The United States is the only wealthy country where the maternal mortality rate has risen over the past two decades. In 2020, the maternal mortality rate in the U.S. was 24 deaths per 100,000 live births — more than three times the rate in most other high-income countries. In the Netherlands, almost no women died from maternal complications. The U.S. maternal mortality rate is exceptionally high for Black women1. Black maternal health has become a crisis due to inequities driven by interpersonal and institutionalized racism, specifically in healthcare settings. In recognition of Black Maternal Health Week, April 11-17, we are sharing how Blue Shield’s Maternal Child Health Equity initiative is addressing the ongoing racial health inequities head-on by intentionally investing in a support system for pregnancy and post-partem communities, especially Black families due to the on-going mortality and morbidity crisis among Black mothers – or birthing people – and infants.
Jackie Ejuwa is vice president of Health
Transformation at Blue Shield of California.
Launched in February of 2022, our initiative focuses on investing in a comprehensive support system for pregnancy and post-partem communities through the inclusion of community-based organization services, doulas, and technology. The core idea is that supporting Black mothers with doulas hired by community-based organizations can reduce racial health disparities through intimate knowledge of the communities they serve.
We’re pleased to share that our pilot program achieved some early wins. Families who participated saw fewer adverse birth outcomes than both California and national averages:
The rate of Cesarian deliveries was lower for those who participated in the doula program (24%), compared to the BSC statewide average for Black and African American mothers (37%) and compared to the California average (32%).
Of the pilot population, 4% had premature births, and 9% of deliveries had low birth weights. In comparison, California’s average rate of premature births is 12%. The average rate of low-birth-weight deliveries in California is 14%.
Our survey data suggested that the doulas helped decrease pregnancy-related stress: 26% of mothers reported high current stress levels, but only 17% reported high stress about birth.
Listening, educating and elevating voices
Blue Shield’s doula pilot program mitigates the effects of discrimination and racism that can happen within the healthcare system by empowering mothers and their families through education on their health care rights during and after their pregnancy and encouraging parents to voice their preferences for their birthing experience. Hear one mother’s story here. Blue Shield is developing a program to expand these efforts later this year based on early success.The Maternal Child Health Equity initiative is part of a larger effort to reimagine health care. Central to that effort is listening to the community.
As such, Blue Shield’s Community Health team and the Black Wellness and Prosperity Center convened a series of Black Maternal Health Circles this past year. The circles provided a safe space for women to share pregnancy experiences and advise Blue Shield on developing equitable solutions. Participants candidly shared experiences about their interactions with health care providers, health plans, and Blue Shield’s maternal health resources.
It is Blue Shield’s duty to our members and California communities to acknowledge the vast inequalities in maternal health care and actively use our work to change the policies and systems that are barriers to equal opportunities. We’re dedicated to supporting our communities so they are set up for healthy success – to not only survive, but thrive.
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