birthing parents living in rural areas have a higher maternal mortality rate than their urban counterparts, and the disparities only increase when looking at Black rural birthing parents compared to white.
• Up to 12,000 children in Flint, Michigan were exposed to drinking water with high levels of lead. Their exposure is believed to be linked to an outbreak of Legionnaires’ disease and also puts them at risk for long-term effects of lead poisoning, including possible increased risk of Alzheimer’s disease later in life. 
• A pregnant woman who can’t afford to fill a prescription drug to stop preterm labor is at higher risk of having a baby born with immature lungs and other complications.

How SDOH affects maternal health equity

Advancing maternal health equity can not be done without addressing the social determinants of health that may be negatively affecting birthing parents across the country. Unjust policies, inequitable distribution of resources, and lack of investments in communities are causing a lack of prenatal care, high postpartum depression rates, and worsening birth outcomes in historically marginalized communities.

How virtual care can address social determinants of health

While the burden of addressing SDOH does not fall on any one group alone, healthcare payers and health systems are uniquely positioned to make an outsized impact on social determinants of health for their members and their communities through virtual care. This work—alongside policy changes, education, and grassroots work—can help create a healthcare system where historically marginalized birthing parents and their families enjoy better health outcomes, improved access to care, and lower healthcare costs.

Improve access to care

Underserved communities often do not have reliable access to care, a barrier to health that’s only been exacerbated by the COVID-19 pandemic. Studies show that rural mothers experience higher rates of hospitalization due to pregnancy complications compared to suburban women. These negative outcomes can be partially attributed to the fact that almost one-half of all counties in the United States don’t have an obstetrician, and 40% don’t have an obstetrician or certified nurse midwife. March of Dimes reports that up to 5 million birthing parents in the US are living in “maternity care deserts,” meaning patients have limited or no access to maternity health care services. These care deserts disproportionately affect Black mothers, as rural counties with higher proportions of Black women are more likely to lose obstetric services than other rural counties.

To address this dangerous lack of access, health plans must continue to embrace and expand virtual care. For many low-risk pregnancies, prenatal care can be effectively provided virtually, while virtual care enables more consistent, continuous care to be delivered to high-risk patients. Some communities are shifting to providing blended care, where physician assistants or nurse practitioners perform in-person prenatal or postpartum checkups that are supported by OB providers remotely. Remote patient monitoring devices can also be used to monitor the vitals of the birthing parent and baby from the comfort of their own home.

Providing culturally-competent care

Improving access to care is only one step in improving health equity for all, as health disparities have persisted even with increased access to care. Beyond bringing qualified care to maternity care deserts, virtual health can also increase opportunities for culturally-competent care and care matching, which is especially powerful for BIPOC and LBGTQ+ patients. ‍

37% of Black mothers say they have been treated unfairly while receiving care due to their race, and 15% of LGBTQ+ people have postponed or avoided medical treatment due to fear of discrimination. Virtual care widens the pool of providers available, so patients can more easily find providers that share their similar background and experiences. One CDC study found that 60% of Black adults and 59% of Latinx adults thought it was important to have a healthcare provider who shared or understood their culture, but 13% of both groups had never seen such a provider.

According to studies, care matching promotes greater trust and understanding between doctors and patients, contributing to better health outcomes and reduced healthcare disparities for underrepresented groups. Pairing Black patients with Black providers or LGBTQ+ patients with LGBTQ+ providers who can relate to their pregnancy experience brings several benefits, including more engaged patient-doctor conversations, improved prescription adherence, better patient understanding of health risks, and a greater willingness to pursue preventative treatment.

Empower patients with health literacy and autonomy

SDOH can also impact health literacy among expecting parents, making it more difficult for some to find, comprehend, and use information and services to inform health-related decisions. Inadequate health literacy is especially common in historically marginalized communities and low-income populations— studies have shown that 32% of Hispanic mothers, 31% of Black mothers, and 72% of low-income mothers were rated as having inadequate maternal health literacy.

This lack of health education can have detrimental effects on the health of birthing parents and babies. Birthing parents with inadequate health literacy had greater odds of cesarean delivery, and infants born to parents with low health literacy had an increased chance of preterm birth and low birth weight.

Some of the responsibility of improving health literacy falls on health payers and systems. Increasing the opportunities for health education when meeting with providers can make a tangible difference in health literacy and patient empowerment. Ensuring maternity care providers have the time and resources necessary to engage with patients at their level of comfort—and giving patients low-cost or free access to doulas, midwives, and other specialty care providers—can help increase expecting parents’ involvement in physical and mental care during pregnancy. Additionally, allowing patients to tap into a library of clinically-vetted content that takes into account where they are on the family-building journey and their level of health education can also help to improve health literacy and achieve more equitable care.

Moving towards more equitable care with Maven Clinic

Maven Clinic is the world’s largest digital health benefit for planning, growing, and raising healthy families, designed to help provide more comprehensive care during the family-building journey. Through Maven, members have 24/7 access to a range of maternity care specialists, resources, and virtual classes to improve health for birthing parents and babies.

Maven is dedicated to addressing SDOH to improve health equity by providing culturally competent care for all, increasing access to specialty providers, and empowering members through clinically-vetted content and virtual classes. Maven receives a 70 NPS from our members, and members also have 20% lower C-section rates and 32% lower NICU admissions.

As your organization strives to improve equitable care provided to your members, Maven is here to help. Schedule a demo with our team today to see how Maven supports families, improves outcomes for all, and reduces costs.