Catalyst for Payment Reform

Want to improve maternity care? Embrace health equity

Want to improve maternity care? Embrace health equity

Mother’s Day is around the corner, and one of the greatest gifts the United States can give to mothers is to improve maternity care. As covered in CPR’s March 24 webinar with Cathie Markow of the California Maternal Quality Care Collaborative, the U.S. continues to have unacceptably high rates of maternal mortality. Due to structural and interpersonal racism, Black and Indigenous women are dying or suffering from poor maternal outcomes at significantly higher rates than non-Hispanic white women. In addition to facing the steep financial costs of childbirth, women with both Medicaid and commercial health insurance (including employer-sponsored coverage) are navigating a landscape where maternity care providers do not reliably adhere to clinical standards of care. Clearly, more needs to be done.

The need for equity-based solutions

Health equity provides the principles and framework to address the maternal health disparity crisis in the U.S. The premise is simple: by improving care for those most likely to face poor outcomes, stakeholders can ensure that the health system is preventing poor outcomes for all patients. New data on maternal mortality in the United States show that non-Hispanic, Black women are dying at higher rates than their white counterparts, and survey data confirm that Black women are also more likely to report being treated unfairly during their stay in the hospital because of their race or ethnicity. Stories in the media, such as Serena Williams’ experience, also underscore why benefit managers should go the length to improve care for Black women, which in turn would likely ensure that all plan participants get care that meets their needs.

Luckily, many equity-based organizations and solutions can help guide this work. Black Maternal Health Week offered myriad examples of providers and community-based organizations that are “centering Black Mamas,” such as The JJ Way®, pioneered by Commonsense Childbirth in Central Florida. The National Partnership for Women & Families also featured Commonsense Childbirth in a recent report on innovative approaches to address maternal health disparities, which our guest speaker, Carol Sakala, cited during CPR’s April 9 webinar.  CPR is grateful for these organizations documenting health equity in practice.

Maternal health equity: an employer-purchaser example

Maternity care makes up a significant portion of employer-purchaser health care spending, so employer-purchasers have a vested interest in tackling this issue. During CPR’s March 31 webinar, Sara Rothstein, director of the 32BJ Health Fund, provided an overview of the Fund’s new program to improve maternity care among its 200,000 plan participants. The Health Fund calls it the High-Value Maternity Care Network.

The program uses patient-reported measures to center the needs of patients who may be more vulnerable to poor quality of care. To do this, the 32BJ Health Fund created an accountability structure, asking patients to respond to the following questions: “Was I treated with dignity and respect during my labor and delivery experience? Were my concerns heard?” Participating health systems made commitments to address instances in which patients report negative experiences in addition to reporting health outcomes by race and ethnicity. These commitments are essential because patient-reported quality measures and maternal health data on race and ethnicity are not widely available across the health system. The use of this accountability structure puts the 32BJ Health Fund’s High-Value Maternity Network on the cutting edge of the health equity movement.

CPR is available to help other employer-purchasers embrace a health equity approach to keep mothers safe and healthy, and to improve the value of their maternity care spending. If you are an employer-purchaser looking for guidance on this topic, please reach out to us at

Photo by Andre Adjahoe on Unsplash.

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