Originally published on LinkedIn
January 23 is Maternal Health Awareness Day. It’s past time we address one of the biggest failings of American healthcare and make pregnancy safer and healthier for women and newborns, especially those from vulnerable Black, Indigenous, and People of Color (BIPOC) populations.
While many complex factors contribute to this health crisis, food-as-medicine programs can have an outsized positive impact on the health and well-being of birthing persons and newborn babies. At NourishedRx, we’ve seen this first-hand through our programs focused on birthing persons with high-risk social needs. Not only do the birthing persons benefit from the healthier food we provide, but their engagement with our Wellness Associates and Registered Dietitians helps ensure they get additional care and support easier and faster when needed.
Grim Facts
The U.S. has the highest maternal mortality rate (MMR) in the developed world – and things are getting worse.
In 2021, according to the CDC, there were 32.9 deaths per 100,000 live births compared to 23.8 in 2020 and 20.1 in 2019. Ethnic and racial disparities contribute to these terrible numbers. The MMR for Non-Hispanic Black women was almost three times as high as for Non-Hispanic White women. American Indians, Alaska Natives, and Asians were also at higher risk. Other measures of health like severe maternal morbidity (SMM) are also higher for minority women.
25% of the increase in maternal deaths in 2020 and 2021 were attributable to COVID-19. But even then, the rate of COVID-related maternal deaths was almost twice as high for Black women as White women, and COVID had a bigger, long-term impact on the health of mothers and newborns in minority populations.
So, what can we do to prevent or reduce bad health outcomes and tragedies among vulnerable women during pregnancy, childbirth, and those critical months after delivery?
The U.S. already spends twice as much on maternal health compared to other developed nations. We need solutions that start with a clear understanding of the real challenges so we can direct resources, programs, and new approaches accordingly.
What’s Causing the Disparities?
According to the CDC, 80% of maternal deaths can be prevented. While individual circumstances always play a part, women who are chronically ill, older, of a racial or ethnic minority, and/or come from communities or regions challenged by health inequities are at higher risk for death or negative health outcomes before, during, and after delivery.
Race or ethnicity affects the quality of care those women receive. For example, much has been written about the implicit and explicit biases that women in general, and women who are Black, in particular, experience in our healthcare system. As described in a recent book by Dr. Monique Rainford, “Pregnant While Black: Advancing Justice for Maternal Health in America,” such biases can lead care providers to overlook or under-attend to health conditions, symptoms, complaints, questions, social health needs, and even emergencies experienced or voiced by Black women who are pregnant or who have recently given birth. In fact, it doesn’t matter whether the Black woman is well off or economically disadvantaged, they are still more likely to have poorer health outcomes than White women.
One effective answer is to support vulnerable women with advocates who can help them be heard and get their health issues addressed. When the physician is also Black or delivery is overseen by a midwife or doula, health outcomes for pregnant Black women and newborns improve significantly.
Health inequities also affect maternal health outcomes. When birthing persons or new mothers struggle with access to care, medicine, behavioral health services, healthy food, transportation, secure housing, and so on, their health is at higher risk because consistent appointments, medication adherence, and access to emergency departments are so important. Community-based and telemedicine services can help give women the support and care they need.
Chronic illness – which is also more common in minorities or vulnerable populations – is another major risk factor for maternal health. When women have preconditions like heart disease, hypertension, diabetes, and depression they are at greater risk of stroke, preeclampsia, and postpartum depression, among other conditions.
Food-as-medicine programs are increasingly deployed to help address chronic illnesses. Culturally concordant food-as-medicine programs provide a powerful solution for improving the health and well-being of birthing persons, and newborns. Federal programs like WIC, while helpful in general, are less effective for ethnic or racial minorities. Instead, targeted food-as-medicine programs can enhance engagement with vulnerable women who may be hard to reach, helping them manage isolation and depression and access care and supportive social services.
In other words, supplying quality food is a solution unto itself but also a doorway to more and better care and support.
Our Food-as-Medicine Approach to Better Maternal Care
In 2021, NourishedRx partnered on a health equity pilot program in Minnesota to address nutrition security and maternal health disparity among members of the Blue Cross Blue Shield Blue Plus Medicaid plan who are Black, Indigenous, and People of Color (BIPOC), or whose first language isn’t English.
Women who were enrolled in the program received food deliveries that were culturally aligned and tailored to their taste preferences and sensitivities and their clinical needs and social circumstances. Those women also got personalized attention, coaching, and support from our Wellness associates, and on-demand access to our registered dietitians by phone or email.
The goal of the program was to assess the effectiveness of food-as-medicine when serving women with high risk social needs for three to five months before delivery and two months postpartum.
Satisfaction and engagement numbers were off the charts – 97% of participants said the program improved their knowledge and confidence in eating healthy food, and 99% said the program would positively affect their food choices going forward. Many of those birthing persons live with multiple family members who benefited as well. The participants loved the food and their risk of food insecurity was significantly reduced. The program also reduced emergency care utilization and overall care costs, and helped lower stress and social isolation.
In September 2023 we launched a similar health equity program with a health plan in New Jersey, though this time plan members with diabetes can also be enrolled.
New Jersey had one of the nation’s highest maternal death rates in 2018, particularly for women of color. The state is committed to addressing those racial and health equity disparities.
Our program manager, Meg Orner, who is overseeing that initiative, notes how effective the weekly check-in surveys are in surfacing social and clinical care needs. Participants respond with symptoms, feelings, concerns, and questions that go beyond food and nutrition, and we’re able to connect them to appropriate health plan and community resources that they would have difficulty accessing on their own.
Conclusion: Food as the Doorway
America’s dismal maternal mortality rate, especially for the socially vulnerable, chronically ill, and racial and ethnic minorities, is an illustration of a system that is not designed to provide the level of support and care that many birthing persons need. The problems are so widespread and complex that they call for systemic changes. But that kind of overhaul won’t help vulnerable women now or even in the near future.
Sometimes the simple things matter most. Quality food. Personal connection. Education and encouragement. Someone to reach out to when you’re feeling overwhelmed, confused, concerned, or alone. The magic of our program is that it provides for basic nutrition needs and helps address nutrition-related health and illness issues, but also opens the door to deeper engagement, support, and care.
That’s a solution we can and should deliver to every birthing individual who needs it today.
To learn more about NourishedRx visit our website at www.nourishedrx.com
