Solving pregnancy care challenges involves addressing the areas of Interest, Investment, and Innovation.
Sometimes problems are relative, sometimes they are absolute. In the United States, maternal mortality is both. As of April 2022, the U.S. ranked last among other high income nations for maternal mortality rates. In absolute terms, the U.S. maternal mortality rates trend up, year after year. Most notably, maternal mortality among Black women is staggeringly high. In fact, Black women are three times more likely to die from pregnancy related causes than their white counterparts in the U.S. These sobering stats are true despite the fact that the U.S. spends more than any other nation on in-hospital maternity care. Despite significant publicity, women continue to die needlessly in their quest to bring new life into the world. This must change.
Sadly, these trends are old news. Over the 20th century, maternal mortality in the United States fell by almost 99 percent. That enormous public health victory stalled in the 1980s. Since then the rate has risen, from about 7 deaths per 100,000 live births in 1986 to 17 in 2016. There is no consensus on why the U.S. fares so poorly compared to other developed nations. However, there is consensus around one thing - it is time to fix these trends and save women’s lives.
Albert Einstein said that if he had an hour to solve a problem he would spend 55 minutes thinking about the problem and five minutes thinking about the solution. There is no question that we are thinking about this problem. High-profile news outlets are publicizing this crisis. This year alone, ABC and the Wall Street Journal published prominent articles about maternal mortality and lack of care in the United States. These articles represent noble efforts to galvanize support to halt and reverse these painful trends. Our federal government has introduced no less than 26 bills to address maternal mortality. State governments have introduced even more than that. Celebrities like Serena Williams, Beyonce, Michelle Obama, and Kamala Harris have all been shouting from the mountaintops about the Black maternal mortality crisis. Major entities like Optum, Merck, and the Wilson Center all dedicate enormous resources to publicizing and understanding the maternal mortality problem.
No doubt, publicity, funding, and legislation like this is good. But the harsh reality is that elevating the profile of maternal mortality is only good if it induces action. We are heeding Albert Einstein’s advice - sort of - by spending time and resources on the problem. Einstein’s quote implies, however, that those 55 minutes should be dedicated to really digging into the roots of the problem, why it exists, and how it came to be. That we have not done.
Unless and until we move from awareness to action, we will not reverse these harrowing trends. We owe it to women to value their lives and the lives of their babies enough to find a new way of thinking about maternal mortality.
To solve this problem we need to focus on three things:Given the publicity mentioned earlier, calling for more interest may seem counterintuitive. Yet, even with all of the publicity and attention, the U.S. population generally, and the medical/public health community specifically, does not focus on maternal mortality in the United States. Merck is one of very few Fortune 500 companies that devote their charitable dollars to maternal mortality. Sure, giants like Walmart, Target, Medtronic, Genentech, State Farm, Best Buy, and Accenture have teamed up to create the Black Community Innovation Coalition. But maternal/fetal health is only a small subset of this effort. While Black maternal mortality is an outsized problem compared to maternal mortality for other demographics, focusing exclusively on the problem for Black women does not address the problem for everyone. In short, most of Corporate America is not yet focused on fixing this problem.
There is also a dearth of interest from the public generally. As former congressman and obstetrician Phil Gingrey wrote in 2020, “more must be done; more coordination, more dedication, and more dollars.” This issue cannot be solved until Americans across the map recognize the problem and demand change from their representatives, corporations, and doctors.
Interest is necessary but not sufficient. Maternal health needs investment. In 2016, pregnancy and postpartum care cost private insurers $52.8 billion, the third-highest private-insurance spending of any condition in the United States. However, conditions like diabetes and back/neck pain impact far more people than pregnancy at any given moment in time. Much of that $52.8 billion could be saved with more investment into new innovations and technologies for prenatal care.
Investment trends for FemTech are, admittedly, good. Venture funding for FemTech roughly tripled between 2015 and 2021, from just over $600 million to nearly $1.9 billion. Even with this increase, FemTech and maternal care is still sorely underfunded. Just 2% of medtech funding goes towards non-cancer related women’s conditions. The trends are in maternal care’s favor. We have reason to be hopeful. But there is still a large gap between the need in the market and the funding to scale solutions. We urgently need passionate and brave investors to see the massive opportunity that exists to modernize pregnancy care and get in on the ground floor of new maternal health technology that opens access, utilizes telemedicine, and changes standards of care.
Finally, we must see innovation in this space. Obstetric ultrasound was created in 1956. In the 1970’s OB ultrasound exploded as the standard of care. But the 1970’s were the beginning and the end of significant technological innovation in maternal care. In the last 50 years, image quality has improved but there has been virtually no significant technological change for maternal care. Doctors still use 40 year old technology to measure and examine pregnant mothers and their fetuses. But there is hope and we are on the cusp of a revolution.
Technologies like Nuvo’s remote maternal-fetal monitoring, PulseNmore’s remote OB ultrasound, and Ouma Health’s telemedicine network will change not just how women are treated, but also who can access excellent care. Until these, and other innovations are created, approved, and adopted at scale, we cannot change the status quo of maternal morbidity and mortality in the U.S. Once real changes in interest, investment, and innovation happen, more mothers will get to see their beautiful babies grow and thrive. The time has come to make this a reality.
The CDC has since reported a fall in the U.S. maternal mortality rate, from 32.9 deaths per 100,000 live births in 2021 to 18.6 in 2023. The gap between Black and White women remains, and the U.S. rate is still the highest among high-income countries.
This article was published in collaboration with Andrea Wolf on LinkedIn.