Let’s build bridges to birth justice l Expert Opinion

As we continue to process the leaked Supreme Court draft opinion on Roe v. Wade, it’s more important than ever to reflect on the high maternal mortality rate in the United States and, particularly, the stark racial disparity in these deaths.

In Philadelphia, Black people are four times more likely to die during — and up to a year after the end of — pregnancy than white people. These numbers, while distressing and frustrating, provide us with a unique opportunity. There is currently more funding than ever before to improve outcomes and build an equitable maternal health ecosystem.

The Philadelphia Maternal Mortality Review Committee (MMRC), established in 2010, is one of a handful of such county-level teams active in the country. We are a multidisciplinary group of stakeholders, including health-care providers and hospital systems, insurers, city agencies, community-based and family support organizations.

We have learned we need a new approach to our long-standing practice of relying on individual stakeholders to make changes based on recommendations from the review process. Previously, stakeholders were not able to fully scale up interventions, a barrier to population-level change. It also created silos and, at times, duplication of efforts. We recognize that maternal mortality is a complex problem that spans many sectors, and that it is essential to start building bridges. To that end, we have formed a coalition called Organizing Voices for Action, otherwise known as The OVA.

The OVA seeks to reduce the racial disparities in maternal mortality in Philadelphia by working across sectors to carry out recommendations made from the Philadelphia MMRC. The OVA includes women and birthing people, governmental agencies, health-care system professionals, insurance providers, maternal support organizations, policy advocates, social determinants of health professionals, and support networks.

The OVA is already working on system-level changes that will help increase birth justice and save lives. We have begun citywide implementation of Heart Safe Motherhood, a text-based postpartum blood-pressure monitoring program aimed at reducing complications of high blood pressure related to pregnancy. We have also disseminated implicit bias training at all Philadelphia birthing hospitals and increased access to doula services for prenatal, labor, and postpartum support.

Other efforts include educating health partners on the impact of unmet legal needs on maternal health, increasing access to family planning for women and birthing people who use substances, and helping to better coordinate referrals for social services.

In addition, we have developed and are disseminating an educational series for early warning signs of severe maternal morbidity to people who work with new parents, have established a cardiology task force to develop citywide recommendations for screening/identification for cardiovascular disease in pregnancy, and are holding focus group to learn what community investment means to Black community-based organizations.

We stand at a unique point in time — a time of increased attention, support, and funding, and we are poised to seize the moment to make meaningful change. We invite everyone to work together to build bridges toward birth justice.

Aasta Mehta, M.D., MPP, is the medical officer of women’s health for the Philadelphia Department of Public Health and vice chair of the Philadelphia Commission for Women. She oversees the Philadelphia Maternal Morbidity and Mortality Program, including the Maternal Mortality Review Committee and The OVA.