A dire public health issue is being addressed in Harris County: vast racial disparities in maternal and infant mortality and morbidity.
According to the Texas Maternal Mortality and Morbidity Task Force and regional health reports, Black women die at nearly three to four times the rate and Black infants die at twice the rate as their White counterparts. The rate of severe maternal morbidity is even higher. The Graduate College of Social Work’s McClain Sampson, MSW, Ph.D., and the Maternal Health Equity Research and Training Center are working to decrease those disparities.
In Houston, this translates to helping those in a very specific group of zip codes, many of which border the University of Houston in Third Ward. Sampson reports a focus on zip codes because “research shows consistent disparities in birth outcomes depending on race and geography.”
Healthy Start is a program that provides wrap-around services for women, infants and fathers living in zip codes with the highest death rates for pregnant and postnatal mothers and infants. Rates of postpartum depression and anxiety nearly double for mothers living in poverty and under-resourced areas. Sampson shared that the chronic stress of being under or uninsured and living far from medical care are powerful contributors to chronic disease, which can put mothers at high risk for adverse birth outcomes. Additionally, systemic racism contributes to the disparities in medical care for already vulnerable populations. In Texas, 50% of births are financed by Medicaid. There is great potential to improve health with a focus on coverage earlier and for longer than 60 days after birth.
The Healthy Start program’s centerpiece is an evidence-based home visiting model. Coordinated care case managers provide screenings for risk factors of maternal and infant morbidity, including numerous social determinants of health. Case managers deliver health education and coordinate care for pregnancy care, mental health and social services. Sampson’s colleague, Reiko Boyd, Ph.D., leads the Community Based Doula training program and hopes to prevent negative birth experiences through the use of doulas, akin to midwives. But, like with so many other things, the pandemic caused delays and challenges to the program’s launch and data collection.
Dr. Kimberly A. Pilkinton, an Obstetrician/Gynecologist at UH’s Tilman J. Fertitta Family College of Medicine, serves on the Healthy Start Community Action Network and helps Sampson to advocate at the policy level. Dr. Pilkinton and Sampson collaborate to refer Healthy Start moms to clinics that accept Medicaid. The UH on campus clinic will hopefully be a Medicaid-accepting choice for these women soon.
“We must use a health equity framework to guide research and programming when it comes to maternal health. The fragmentation of our health care services, and inadequacy of insurance coverage combined with community mistrust of the medical and social service system prevent women from optimal health,” said Sampson. “Mothers are often left out of the conversation about their own health and this needs to change. By working upstream to promote a culture of health and to eliminate barriers to engagement in prenatal and postnatal care, we hope to make a difference.”
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