Maternal mortality remains an alarming issue in the United States, with rates that far exceed those of other developed nations. For every 100,000 live births, approximately 22 women die due to pregnancy-related complications — an unacceptable statistic in a country with such advanced healthcare capabilities. It remains true that those most affected are women of color, with Black women experiencing mortality rates two to three times higher than their white counterparts. Achieving improvement in the areas of maternal mortality and mental health, implicit bias, and social determinants of health will continue to be a top priority until we can reverse the trend.
This crisis cannot be solved by focusing solely on clinical interventions. As data and research show, the broader issues of mental health, implicit bias, and social determinants of health play a significant role in maternal outcomes. Tackling these challenges requires a holistic approach — one that combines clinical best practices with comprehensive behavioral health support, anti-bias training, and improved access to resources.
In a breakdown of contributing factors to maternal mortality from data collected by state Maternal Mortality Review Committees over a 10-year span, 51% of maternal deaths were attributed to patient factors, 20% were provider-related, and 21% were due to system-level issues. Provider factors, such as delayed diagnosis or inadequate communication between healthcare professionals, underscore the need for continuous education and teamwork in maternal care.
Maternal mental health: A critical but overlooked factor
Maternal mental health has often been treated as secondary to physical health in pregnancy and postpartum care. However, this perspective is changing, in light of new data from organizations like the Centers for Disease Control (CDC) and Maternal Mortality Review Committees (MMRCs). Mental health issues such as peripartum depression, anxiety, and even suicidal ideation are significant contributors to maternal morbidity and mortality, particularly in the first year after birth.
The Maternal Mental Health Report Card, produced in collaboration with George Washington University, evaluated how well the U.S. is addressing maternal mental health issues using data from healthcare providers, public health organizations, and payers. This report showed that the U.S. improved slightly from a D to a D+ in addressing maternal mental health — still far from acceptable.
With over 600,000 women affected by maternal mental health issues annually, the report highlights the urgent need for better mental health screenings, diagnosis, and follow-up care, particularly for vulnerable populations. Together, these insights show the importance of a comprehensive strategy that addresses not just clinical risks but also the behavioral health and systemic factors contributing to poor maternal outcomes.
Yet, despite the risks, mental health screenings are not standardized across all healthcare settings. According to a recent Relias survey, only 57% of clinicians consistently screen for mental health issues during pregnancy, and just 50% screen for substance use disorders. Without proper screening and follow-up, patients often leave the hospital without the care they need, exacerbating their conditions in isolation.
To improve outcomes, mental health must be incorporated as a core component of maternal care. A simple screening process is not enough — there must be postpartum support, consistent follow-ups, and community resources available to mothers, especially those in rural areas who may lack easy access to mental health services.
The role of implicit bias and racism in maternal care
Racism and implicit bias are deeply ingrained in the healthcare system and contribute to stark disparities in maternal outcomes. Despite mounting evidence of their impact, a surprising number of clinicians are still unaware of how bias affects the care they provide. In fact, our data showed that one-fifth of surveyed clinicians did not view racism and bias as a factor in maternal mortality.
This perception must change, as it comes from a lack of awareness and knowledge on the part of nurses and providers. Studies have consistently shown that Black and Brown women are not only more likely to die from pregnancy-related causes but also less likely to receive appropriate, timely care. Implicit bias leads to delayed diagnoses, miscommunication, and inadequate pain management, among other issues.
Fortunately, some states have recognized this problem and now require annual implicit bias training for healthcare providers working with pregnant people. But this effort needs to be widespread. Every healthcare organization should prioritize anti-bias training and foster an environment where these issues are openly discussed and addressed.
Social determinants of health: Factors beyond the hospital
Many maternal health risks stem from social determinants of health — factors like access to healthcare, stable housing, economic stability, and social support systems. These social determinants have a direct impact on whether a woman receives evidence-based maternal care. People who live in a healthcare desert, for example, might need to drive hundreds of miles to reach a hospital, putting themselves and their babies at greater risk during emergencies.
To address these challenges, healthcare organizations need to act to bridge the gap between hospital care and the home environment. This includes better discharge planning, ensuring that women are connected to community resources, and incorporating home visits into postpartum care whenever possible. Holistic care models should be adopted to ensure that clinicians are aware of a patient’s social risk factors and address them accordingly.
The power of e-learning in maternal care training
With the challenges of staff shortages and workforce turnover, especially in rural healthcare settings, e-learning has become an essential tool for training clinicians. E-learning platforms allow for consistent, engaging education that can be accessed anywhere, bringing evidence-based practice to the forefront of maternal care.
Our survey showed that e-learning is one of the most effective training methods for behavioral health and social risk topics. By using a blended learning model comprised of e-learning, immersive training tools such as virtual simulations, and team-based training, healthcare organizations can better equip their staff to handle the complexities of maternal care, including mental health, racism, and social determinants.
Federal initiatives supporting maternal health equity
In recent years, the federal government has taken significant steps to address maternal mortality and improve maternal health equity through various initiatives. The White House’s Maternal Health Blueprint, introduced by the Biden-Harris administration, allocates millions of dollars toward reducing maternal mortality and morbidity, with a particular focus on addressing racial disparities and social determinants of health.
The White House Blueprint included the Birthing-Friendly hospital designation, a program that encourages hospitals to participate in perinatal quality collaboratives and adopt evidence-based practices to improve maternal outcomes. Additionally, the American Rescue Plan expanded Medicaid coverage for postpartum women, extending it from 60 days to a full year after birth in many states, ensuring that more women have access to critical mental health services during the postpartum period. These federal efforts represent a major push to standardize care, address implicit bias, and ensure that no mother is left behind due to inequitable access to healthcare.
Team-based care and data-driven improvements
Preventing maternal mortality and morbidity requires a multidisciplinary, team-based approach, where physicians, nurses, midwives, and other healthcare professionals collaborate to provide comprehensive care. No single clinician can address all the factors affecting maternal health — especially when it comes to managing complex cases involving mental health issues, clinical risks, and social determinants. Teams must work together, ensuring that every interaction — from prenatal visits to postpartum check-ins — includes consistent mental health and clinical screening, effective and culturally aligned communication, and coordinated care.
The use of data-driven improvements is also essential to reducing care variation and improving outcomes. By actively using real-time data from Maternal Mortality Review Committees and hospital perinatal dashboards, healthcare organizations can identify gaps in care, tailor interventions, and track progress in reducing maternal mortality. This data-driven, team-based approach not only fosters accountability but ensures that every aspect of maternal health, from clinical safety to behavioral health, is addressed.
A call to action to improve maternal care
The path to reducing maternal mortality in the U.S. requires a fundamental shift in how we view maternal care. We must move beyond clinical protocols to adopt a holistic approach that blends the critical impacts of mental health, implicit bias, and social determinants of health.
Healthcare organizations must prioritize continuous education, create transparent systems of accountability, and engage in consistent efforts to support the most vulnerable populations. By addressing these factors head on, we can create a safer, more equitable system of care for all birthing people and ensure that maternal health is a top priority in our healthcare system.
2024 Maternal Mortality and Morbidity Prevention Report
Preventing maternal mortality and morbidity is a top priority at Relias. We are constantly looking at ways to help healthcare organizations reduce these risks through awareness, attention, and the consistent use of evidence-based practices. Read our report based on a survey of U.S. nurses and physicians who treat perinatal patients to gain current insights into maternal mortality and morbidity reduction practices, education, and performance improvement.
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