Four-point plan will address implicit bias, increase surveillance, enhance maternity care and expand public education
First Lady McCray and Deputy Mayor for Health and Human Services Dr. Herminia Palacio announced New York City’s first comprehensive plan to reduce maternal deaths and life-threatening complications of childbirth among women of color. The five year plan aims to eliminate disparities in maternal mortality between Black and White women – where the widest disparity exists – and reduce by half the number of severe maternal morbidity events in the five boroughs. Severe maternal morbidity is defined as life-threatening complications of childbirth; maternal mortality is defined as a death of a woman while pregnant or of the termination of pregnancy due to any cause related to or aggravated by the pregnancy or its management.
The City will invest $12.8 million over the next three years in this plan. Funding will go towards four initiatives: 1) Engaging relevant private and public health care providers across the City in adopting implicit bias training – the unconscious attitudes or stereotypes that can affect behaviors, decisions and actions in their treatment of women of color who are pregnant; 2) supporting private and public hospitals to enhance data tracking and analysis of severe maternal mortality and maternal morbidity events to improve quality of care and eliminate preventable complications; 3) enhancing maternal care at NYC Health + Hospitals’ facilities; and 4) expanding public education in partnership with community-based organizations and residents.
In New York City, more than 3,000 women experience a life-threatening event during childbirth, and about 30 women die from a pregnancy-related cause each year. Preliminary data shows that in New York City, Black non-Hispanic women are eight times more likely to die of pregnancy-related complications than White women, much higher than the national average.
“We are losing far too many mothers – especially women of color – to pregnancy-related complications,” saidMayor Bill de Blasio. “That is unacceptable. This new plan will put our hospitals and healthcare system on track to save the lives of mothers and make healthier the futures of their children.”
“New York City is making women’s health care priority number one,” said First Lady Chirlane McCray. “No mother, in this great City of world class health providers, should ever worry about the quality of care she’ll receive when building her family, before, during or after childbirth.”
“Maternal mortality is not just a health crisis but also a human rights issue. It is a heartbreaking fact that maternal mortality greatly affects women of color. This investment is the City’s commitment to provide the best healthcare services to all New York women and the next step in ensuring the protection of all women, especially women of color. I thank Council Member Helen Rosenthal for bringing attention to the maternal mortality crisis, and I applaud the Administration for working with us on making New York City safe for all pregnant people,” saidCouncil Speaker Corey Johnson.
“The birth of a child should be a joyous moment for all families, and it is unacceptable that in 2018 we have so many Black mothers who are dying because of complications during childbirth,” said Deputy Mayor for Health and Human Services Dr. Herminia Palacio. “This ambitious plan is an example of joining medicine and hospital delivery systems with public health systems to help close health inequities and save the lives of mothers across New York City.”
“We know one of the key drivers of racial disparities in maternal mortality is structural racism. Decades of inequitable distribution of resources across neighborhoods and unequal treatment within healthcare settings have resulted in racial differences in birth outcomes,” said Health Commissioner Dr. Mary T. Bassett. “We want to thank First Lady Chirlane McCray and Deputy Mayor Palacio for investing in a bold plan to address maternal deaths. This builds upon the efforts of the Health Department to improve maternal health and close the racial gap by transforming how
mothers, and specifically women of color, are cared for and supported throughout their pregnancy.”
“Despite years of work by the Health Department and many others, the stark and unacceptable racial and ethnic disparities in maternal death and life-threatening complications of childbirth have persisted,” said First Deputy Health Commissioner Dr. Oxiris Barbot. “We are excited that as a City we are prioritizing investing new resources to improve women’s and maternal health. We are confident that by aligning and coordinating efforts of our public health and public hospital systems in partnership with community leaders, organizations, and residents, we can move the needle in a positive direction.”
“Every incidence of maternal mortality is a tragedy, and we believe many such tragedies can and must be prevented,” said Machelle Allen, MD, Chief Medical Officer of NYC Health + Hospitals. “We believe a good number of other incidents that are life-threatening to women during childbirth, and especially women of color, are also avoidable—which is why we are excited to play an active role in embracing the steps New York City is announcing. We owe our patients nothing less than the best of care possible.”
Issues around maternal mortality rates are complex, particularly for Black women. Contributing factors to this epidemic include the health status of Black women, such as the prevalence of obesity and decreased access to care; issues of poverty, such as inadequate housing; residential segregation and lower educational attainment; and the stressors stemming from racism. Even when controlling for socioeconomic and educational status, Black women are still more likely to suffer from severe maternal morbidity and maternal mortality than women of other races and ethnicities.
Components of the plan include:
1. Creating A New City-Wide Maternal Hospital Quality Improvement Network: The Health Departmentwill create a Maternal Hospital Quality Improvement Network aimed at developing hospital-specific recommendations to reduce the number of life-threatening complications during and after childbirth. The Department will target a total of 23 of the 38 public and private maternity hospitals in NYC over a four year period, prioritizing providers in neighborhoods with the highest rates of pregnancy related complications – South Bronx, North and Central Brooklyn, East and Central Harlem, and Jamaica and St. Albans in Queens. Hospitals will collect and review severe maternal morbidity data to identify problem areas in care and incorporate best practices to improve patient outcomes. Hospital staff will participate in practice drills to help them recognize and treat these events in a timely manner.
2. Creating Comprehensive Maternity Care at NYC Health + Hospitals: Building upon the efforts already undertaken by NYC Health + Hospitals to ensure safe maternity care, the public healthcare system will implement the following initiatives:
· Embed simulation training in all hospital obstetric units to focus on identification and response to the two top causes of pregnancy-related deaths for women of color—postpartum hemorrhage (bleeding) and thromboembolism (blood clots).
· Hire maternal care coordinators to assist an estimated 2,000 high-risk women in the prenatal and postpartum periods to keep appointments, procure prescriptions, and connect women to eligible benefits.
· Co-locate newborn and postpartum appointments to increase the number of women receiving postpartum care from 60 percent to 90 percent. Postpartum care will include contraceptive counselling, breastfeeding support and screening for maternal depression.
· Establish primary care interventions to identify women who are planning to have a child within six to 12 months. Providers will assess hemorrhage risks and establish a care plan for women seeking to give birth within that timeline.
3. Enhancing Data Quality and Timeliness:
· The NYC Maternal Mortality and Morbidity Review Committee, launched by the Health Department in December 2017, will drive data quality improvement by examining maternal deaths and analyzing and compiling data on severe complications experienced by expectant and new mothers.
· To address the challenge of data having historically been on a two to three-year time lag, the Health Department will provide preliminary estimates of mortality annually. The City will also request the NY State Health Department to release relevant hospital data .
4. Launching Public Awareness Campaign on Pregnancy-Related Health Risks: The Health Department will expand its targeted public education campaign with community residents and providers, emphasizing safe and respectful childbirth, prenatal and post-partum care starting in 2019.
This plan builds on the City’s significant commitment to improve maternal health, including increased screening for maternal depression through the ThriveNYC Maternal Depression Learning Collaborative, which has 30 participating hospitals to screen and treat pregnant women and new mothers for maternal depression, and the creation of the Maternal Mortality and Morbidity Review Committee, which reviews deaths and severe complications related to pregnancy and childbirth. Additionally, the City became the first municipality in the nation to establish a severe maternal mortality surveillance program in 2016. The Health Department also is focused on supporting women’s health before and during pregnancy to ensure optimal outcomes. In May, the Department announced the Maternal Care Connection, a collaboration with SUNY Downstate Medical Center to improve obstetric care and chronic disease management, both of which contribute to racial disparities in birth outcomes. The Department also supports a Nurse-Family Partnership program and Newborn Home Visiting Program, the By My Side program, which provides doula support services through Healthy Start Brooklyn, and new Family Wellness Suites at the Neighborhood Health Action Centers.