In the United States, systemic racism and implicit bias in healthcare has resulted in maternal deaths among Black women of all socioeconomic levels. Can a more patient-centred approach help to mitigate these unnecessary deaths?

Advancing racial and health equity is at the forefront of the conversation for leaders in U.S. Health at Palladium, and it’s a multifaceted and sector-wide conversation that includes putting patients at the centre of healthcare. The team shared their insights on what the next year may bring for healthcare in the midst of a soaring job market and how increased employer focus on healthcare could increase retention but shift the conversation on healthcare itself.

Racial Equity in Pregnancy and Postpartum Care

“Black birthing people are three times more likely to die during and after childbirth than white birthing people,” explains Chinwoke Isiguzo, Palladium Senior Technical Advisor. According to a recent report from the Centers for Disease Control and Prevention, 80% of these deaths are preventable. Mental health conditions like perinatal depression are among the leading underlying causes of pregnancy-related death. While these adverse outcomes vary by race and ethnicity, Black women are at a higher risk for perinatal or postpartum mood and anxiety disorders.

A myriad of social and structural barriers put Black women at a disadvantage – structural racism, a historical mistrust of the healthcare system, lack of universal screening and mental health education, lack of culturally and racially concordant care, and missed or delayed diagnoses. These barriers lead to racial disparity in perinatal health outcomes for Black women in the U.S.

“Providers and health systems need to make conscious efforts to create safe spaces where Black birthing people can voice their concerns and feel empowered to advocate for themselves,” says Isiguzo. Appropriate screening for mental health conditions should also be implemented, in addition to postpartum education and support during healthcare visits. Social support during the perinatal period cannot be overemphasized.

HIV Prevention and Contraception

In the U.S., Black cisgender women have higher rates of unintended pregnancy than any other group, and HIV risk factors often overlap with the risk factors for unintended pregnancy. The most effective form of biomedical HIV prevention is daily use of PrEP (pre-exposure prophylaxis), which reduces the risk of getting HIV from sex by 99%. Though there has been exponential growth in PrEP use since 2012, this growth has been mostly among men who have sex with men, rather than cisgender women.

“Black cisgender women have low knowledge about PrEP, lower than any other group of women, and there are very few campaigns focused on Black cisgender women for PrEP,” explains Hanna Tessema, Senior Monitoring and Evaluation Advisor. To further complicate this issue, Tessema notes that “Black cisgender women are less likely to receive a prescription from their clinical provider for PrEP than other women.”

One way to increase uptake of PrEP among Black cisgender women is to ensure that HIV prevention is discussed at routine reproductive health appointments. Bundling HIV prevention with prevention of other sexually transmitted infections and unintended pregnancy can reduce burden on the healthcare system, and ultimately improve health outcomes among Black cisgender women.

Fertility Benefits are a Commitment to DEI

Ensuring positive health outcomes falls not just on the shoulders of healthcare providers, but on employers as well. In addition to providing standard health insurance plans, it is increasingly common for employers to offer fertility and family-forming benefits. While these benefits are often included as a means to increase retention and make employers more attractive to top talent, they are also a concrete commitment to diversity, equity, and inclusion, explains Ellen Smith, Senior Technical Advisor for U.S. Health.

“Many LGBTQ+ employees need medical interventions to form their families. Furthermore, BIPOC women are more likely to experience infertility than white women, making these benefits relevant to reducing racial inequities in maternal and reproductive health,” Smith adds. Employers and their benefits managers increasingly acknowledge that healthy pregnancies, births, and newborns are important to the company’s bottom line.

“Poor health outcomes during this time of life can be very costly to employers.” Smith notes that fertility benefits are one way to avoid or manage high risk maternity-related expenses, such as by reducing the financial incentive to transfer multiple embryos in one cycle.
Smith is hopeful to see an uptake in companies providing fertility benefits to their employees, including ones that cover supportive services, such as doulas, that can improve birth outcomes especially among the BIPOC community.

For healthcare in 2023, it’s all about ensuring patient-centred positive health outcomes. For healthcare providers, taking a holistic approach to care is vital to protecting unwanted pregnancies and preventing HIV among Black women.

With a saturated job market, individuals might be taking the time to ensure a prospective company offers fertility benefits and mental health support services. Employers are a key group uniquely positioned to close the maternal mortality gap by providing employees with benefits packages which support healthy birth outcomes and help to maintain productivity.

Palladium is collaborating with the Pittsburgh Business Group on Health and Innovu, a fiduciary data analytics partner to address these inequities. Palladium’s U.S. Health Team is also collaborating with the Greater Washington Urban League, Mary Center, and other key maternal health stakeholders to contribute to closing the gap in the racial disparities in perinatal mental health. For more information, contact info@thepalladiumgroup.com