Employers can take steps to help reduce high maternal mortality rate in U.S.

The United States is in the unenviable position of having the highest maternal mortality rate among high-income nations, and this rate is steadily increasing. The good news is that more than 80% of recorded pregnancy-related deaths are preventable, and employers can play an important role in reducing that number.

“Employers are in a unique position to hold health insurers and vendors accountable for the work they do and how equitable access to quality care is achieved,” according to a new report from Mercer. “Without pressure from employers, insurers and vendors are unlikely to change the current practices that are not adequately supporting birthing people of color. As with many areas of health, employers can look to public health initiatives and follow Medicaid’s focus on trying to address the complex factors that contribute to maternal mortality and morbidity in the United States.”

The causes of maternal morbidity include obstetric hemorrhages and heart conditions, as well as mental health-related conditions that surface during pregnancy and worsen during the postpartum period. Black and native women and those living in rural communities experience maternal mortality and morbidity at significantly higher rates than their white and urban counterparts. For black women, the maternal mortality rate is three times that of non-Hispanic white women.

Contributing to this disparity in outcomes are chronic conditions, which are exacerbated in pregnancy by unequal access to high-value care and limited availability of culturally sensitive and patient-centered maternal health care.

Primary efforts should focus on ensuring access to quality providers of choice and reducing barriers to true and informed choice during pregnancy, birth and early postpartum. Access to certified nurse midwives and certified professional midwives, who focus on holistic, patient-centered care with the assumption that birth is a unique life event rather than a strictly medical event, is associated with significantly lower rates of intervention compared to obstetric care and should be prioritized as an option, particularly for low-risk individuals.

Continuous labor support from doulas (trained companions who are not health care professionals) is associated with lower rates of medical intervention and better birth outcomes, particularly for women of color. Because doulas typically provide in-person support, they often are community-based and selected by members based on “fit.” Although the relatively low cost of doula support can still be a barrier for members, for an employer it would represent a minimal investment with probable far-reaching positive impacts for a member’s physical and emotional health.

The report recommended six actions for employers:

• Provide expectant families with financial reimbursement to cover doula support. Ensure that members have access to a network of community-based providers who can support them in person if desired, and that members can select doulas based on racial, ethnic, religious, gender or sexual identity, as well as lived experience.
• Review plan language and limitations surrounding out-of-hospital birth (at-home birth and birth centers). Consider an out-of-network benefit to provide some level of assistance where health plan networks may be insufficient.
• Review network access and discuss network inclusion requirements with the health plan administrator for freestanding birth centers and midwives, using state regulations and evidence-based recommendations from leading regulatory bodies such as the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and American College of Nurse-Midwives as a guide.
• Hold carrier partners and vendors accountable for provider matching capabilities, ensuring that members can search for and select providers who self-identify with a particular race or ethnicity, sexual and/or gender orientation, lived experience or training/expertise.
• Collect race and ethnicity data from members, send it on eligibility files to vendors and hold vendors accountable for health outcomes stratified by race and ethnicity.
• Review the health plan’s maternity coverage. Ensure that members have virtual and in-person access to both traditional and alternative providers, such as midwives and pelvic floor physical therapists.

Related: High Medicaid disenrollment patterns after individuals give birth

In addition to increasing access to providers, employers should ensure that their culture and policies support pregnant, birthing and newly postpartum individuals through generous paid parental leave and phased return-to-work programs.

“Provide manager training on how to support expectant and new parents of all genders and family makeups to reduce stigma associated with talking about pregnancy and birth, as well as lactation,” the report says. “Finally, consider whether you need to reset the standards for benefits communications within your organization to ensure that images and language are inclusive.”