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Health equity for women and babies: transforming maternal healthcare

Trisha Swift DNP, MS-MAVIM, Managing Director, Health Transformation, PwC US 09 Jun 2023

Maternity care is one of many important issues in providing safe access to healthcare for women. Health equity factors into many areas of women’s health, including family planning, the misdiagnosis of heart attacks and strokes that can often go undetected in women and the rising percentage of women in medical school enrollment and how this can help bridge the gap in representation. Further, it's important to recognize that maternal care begins well before pregnancy with safe and reliable reproductive healthcare options.1

To hear a discussion on maternal care, listen to PwC’s Next in Health podcast, Next generation maternal health.

Transformation of the maternity care system will likely require new models of health care delivery that can improve the health of mothers and babies. Policy changes, payment and benefit reforms and new mothers are driving a need for innovation in the maternal care model. These changes are welcome, as the United States’ maternal health system lags behind other well-developed countries:

  • The US ranks the highest of any high-income country in maternal mortality.2
  • Every year, more than 50,000 women experience severe medical problems resulting from labor or delivery.3
  • Thirty percent of maternal deaths happen during pregnancy and 52% happen in the first year of a baby’s life.4
  • Studies show that 60% of maternal deaths are preventable.5

Viewing these stats through a health equity lens, Black women consistently experience three- or four-times worse outcomes compared to White women.6 Other factors associated with the US maternal health care system include:

  • High rates of C-sections.7
  • High rates of preterm births8 and NICU stays.
  • High rates of perinatal anxiety and depression.9

Clearly there is a reason for concerted attention on women's healthcare access, equity and quality.

Improving maternity care

Profound shifts are needed to help innovate the future of maternity care in America:

Policy changes

The experiences of Black mothers are shining a light on the racial disparities and inequities in the system. Through their voices, a powerful push toward policy change is underway. Forty percent or more of births are paid for in the US by Medicaid, which makes Medicaid the largest payer for maternal health in the country.10 A large percentage of Medicaid births occur to women of color. As a result, Medicaid-oriented reforms are being passed that can help to extend the reach of care to Black communities. For example, state by state, many policy actions have taken place that are designed to:

  • Expand prenatal education;
  • Remove incentives that contribute to high rates of C- sections when they’re not medically necessary;
  • Expand access for coverage to mothers beyond 60 days and to the first year of the baby’s life;
  • Cover doulas through insurance dollars and more generally, expand the perinatal workforce, especially midwives;
  • Provide access to safe and comprehensive women’s healthcare, an imperative for driving equity.

All these actions are intended to help improve overall access and maternal health care coverage to mothers and to the Medicaid population at large. There are also Medicaid pushes to cover birth centers. These are lower-cost settings that are alternatives to traditional hospitals. These birthing sites can give women a safe way to access care.

Payment and benefits reforms

Virtually every commercial payer has introduced bundled payments that essentially provide a flat fee for all episodes of a patient’s care. This contrasts with the traditional fee-for-service model that creates incentives for more procedures and more medical interventions. Health systems are starting to think about creating a different care mix – both in terms of the care providers and the care setting – while coverage for maternity care still varies. For example:

  • Midwife-led outpatient birthing suites are beginning to emerge as an alternative site of care. These suites have access to neonatal intensive care unit (NICU) facilities, specialized staff and equipment that may be required in acute care on the labor and delivery floor. This holistic model of care differs from the one-size-fits-all approach where mothers and their babies may be treated “per protocol,” which can often result in higher costs and a propensity for unnecessary tests and interventions.
  • Group prenatal care is an alternative to traditional, individualized care. Under the model, providers offer the same physical health care services for individual patients, who also convene as a group for facilitated discussions on topics ranging from preparations for parenthood and stress management to breastfeeding and nutrition.11 Integrating physical and emotional health into one care model can support women on their motherhood journey by surrounding them with peers experiencing the same milestones and challenges.
  • While the Affordable Care Act (ACA) strengthened maternity care coverage, access to benefits often depends on the type of insurance and geographic location, and out-of-pocket costs can vary significantly. Many types of non-ACA-compliant plans, such as short-term plans or association health plans as well as some student health plans, don’t cover maternity benefits. There is a need for equitable and comprehensive coverage for maternity care and women's health overall.

Holistic and digital care

America’s millennial mothers account for more than 80% of today’s births.12 These women may favor holistic care that pays attention to their wellness and mental health as they move through pregnancy:13

  • They likely want to be active participants in their own care choices and seek to be better informed.
  • They’re likely adopters of telemedicine and have seen how digital models can improve the experience for women would like the same options for maternal care. However, age, sex, median household income, insurance status and marital status are associated with patient participation in telehealth.14
  • They likely want greater support for self-care during post-partum healing and support for physical, emotional and family needs as well as guidance on how to find a supportive network.

We will explore other women’s health equity topics in future blogs.

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