In December, 2020, the United States Department of Health and Human Services published three documents detailing the surgeon general's call to action to improve maternal health in America (United States Department of Health and Human Services [US DHHS], 2020a, 2020b, 2020c). They offered targets to accomplish within 5 years: decrease maternal mortality rate by 50%, decrease low-risk cesarean birth rate by 25%, and control and treat hypertension for at least 80% of women of reproductive age who have hypertension, with rationale for each (US DHHS, 2020a). Specific challenges listed to achieve these targets included racial disparities and health care inequities, lack of or inadequate health insurance coverage, lack of access to care, especially in rural America, variation in clinical practice, minimal quality data that are not often current or timely to inform improvement efforts (US DHHS, 2020a).

A model incorporating prepregnancy, pregnancy, and postpartum included four goals; healthy outcomes for all women of reproductive age, healthy pregnancies and births, healthy futures, and improvements in data and support for research (US DHHS, 2020a). Each goal included objectives and what HHS was planning to do to achieve them. For example, they listed a competition for research funds to support development, publication and implementation of state-of-the-art models of care, strengthening publicly reported quality measures and hospital participation in perinatal quality improvement collaboratives, support for the Alliance for Innovation on Maternal Health (AIM) initiatives and development of more of their hospital-based safety bundles, specifically including those for cardiovascular disease and sepsis, implementing AIM bundles at all Indian Health service federal facilities, and using AIM bundles in outpatient and other community settings.

Healthy futures should be supported by all states enacting extension of Medicaid coverage for postpartum women with substance use disorders from 60 days to 365 days, and other strategies to make sure all women are covered as needed. They stopped short of recommending coverage for all women on Medicaid for at least 1 year postpartum. A nationwide paid family leave program was recommended so mothers can focus on their health and establishing healthy bonds with children. An initial $3 million fund for new projects for maternal health data was recommended, although that amount seems very limited. Addressing racial disparities in maternal morbidity and mortality to support original, innovative, multidisciplinary research to promote understanding, prevention, and reduction of maternal mortality or morbidity among racial and ethnic minority women and socioeconomically disadvantaged women, including in rural settings was recommended. Plans for developing a program of rural obstetric readiness in 2021 for rural sites that include an emergency department but do not have on-site labor and birth services were discussed.

When the publications were released, there were numerous comments on social media about the lack of well-known Black perinatal health scholars being involved and lack of citation of their work, a major omission of the voices of those who serve women who have suffered the most from health care inequities and racial discrimination, which are in large part responsible for the disparities in maternal and infant outcomes in the United States. Timing of publication is concerning as those who were responsible were in a lame duck period about to leave office, and likely had little chance of seeing any of their goals, objectives, and recommendations get started. Hopefully the career public health professionals who contributed remain in service and promote the work. Funding recommended for many of the goals was minimal at best; much more financial support for health of childbearing women is warranted to have any possibility of widespread and long-term success. It's now May 2021, so we should have an idea of how the new administration will follow through with this call to action to keep mothers and babies safe during pregnancy, childbirth, and the first year.

References