Commentary: Recycled ‘solutions’ won’t remedy maternal health inequities Posted on : Thursday, January 4th, 2024
There’s a quote from Martin Luther King Jr. that has become ubiquitous in monthly newsletters from health-focused nonprofits: “Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.” Few people realize King’s remark originates from a 1966 press conference held here in Chicago.
And even fewer people are aware that King was highlighting the fact that the infant mortality rate among Black infants in Chicago was no better than among Black infants in Mississippi.
There’s a quote from Martin Luther King Jr. that has become ubiquitous in monthly newsletters from health-focused nonprofits: “Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.” Few people realize King’s remark originates from a 1966 press conference held here in Chicago. And even fewer people are aware that King was highlighting the fact that the infant mortality rate among Black infants in Chicago was no better than among Black infants in Mississippi.
I imagine many people would be shocked to hear that the Black infant mortality rate in Cook County today (11.4 per 1,000 live births) is no better than the Black infant mortality rate in Mississippi (11.2 per 1,000 live births). In fact, the Black infant mortality rate in Illinois in 2017-2019 (12.2 per 1,000) was worse than in Mississippi (11.2 per 1,000).
Callan Jaress is co-founder and chief strategy officer of Holistic Birth Collective.
Critical review of the most recent Illinois Maternal Morbidity & Mortality Report (reporting on statewide data for 2016-2017) reveals that the rate of avoidable mortality amenable to health care among Black mothers (35 per 100,000 live births) exceeded that of non-Hispanic white mothers (2 per 100,000 live births) by a factor of more than 15 to 1. Put another way, if our maternal health system furnished timely and effective health care to Black mothers as well as it did for white mothers, the rate of pregnancy-related deaths due to medical conditions among Black mothers would decrease by more than 80%.
Maternal-infant health injustices are the product of health system dysfunction in Chicago. In 2014, an article in The Lancet called for “a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all.” Targeted investments in growing the midwifery workforce in Chicago are necessary to addressing dysfunction in our maternal health care system.
Licensed certified professional midwives are newly legal in Illinois. Like certified nurse midwives, licensed certified professional midwives, or CPMs, are trained and educated to international standards and capable of providing the essential components of maternal-newborn care needed by 90% of the childbearing population. And importantly, licensure as a CPM does not require a bachelor’s degree.
Chicago should install a direct-entry midwifery program within one of the City Colleges of Chicago and have a new cadre of licensed CPMs ready to go within three years. And because licensed CPMs specialize in working in out-of-hospital settings, there is no reason to exclude underinvested neighborhoods from program installation. The “capital intensive” resources necessary to support conventional health care education programming (e.g., hospital simulators) are not necessary for successful community midwifery programs.
If we want something different, we have to be open to doing something different. But too many initiatives being marketed to taxpayers as “solutions” to maternal health inequities merely recycle the same old strategies that have already proven ineffective. Increasing “access” to perfunctory, low-value maternity care did not work in the ’90s, and it’s not going to work now. Dumping over $12 million of general revenue funds into “evidence-based home visiting” programs does not change that the best research available concluded that those programs fail to benefit any relevant maternal health outcome. The same is true of “care coordinators,” “case managers” and “patient navigators.” Band-Aids on broken legs are politically expedient, but they do not realize population-level health improvements.
The path of least resistance is a dead end.
