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Researchers at Michigan State University, Henry Ford Health and Corewell Health are launching a new, $19 million research center aimed at reducing disparities in pregnancy-associated deaths among Black, Hispanic, American Indian/Alaska Native women, and those who live in rural areas of the Lower Peninsula.
Called the Multilevel Interventions to Advance Maternal Health Equity Center, or the MIRACLE Center, it’s one of 10 nationally to win funding from the National Institutes of Health to address racial health disparities in maternal mortality. It also is the first of its kind in Michigan.
“It is absolutely appalling to see the rates (of maternal mortality) that this country has experienced, given the wealth and the resources that we have,” said Peggy Vander Meulen, director of Kent County’s Strong Beginnings, manager of community health programs at Corewell Health and a co-leader of the MIRACLE Center.
“What is the most upsetting is not only that maternal mortality overall has increased, but the rising disparities and inequities, particularly for Black and indigenous persons and also for Latino persons.”
The underlying driver, she said, is “the systemic, institutionalized and structural racism that is been intentionally woven into the fabric of the society from the very beginning, and continues to intentionally or unintentionally result in inequities.”
It affects everything from employment opportunities to access to safe and affordable housing, transportation and child care — and increases the risk that a woman will die during pregnancy and in the year after a baby is born, Vander Meulen said.
Black women 2.8 times more likely to die of pregnancy-related causes
In Michigan, the state Department of Health and Human Services reports that of the 80-90 maternal deaths that occur each year, 64% are preventable.
Black women in Michigan were 2.8 times more likely to die from pregnancy-related causes in 2015-19 than white women. The maternal mortality rate for Black women was 29.8 per 100,000 live births. For white women, it was 10.7 deaths per 100,000 live births, according to state data.
“The cause of all the disparities are racism, racism and racism,” said Jennifer Johnson, C.S. Mott Endowed professor of public health in the MSU College of Human Medicine, and a co-leader of the MIRACLE Center.
“We’re looking at two different kinds of disparities: One is the direct medical causes. Another is suicide, overdose, homicide. I think people are clear (in understanding) how the suicide, overdose, homicide deaths are responses to life stress. But more than half of the deaths occur after birth. … If a mom is just trying to make ends meet, she may not go back for a two-week or a six-week checkup or she may be having headaches or she may be having shortness of breath. These other concerning symptoms and just sort of shake off or think, ‘Oh, I don’t have time for this’ and then she dies.”
Support for new mothers falls short
Exacerbating the problem is a lack of support for families, Vander Meulen said.
“People talk a great line about family values. However, we don’t have … mandatory parental leave or affordable child care,” she said. “How do we expect parents and children to thrive? We have clients going back to work two weeks after delivery because they can’t afford the time off. They can’t afford to miss work at the minimum-wage jobs they’re working just to keep food on the table.”
The rate of maternal mortality in Michigan more than doubled from 2018 to 2019 to a rate of 23.2 pregnancy-related maternal deaths per 100,000 live births. Official data on maternal mortality in Michigan for 2020, the first year of the coronavirus pandemic, won’t be released until early 2024, state health officials told the Free Press for a previous story.
Access to health care also is a problem, both in rural parts of the state as well as urban centers, said Cristian Meghea, an associate professor of obstetrics, gynecology and reproductive biology in the MSU College of Human Medicine and co-leader of the MIRACLE Center.
“Having Medicaid insurance, that’s great,” Meghea said. “However, securing access to care and having an OB-GYN or even a general practitioner accepting new patients on Medicaid, that’s a whole different problem. And a third problem is reaching that provider … without having a car or without having reliable bus transportation. Or, being late and then getting your appointment canceled. These are all multiple hoops that that a lot of women have to go through.”
More:At least 60% of maternal deaths in Michigan are preventable
Access to care isn’t enough. Women also need respect
Johnson added that even when people overcome all those barriers, they may face overt or implicit racism in the doctor’s office.
“Once you get there, there’s a respect issue. Am I being listened to? Am I being heard? Am I being respected when I voiced my concerns? Is my partner being respected when he joins me or when he is unable to join me?
“And so you have all these layers that contribute to mom saying, ‘Well, yeah, I can find a provider. I have one, but when I go, I’m being so disrespected, I don’t want to go. I’m willing to just wait it out until delivery and just show up to the emergency room.’ And so that’s another component of how do we make sure we’re getting women not just access to care, but the proper and respected care that they deserve?”
The center is launching three projects that begin immediately and will continue for seven years across 20 counties in the Lower Peninsula.
- Project 1: Community health workers, visiting nurses and social workers will periodically visit the homes of pregnant and postpartum Black and Hispanic women in Kent, Wayne and Genesee counties to coordinate community and clinical care.
- Project 2: Expands the use of a self-screening digital application that pregnant Black women and women living in rural areas can use to identify health warning signs. They can use it to live chat with community health workers who can connect them with services in 10 counties: Kent, Genesee, Ingham, Isabella, Emmet, Grand Traverse, Otsego, Alpena, Midland and Gratiot.
- Project 3: Works to identify the best ways to improve equity in maternal care across 14 Michigan counties, focusing on improvement in the quality of care in both the medical setting and within the community. The counties involved are: Genesee, Kent, Wayne, Oakland, Ingham, Isabella, Macomb, Muskegon, Calhoun, Jackson, Saginaw, Kalamazoo, Berrien and Washtenaw.
“It is possible to improve the overall quality of obstetric care without changing disparities,” Johnson said. “What Project 3 does is it looks at quality improvement efforts, targeting outpatient care and community care, and enhanced prenatal care because that’s where most of the deaths occur. It looks at quality improvement approaches that directly target disparities.
“Despite some of the biases, white moms are actually more likely to die by overdose in pregnancy and postpartum than African American moms. But our African American moms are much more likely to die by homicide. As a matter of fact, for African-American women, the risk of dying by partner violence while pregnant increases eight fold.
“In general, if a woman dies, more than half the time it is by a current or former partner. Most of the deaths … are suicide, overdose, homicide.
The MIRACLE Center will work through partnerships among university researchers, doctors, nurses and others at Henry Ford Health, Corewell Health, the Flint Community Based Organization Partners, Flint Odyssey House, Hurley Medical Center, Munson Healthcare, MyMichigan Health, and the Michigan Department of Health and Human Services.
Contact Kristen Shamus: kshamus@freepress.com. Subscribe to the Free Press.
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