The Social Drivers of Maternal Health


pregnant woman, mom

The U.S. ranks last among industrialized nations for its high maternal mortality rate, with 17.4 women dying per 100,000 pregnancies. Black women, in particular, experience maternal deaths at 2.5 times the rate of white women and three times the rate of Hispanic women, and medical professionals are more likely to disregard reports of pain or discomfort from Black patients compared to white patients. 

Due to reproductive oppression and implicit bias, stemming from institutionalized racism, Black women face a greater risk of maternal health problems, which can lead to grave complications during pregnancy and birth. Rural pregnant women also face a nine percent higher risk of severe maternal morbidity and mortality (SMMM) compared to urban pregnant women and pregnant women who are uninsured or on Medicaid face a 33 percent increased risk for SMMM compared to pregnant women with private insurance. 

This rising maternal health crisis has sparked long overdue change across the country and in the healthcare system, leading to a number of changes and the introduction of numerous bills. Among them are the Maternal Health Quality Improvement Act of 2021Rural MOMS Act, and the Black Maternal Health Momnibus Act, a package of twelve bills focused on diversifying the perinatal workforce, improving data collection, and investing in telehealth and social determinants of health (SDoH) to improve maternal health outcomes.  

The role of SDoH 

“Social determinants of health have been shown to affect many conditions treated by obstetrician-gynecologists, including but not limited to preterm birth, unintended pregnancy, infertility, cervical cancer, breast cancer, and maternal mortality,” according to the Committee on Health Care for Underserved Women for the American College of Obstetricians and Gynecologists (ACOG) 

From housing and transportation to employment and education, women face many barriers to care, especially when it comes to maternal health. A pregnant patient may forget to take her prenatal vitamins, for instance, because she lives in unstable housing and moves from home to home on a regular basis. Rather than reminding her to take supplements on a daily basis or follow dietary guidelines, you could address her housing situation, which would supply her with a kitchen and enable her to focus more on her vitamin and nutrition needs.  

All social determinants of health play an important role in maternal health, but food and housing are often the most pressing needs for pregnant women, especially those living in low-income communities, who may not be able to access or afford stable or safe housing and food, let alone nutritional food. 

Housing instability linked to premature birth  

Between four to nine percent of pregnant women experience homelessness—and countless others face housing instability, which has been shown to have a significant association to adverse perinatal outcomes, such as preterm birth, low birth weight neonates, neonatal intensive care unit admission, and delivery complications. 

To study the effects of housing programs on infant health and mortality, a housing pilot program “Healthy Beginnings at Home,” established by our partneCareSource, as well as CelebrateOneHomeless Families FoundationColumbus Metropolitan Housing Authority (CMHA)Nationwide Children’s Hospital enrolled a cohort of 100 Medicaid-eligible pregnant women who were near homeless or experiencing homeless. Half of the women were provided with basic community-based services, while the other half received these services, in addition to rental subsidies and housing stabilization services.  

Comparing the “usual care group” and the “housing intervention group,” the findings of the initial pilot program showed that the housing intervention group saw better maternal health outcomes than their peers. 

  • No fetal deaths occurred in the housing intervention group, compared to four in the usual care group.  
  • Forty out of 51 babies were born full-term and at a healthy birth rate in the housing intervention group, compared to just 24 out of 44 in the usual care group.  
  • Among the infants that were admitted to the NICU, babies born to women in the housing intervention group stayed an average of 8 days, compared to an average stay of 29 days for babies born to the usual care group. 

This program revealed what many have known for a long time: housing and health are closely linked. If we want to protect the health of a woman and her unborn child, we must address her basic housing needs. Safe and stable housing isn’t always easy to find, but community partners have the expertise, resources, and connections required to facilitate arrangements. This is why cross-sector, multi-stakeholder partnerships are so important. 

Food insecurity increases stress and perinatal depression  

According to a 2019 Planned Parenthood survey of low-income women of reproductive age (ages 18 to 44), two-thirds of participants reported that they had difficulty paying for food, housing, medical care, or heating. Twenty-three percent of respondents reported needing food for themselves and their families, a percentage which likely rose in 2020 when the number of food-insecure households with children tripled to 30 percent.  

Not only does food have a direct correlation to health, but it also impacts maternal mental health. Findings reveal that: 

  • Food-insecure mothers experience generalized anxiety disorder and major depression twice as often as mothers who are food secure. 
  • Food-insecure mothers are more likely to supplement or switch to formula feeding, due to concerns about the supply or quality of their breastmilk.  
  • One study conducted in Illinois found greater odds of pregnancy morbidity among pregnant women living in food deserts.  
  • Low-income pregnant Latina women experiencing food insecurity were 2.5 times more likely to experience depressive symptoms during pregnancy than non-Latina white and African American or Black women. 

Though the impact of food insecurity on health is well-documented, more data is needed to understand the full impact of food insecurity on maternal and neonatal health outcomes, though we suspect it’s significant. 

How to drive better maternal health outcomes 

There is no doubt that SDoH play a large role in the health of mothers and babies, but in order to achieve better maternal health outcomes, payers, providers, CBOs, policymakers, and other key stakeholders must work together to address social needs in pregnant women and new mothers.  

Here’s what you can do to improve maternal health outcomes: 

  • Support the Black Maternal Momnibus Act.  
  • Expand Medicaid coverage for pregnant and postpartum women.  
  • Invest in SDoH programs that provide housing, food, non-emergency transportation, and other social services to pregnant women and new mothers. 
  • Encourage a patient-centered approach to care by recognizing the impact of structural racism on health.  
  • Encourage providers to implement implicit bias training. 
  • Improve data collection and analysis to better understand and document the impact of social drivers on maternal and neonatal health.  

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Topics: social determinants of health health disparities SDoH interventions SDoH partnerships sdoh

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