Federal health officials on Thursday said improving clinical care quality and expanding healthcare coverage will go hand-in-hand to improve maternal and infant mortality rates in the U.S.
HHS unveiled a new action plan Thursday that outlined strategies for addressing maternal risk factors with an aim of reducing the country’s maternal mortality rate by 50% by 2025.
The action plan also eyes lowering the number of low-risk, cesarean deliveries by 25% over the next five years. Low-risk cesarean deliveries are first-time mothers delivering a single child headfirst at full term. Experts say these C-sections are mostly unnecessary and have been linked with longer hospital stays and higher risks of infection and bleeding.
A 2019 Leapfrog Group analysis found C-sections were performed in 1 in 3 births, with more than quarter of those procedures performed for first-time pregnancies.
HHS wants to increase the proportion of reproductive-age women with hypertension who have their blood pressure controlled to 80% by 2025. According to the CDC, nearly 10% of women between the ages of 20 and 44 have hypertension, and 17% of those are unaware of their condition. Approximately 41% have uncontrolled blood pressure levels.
In a call with reporters on Thursday, U.S. Surgeon General Dr. Jerome Adams said two-thirds of maternal deaths in the U.S. were preventable and a woman still dies every 12 hours due to pregnancy-related complications.
“This is not just unacceptable, it is something that we need to understand is not inevitable,” Adams said.
Those efforts need to focus more on racial disparities in maternal mortality. Black women die from pregnancy complications at more than twice the national average, with 37 deaths for every 100,000 live births.
Black maternal mortality remains higher than other racial groups regardless of income or educational level. Black women die from pregnancy-related causes at nearly twice the rate of white women without a high school diploma, according to the CDC.
HHS called for improving the quality of and access to postpartum care, with particular focus on providing more mental health and substance use services. The agency recommended that states should be allowed to extend Medicaid coverage for postpartum women with substance use disorder from 60 days to up to one year after birth. The Medicaid and CHIP Payment and Access Commission supported this policy in October, and it has also gained momentum among lawmakers.
The agency called on CMS to align quality measures for maternal care within Medicaid and Medicare.
HHS partnered with the March of Dimes Thursday to promote evidence-based best practices to improve healthcare quality at hospitals, citing the racial gaps in maternal health outcomes. The agency also plans to launch a $3.3 million competition to develop care models that can ensure pregnant women receive hypertension monitoring and postpartum follow-up care after they give birth.
Adams warned the COVID-19 pandemic could worsen maternal health outcomes as pregnant women may forgo routine doctor visits to avoid contracting the virus.