Youngkin on Maternal Health: Find Out What Works
by James A. Bacon
In 2022 there were 67 pregnancy-associated mortalities per 100,000 live births in Virginia. Although that translates into a rate of less than one per 1,000 births, maternal mortality has become a major issue because the rate for Black women is more than twice that of White women.
The Office of Health Equity at Virginia Commonwealth University attributes the disparity to “structural racism” reaching back to the slave era, Blacks’ resulting mistrust of the healthcare system, and the racial biases of providers. The solution? VCU has developed learning modules and symposia to “educate” health professionals about the historical and current factors contributing to racial disparities.
Well, guilt tripping White health professionals is one way to go about it.
Fortunately, Governor Glenn Youngkin has chosen a more constructive approach. He has convened a Maternal Health Data Task Force to improve improving maternal health outcomes by addressing underlying medical conditions like high blood pressure.
At the inaugural meeting last week, State Health Commissioner Dr. Karen Shelton focused on cardiovascular maladies as a driver of maternal mortality. A press release from the Governor’s Office summed up her remarks this way:
She emphasized that women of color bear the burden of these deaths, with Black women experiencing significantly higher rates of death from cardiac-related causes compared to their White counterparts. Shelton stressed the importance of implementing targeted interventions to protect mothers and reduce preventable deaths.
Note the phrase “targeted interventions.” The idea is to gather data and mine it to determine where the points of failure are occurring and addressing them directly.
VCU wants to address maternal mortality by lecturing doctors and nurses about their racism. Youngkin proposes to address maternal mortality by educating expectant mothers about how to stay healthier.
VCU’s Office of Health Equity wants to address the “social determinants of health,” such as income inequality, educational access and food insecurity. Youngkin wants to address medical conditions such as high blood pressure that contribute directly to higher mortality rates.
“The right information at the right time during pregnancy can save lives and futures,” said Secretary of Health and Human Resources Janet V. Kelly.
The Youngkin administration used the meeting of the task force to unveil its “Ask About Aspirin” campaign, which encourages expectant mothers to talk to their physicians about prescribing aspirin during pregnancy.
“The ‘Ask About Aspirin’ campaign is a simple, effective approach that can save lives.,” Kelly said. “Paired with better data and a renewed commitment to maternal health, this initiative will help improve outcomes across Virginia, especially in underserved communities.”
“Ask About Aspirin” is just the opening salvo. Better metrics can inform other strategies. For example, do pregnant mothers have access to physicians? If not, why not? Do they make it to their appointments? If not, why not? Do they take prescribed medications? If not, why not? Where is the system breaking down and what can be done about it?
The VCU Office of Equity approach to disparities in maternal outcomes is based upon the a priori premise of structural racism, and it proposes remedies arising upon that premise. If the premise is wrong, the fixes are worthless. Youngkin’s empirically driven approach uses data to undertake a granular analysis, identify where the problems are, and address the problems directly. VCU is looking for societal transformation. Youngkin is looking for what works.
