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America leads wealthy countries in maternal deaths. Our local data might change that.

A pregnant woman wearing a mask and gloves waits in line to shop during a food drive at St. Mary’s Church in Waltham, Mass.

The recent Biden-Harris Maternal Health Day of Action brought the nation’s attention to shameful and inexcusable facts about the health and survival of our mothers. Not only is the overall maternal mortality rate in the United States the highest among rich countries, death occurs more than twice as often for Black, Native American and Alaska Native Women.

The day has seen dozens of organizations, including ours, make important commitments to act, but how do you increase the chances that these actions will help reverse decades of worsening health inequalities?

On health, it’s time to go hyperlocal

We have to be local – hyperlocal. To solve the crisis, we must understand the interplay of local factors that contribute to maternal deaths and use this precise knowledge to target local action.

We know that social and environmental factors play an important role. Black women are 1.6 times more likely than white women, and Native American and Alaska Native women are 2.6 times more likely to live in conditions that are not conducive to optimal maternal health.

But what exactly are these conditions, how do they differ across regions and communities, and how important are they in moving the needle forward?

Dr. Mary-Ann Etiebet in New York in 2019.

Dr. Mary-Ann Etiebet in New York in 2019.

Answering these questions is key to unlocking the full potential of policy and programmatic solutions.

And it will require a revolution in the use of data to better understand local factors. It’s time to move beyond averages and aggregates and into more detailed, disaggregated information that uses all the tools needed to increase accuracy and allocate scarce resources more efficiently.

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In support of these goals, Surgo Ventures recently launched a new data tool, the Maternal Vulnerability Index (MVI), which provides county-level data on the social, structural, and environmental factors driving maternal mortality. It ranks each county and US state on overall vulnerability as well as six vulnerability “themes”.

Sema K. Sgaier in Washington, DC, in 2018.

Sema K. Sgaier in Washington, DC, in 2018.

Understanding racial disparities was a central goal in our development of the MVI. There are multiple forms of racism – structural, systemic, interpersonal and internalized – and different regions manifest them in different ways. The MVI allows us to better understand in each geography not only what determines how women fare in their pregnancies, but also what drives the vulnerability of each racial and ethnic group.

For example, the MVI showed that contextual factors such as environment in which a woman lives, her Socioeconomic status and the local resources available to her partly explain the disparity in vulnerability between black and white women, but they do not explain the whole problem.

Also present are systemic and interpersonal racism, such as biases in clinical care affecting women of color and the chronic stress caused by these biases.

Dealing with the crisis is doable

As painful as these realities are, we should take comfort in what else the data shows: rather than being intractable, the problems are modifiable. Local data allows us to focus on changing drivers, track their evolution, and empower ourselves to address them. These data systems are most powerful when in the hands of local leaders and community members, because the data itself must be contextualized – married to personal insights and lived experiences.

We have seen examples of this in action. Through the Merck for Merck for Mothers Safer Childbirth Cities Initiative launched in 2018, community coalitions in 20 cities address racial inequities in maternal health by addressing local factors, embedding local strengths, and tracking the outcomes that matter most in their communities.

At Surgo, we explore ways to partner with the private sector to address local health access issues. For example, our partnership with Uber matches pregnant women in Washington, DC with free rides to their medical appointments in qualified health centres.

My mother’s life could have ended in tragedy: Addressing Maternal Health Disparities, Mortality with Data and Better Care

America’s maternal mortality crisis is a multi-faceted problem, but it’s time to turn it into an opportunity. The variety of unique factors at play means that each of us – policymakers, funders, community health organizations, researchers, advocates and the general public – can contribute to whole-of-society solutions. We owe it to every mother to reverse dangerous trends in maternal mortality and ensure that every pregnant woman has the right to safe, healthy and respectful maternal care.

Dr Mary-Ann Etiebet is Assistant Vice President for Health Equity at Merck and leads Merck for Mothers, Merck’s global health initiative that helps create a world where no woman has to die giving birth. Sema Sgaier, co-founder and CEO of Surgo Ventures, is an Affiliate Assistant Professor of Global Health at the University of Washington.

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This article originally appeared on USA TODAY: Racial inequality, maternal death: we can’t solve what we don’t measure



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