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Join us as we dive deeper into the rising severe maternal morbidity and maternal mortality rates in the United States through a data-driven, quality improvement lens. Each episode will foster discussion with those committed to improving maternal health outcomes and saving lives.
Christie - 00:00:04:
Welcome to AIM for Safer Birth. I'm your host, Christie Allen. I'm the Senior Director of Quality Improvement and Programs at the American College of Obstetricians and Gynecologists, or ACOG. ACOG is a proud participant and sponsor of Black Maternal Health Week this year. On this special episode of our podcast during Black Maternal Health Week, we're going to dive deeper into topics around the prevention of severe maternal morbidity and maternal mortality in the United States through a data-driven quality improvement lens. So I'm joined today by two special guests, U.S. Congresswoman Lauren Underwood, who is the co-chair and co-founder of the Black Maternal Health Caucus and the lead sponsor of the Black Maternal Health Momnibus, which is a package of 13 pieces of legislation that comprehensively addresses the drivers of the maternal health crisis. My second guest is U.S. Health Resources and Services Administration, or HRSA, Administrator Carole Johnson. Carole leads the incredible multifaceted work that's being done nationally on maternal health. And my guests together recently launched the Enhancing Maternal Health Initiative in January of 2024. This initiative AIM to address maternal mortality and health disparities by strengthening HRSA's maternal health efforts in collaboration with various stakeholders, including mothers, community organizers, and state health officials. As we're recognizing Black Maternal Health Week nationally and also here at ACOG and in the AIM program, I'm so excited to have them both here today to discuss the work happening around Black Maternal Health and to achieve how we want to achieve those measurable progress pieces in addressing maternal mortality in the United States. So thanks so much for joining me, Administrator Johnson and Congresswoman Underwood. It's really a pleasure to have both of you. I want to dive into the work that HRSA is doing, but first I want to get to know more about both of you and your work. So Congresswoman Underwood, could you start us off today with what brought you to maternal health work and advocacy?
Lauren - 00:01:53:
Well, Christie thank you so much for having me. I'm so excited to be on with my friend and partner in all things maternal health, the great Carole Johnson. I came to this really based on my experience as a nurse. I remember early in my clinical education learning about the disparities in infant mortality, then preterm birth, and then maternal mortality. And so I've cared a lot about maternal and child health throughout my career. My focus on maternal mortality was sharpened when a good friend of mine from my graduate program, her name was Dr. Shalon Irving, died a couple weeks after delivering a beautiful baby girl in early 2017. And so I knew that if I won my congressional election, this would be an issue I wanted to work on in Congress. And so I teamed up with Alma Adams in April of 2019 to launch the Black Maternal Health Caucus.
Christie - 00:02:43:
Thank you so much for that. First of all, fellow nurse, so love to meet another nurse. I'm very familiar with Dr. Irving's story. I think for listeners, we will also link to... A video that Dr. Irving's family made with us about that experience because it's deeply meaningful and because we need to remember her and the roots that we have that helped grow this work. So Administrator Johnson, I was wondering if you could describe your role at HRSA a little bit in support of maternal health and the AIM program. As folks know, we're a cooperative agreement with HRSA, and I'd love for you to talk more about that today.
Carole - 00:03:16:
Thanks so much, Christie. Thank you for having me. And I'm just so delighted to be here with my friend and colleague and the champion for all of this work, Congresswoman Underwood. We're all so fortunate that she not only worked here in HHS, so knows what it takes to get the work across the line on the administrative side, but has been just such a fierce champion in Congress. You know, so here at HRSA, as you know, we have been very fortunate to work with Congress to secure the resources necessary to fund AIM and then make AIM happen in states across the country. And, you know, it is sort of quintessential quality improvement work. If we're going to make a difference in health care outcomes for women across the country, then we need to be focused on what happens and what the evidence shows us and what best practices show us is necessary to happen inside the hospital walls, but not just inside the hospital walls, in the community. And so we're increasingly seeing AIM not only be, the checklist of best practices in the labor and delivery unit, but also what happens when people leave. How do we make sure that people experiencing substance use disorder are connected to medications for opioid use disorder or are connected to treatment sites? How do we think not only about making sure that everyone whose 24-7 job it is to care for women is as trained and as supported as possible, but also that they have the tools and resources and support to make sure that women can get the support and the community they need. And that's really what the Congresswoman has been such a champion of, thinking holistically about this experience, not just pieces of the puzzle, but the whole puzzle.
Christie - 00:04:52:
I really appreciate you both expanding on and highlighting the lifespan continuum. That's an approach that I think we have to take. We're foolish not to. People are whole people. They're pregnant a lot less of the time than they are not. And I really appreciate the wide focus that you all are taking in your work as well as supporting us in the AIM work. I was wondering if you could take a minute, Representative Underwood, and talk to us about Black Maternal Health Week in particular. I think many of our listeners are very well versed in the vast inequities that we know lead to disparities and outcomes. But what specifically are we looking at recognizing, particularly for Black families? Why are we recognizing this week?
Lauren - 00:05:27:
So Black Maternal Health Week begins on April 11th, and it's an opportunity to come. Together and recognize the severe impact of both maternal mortality, which is maternal deaths, and severe morbidity, which are those complicated. Deliveries and that have had across the Black community in particular. The data tells us that nationwide for every death, we have 70, 7-0 near misses. And so this ends up being a really prevalent dynamic, particularly in the Black community, because of the high rates of maternal death in our country. And so it's an opportunity for us to lift up the local leadership by community-based nonprofits, the great work of our committed providers to talk about recent wins, like we've seen through appropriations and the launch of incredible new initiatives like coming out of agencies like HRSA, but also to make sure that we are focused on addressing immediate challenges. And so since the last Black Maternal Health Week, for example, we've gotten New nationwide data that suggests that since 2018, the maternal mortality rate went up nationwide 89%. And so we can really put a bright spotlight on the current situation as we focus all of our efforts on ending these disparities and saving lives.
Christie - 00:06:46:
I really appreciate your point about amplification. I think that is what it always should be. And there should be folks talking about this that are impacted by it. We've been really fortunate and AIM to integrate some folks with lived experience and expertise, but there's nothing better than that community focus and the community organization focus. And frankly, by Black women-led organizations who spearheaded Black Maternal Health Week. Administrator Johnson, are you able to describe how HRSA programs and resources improve the well-being for those we care for during and after pregnancy? You touched on this a little bit before as you were talking about sort of across the span, but I'd love to hear in your words some of the highlights maybe.
Carole - 00:07:23:
Let me just start by saying that the data that Congresswoman Underwood just walked through is just completely unacceptable. It cannot be the case that in the United States of America, we're seeing this level of maternal mortality and morbidity and the incredible disparities that we see. And that's why, as the Biden-Harris administration, when we walked in the door three and a half years ago, we said, basically, we need to use all of the resources we have across government to be able to tackle this crisis. And that's why the president insisted we have a White House blueprint for tackling the maternal mortality crisis. That's why the vice president convened the first ever cabinet meeting on these issues, where I got to sit next to and around the table with the secretary of housing and the secretary of labor and really focus on how this is, importantly, is a health care issue, but it also is an issue about jobs and housing and transportation and child care and all the things that make it possible to get the best possible health. And really, what we try to do at HRSA is think holistically, as you pointed out before, like women don't experience pregnancy in the pipelines of where we get appropriations or the way programs are designed. They experience pregnancy holistically as part of their lives. And so we need to make sure at HRSA what we're doing is we're focused on prenatal care, early access to prenatal care. We're focused on the pregnancy experience, what happens inside the hospital walls. We're focused on postnatal care, making sure not only that, the infant gets follow up care, but that moms get follow up care. And we're focused on making sure and the president has really been committed to making sure that that health, those health care services are available 12 months post pregnancy and not just the 60 days they were before. And as important as that is, it matters that your insurance card has a place to take you, that we're not just saying you have Medicaid for 12 months. We're saying you have Medicaid for 12 months and there's a high quality place where you can get health care. And that's why we're investing in making our health centers that see people regardless of their ability to pay as well structured and well funded to deliver prenatal and postnatal care to deliver women's health. And that's why we're focused on in supporting social determinants of health, which is really about what does it take to make sure, you know, if I have to take off work and take three buses and find childcare for my kids in order to get to a prenatal visit, that may just be too high a barrier. And we need to make it easier and we may need to make the choices and the capacity, and the supports as easy as possible so people get the care they need.
Christie - 00:09:56:
Even with all the privilege in the world, those barriers can feel insurmountable. Just navigating the systems. I know that last season on our podcast, we talked about the navigation piece and how important that is. And I appreciate what you all are doing to make that navigation meaningful and possible for folks on the ground. You know, it's an unacceptable marker of well-being is did you die when you hadn't your child, right? The unacceptable. And so I appreciate that we're taking a more comprehensive and the flexibility that has been afforded to us, at least in the AIM program, to address emerging topics. I think that's also been a real advantage to working with the funding that you all were able to secure and are able to offer us here at ACOG as we do the AIM works. So I really appreciate that.
Carole - 00:10:34:
I appreciate you raising that. I noted that in one of the previous podcasts, you really talked about how we talk about this and how women experience the system and how too often, you know, we hear women say things like at one of our at the kickoff meeting for our Enhancing Maternal Health Initiative, we hear women say things like, I did everything right and I still had a bad outcome. And that's just the like, that is tragic. Not only these women experience tragedy, but then they somehow are carrying this burden that about their experience, as opposed to recognizing that the system failed them. They didn't fail themselves. And we need to build the tools and supports so that that we're supporting them the way that the system is supposed to.
Christie - 00:11:15:
Yeah, I really appreciate that. You shouldn't have to do everything right to have a healthy pregnancy and a healthy baby. That's what safety nets are for. That's what support is for. That's what clinicians are meant to be, is providing that respectful, supportive, and equitable care so that it's also high quality. It's so fundamental. So I really appreciate that. I do want to start with some insight from Capitol Hill, Representative Underwood. What is the momnibus? You folks heard me say that earlier. And if you're not sort of a policy geek on top of being a quality geek and listening to this podcast, which I happen to be both, you may not know what those are. So what is the Momnibus? What does it do? And where is it in the process right now?
Lauren - 00:11:53:
So the Momnibus is comprehensive legislation that I introduced first in 2020 with then, Senator and now Vice President Kamala Harris as a comprehensive approach to address every clinical and non-clinical driver of our nation's maternal health crisis, really focused on addressing maternal mortality and the disparities that we see across the country. The Momnibus is now 13 bills, and our Senate sponsor is Senator Cory Booker. And we are addressing things like social determinants, so housing, nutrition, transportation, environmental conditions. We have a WIC expansion in the Momnibus. We are addressing provider issues to both grow and diversify what we call the perinatal workforce. So yes, more OBGYNs, but also more midwives and doulas and lactation consultants. We're addressing emerging technologies to make sure that things like your Count the Kicks app is available equitably across the country. And then making sure that we're tackling the leading causes of maternal death in our country, like mental health, behavioral health, and substance use disorder. When you combine suicide and overdose, you have the leading cause of maternal death across the United States, including for Black moms. And so this is an opportunity to address all of these factors in one, because we know that when we improve the quality of care for Black moms, it improves the quality of care for all moms, including all moms in every community. So you shouldn't have to live in the shadows of an academic medical center in the United States in order to have a choice of providers. You shouldn't have to live in an urban or suburban area to know that you can. Deliver at a hospital or a birth center, or you could get just the quality care that you need. Now, what's not in the Momnibus is the postpartum Medicaid expansion. And so we are very supportive of what has already been done, which is creating that state option for postpartum Medicaid and the ongoing legislative efforts to make that mandatory. But that is not in the mom-to-bus because that was sort of moving and with bipartisan support before I got to Congress. And so we didn't want to do anything to disrupt that initiative. But there's some other things that need to be done.
Christie - 00:14:06:
Thank you so much for explaining that, Representative Underwood. That is, hold up the hill endeavor, it sounds like, and incredibly complex, but we are very grateful for the funding it secures. As a former WIC kid, I appreciate the approach to really holistically looking at what helps people be well and thrive. Next, I'd love to talk, maybe Administrator Johnson, you could share with us some insight into the specific goals and objectives. We've mentioned now a couple of times the Enhancing Maternal Health Initiative, which I know all of this work is made possible by the work on the Hill, but I'd love to hear about what the intent of that is from the HRSA side.
Carole - 00:14:40:
Yeah, thanks so much. You know, so we recently launched our Enhancing Maternal Health Initiative, which is really our opportunity to focus on those places where the rates are too high. And we at HRSA have done some, thanks to Congresswoman Underwood's help, and frankly, many of the people on this line who've been doing this work for years, and we're able to leverage their expertise and support and really focus on states where we have significant HRSA investments and we can work together to make the whole greater than the sum of the parts. So there are places across this country where we are focused on investing in AIM in the clinical setting, as you and your colleagues are working on, where we're focused on Healthy Start initiatives, where we have community-based organizations doing that high-touch support services for soon-to-be-pregnant, pregnant, new moms, and postpartum moms, helping with food assistance and tenant assistance and getting connected to school and getting all of those supports. We also focus on home visiting, where we're able to bring nurses and social workers and parents as teachers into the homes of new moms. And everyone knows the start of having a new infant-at-home is hard and challenging. Being able to bring that support in and get people connected to resources and really thinking about how all of our communities supports work together to best deliver for folks. And we're also training more doulas, training more labor and delivery nurses, training more nurse midwives, so that we can build out the support that's necessary in the community to center the services around women's needs and women's voices. Women are telling us what's not working. And we are prepared to stand up and respond with what we know will work and does work. That's what the Congresswoman has been a champion of. That's what we're working on. And we're focused on. And so one of those couple of things that Congress has delivered for us in the last couple of years, thanks to the voice of champions like Congresswoman Underwood, is one, we've launched a new research network with maternity, with minority serving institutions around the country for the first time to really have, you know, for so long, research has been focused on kind of what happens in the institutions, in the big, you know, traditional legacy institutions. This is to bring maternal health research to the community and particularly to minority serving institutions that will work with communities to be able to identify and take to scale, help us take to scale where things are working, what we need to do, what those barriers are, how to bring them down, and how to really succeed in helping better support women. And we've also, with the support of Congress, launched the Maternal Mental Health Hotline. The Maternal Mental Health Hotline is at 833-TLC-MAMA. Mental health is among, is the top leading cause of preventable death when it comes to pregnant and new moms. And we need to have a safe, confidential place for people to call and get emotional support and mental health support 24-7, call or text. You know, that is part of a larger solution that we're working on where we're working to support maternal health providers in better training them to support the mental health and substance use disorder needs of their patients. So we're thinking about this holistically. And our initiative is about really putting a laser focus on that and building some shared metrics for those outcomes.
Christie - 00:18:10:
So a truly integrated approach.
Carole - 00:18:13:
That's right.
Christie - 00:18:15:
So as we head into season two of the AIM for Safer Birth podcast, our theme this season is the one thing. And I'm hoping you all can help me start that as we wrap this special episode. Can you share, Administrator Johnson, the one thing that you'd want our listeners to know about maternal health, even if it's something we've already covered? What is really important to reinforce in this space?
Carole - 00:18:36:
So I think what I would say is I hope what people come away with is the real sense that this is a priority of the Biden-Harris administration. We are pulling all levers of government, both policy and funding, to be able to support what it takes to change these dynamics on the ground. And we're doing that in a way, my one thing really is, about centering things around women's voices, around making sure that women's voices are heard, about building a health care system that responds to what women need. We heard heartbreaking stories at the launch of our Enhancing Maternal Health Initiative from Black women after Black women about how they knew something was wrong and they weren't listened to. And that's what needs to change.
Christie - 00:19:26:
Thank you so much for your time.
Carole - 00:19:28:
Well, thank you to you and thank you to your listeners for all the work that everyone is doing and has done. It makes a tremendous difference in communities across the country.
Lauren - 00:19:37:
Thank you for having me. Carole thank you so much for your tremendous leadership and happy Black Maternal Health Week, everybody.
Christie - 00:19:49:
Thanks for tuning in to AIM for Safer Birth. If you like this show, be sure to follow wherever you get your podcasts so you don't miss an episode. To get involved in work related to addressing maternal mortality, be sure to check out the Alliance for Innovation on Maternal Health at saferbirth.org. Together, we can work towards safer birth and healthier outcomes for all families. I'm Christie Allen, and I'll talk to you next time on AIM for Safer Birth. This podcast is supported by the Health Resources and Service Administration, or HRSA. Of the United States Department of Health and Human Services, or HHS, as part of an award totaling $3 million annually and is 100% funded by HRSA. The views are those of the hosts and do not necessarily represent the official views of nor endorsement by. HRSA, HHS, or the U.S.