The maternal and child health crisis in Washington, D.C. is “a public health crisis that has been hiding in plain sight for 30 years”, said D.C. Mayor Muriel Bowser at the second annual Maternal and Infant Health Summit on September 10 at the Walter E. Washington Convention Center. Panelists at this year’s summit discussed issues such as racial disparities in healthcare, proper nutrition and breastfeeding for new and expectant mothers, and support for midwives and doulas in D.C. “The health of a nation is dependent on the health of its women,” said actress and activist, Alyssa Milano.

Every 12 hours in the United States, a woman dies due to complications related to pregnancy, said March of Dimes President and CEO Stacey D. Stewart. At 36.1 maternal deaths per 100,000 live births, Washington’s maternal mortality ratio is almost twice the national average (20.7 maternal deaths per 100,000 live births) and higher than all 50 states’. At 7.8 infant deaths per 1,000 live births as of 2018, Washington’s infant mortality rate is also higher than the national average (5.9 infant deaths per 1,000 live births). Many D.C. residents face economic hardship and 26 percent of children younger than 18 live in poverty. Wards 7 and 8, which suffer from high poverty rates and high maternal mortality rates, are home to almost 165,000 people served by one hospital, United Medical Center, which recently lost its funding. It is set to close by 2023.

Black Women Experience Poorer Maternal Health

The health crisis facing black women and babies is no longer a surprising trend, said Dr. Faith Gibson Hubbard, Executive Director of Thrive by Five. Maternal health outcomes reveal stark racial differences. Black women are three to four times more likely to die in childbirth than white women. Black women are also 22 percent more likely to suffer from heart disease and 71 percent more likely to be diagnosed with and die from cervical cancer than their white counterparts. Panelists and speakers pointed out that this disparity can be traced back to a hospital and healthcare system that has historically not worked for black women. Black women today still experience the negative impacts of a segregated hospital system, said Stewart. “We cannot erase generational stress,” said Mayor Bowser, but it is important for providers and policymakers to understand the disparities black women face.

The summit emphasized the importance of utilizing midwives and doulas to improve maternal health outcomes. Ebony Marcelle, the Director of Midwifery at Community of Hope, pointed to midwifery as “relationship-built care.” Speakers also discussed the increasing importance of midwifery in light of an increasing shortage of obstetricians in the United States. They spoke to the need for greater representation of women of color as healthcare providers and paraprofessionals, as only 11 percent of obstetricians and 2 percent of midwives are black women. Supporting more midwives, doulas, and nurse practitioners for maternal health has significant impacts. According to the World Health Organization, “83 percent of all maternal, infant, and newborn deaths could be averted with full midwifery care, including family planning.” This low-cost, high-impact model of care can be implemented in D.C. to address the high rates of maternal mortality and morbidity in the district, especially among black women.

Nutrition Rx: Food as Medicine

The summit also explored the effect of good nutrition and breastfeeding on maternal, infant, and child health outcomes. Lauren Biel of DC Greens described how the nonprofit takes a healthy-food-as-medicine approach. DC Greens runs an initiative called Produce Rx, which allows medical professionals to prescribe fresh fruit and vegetables to patients dealing with diet-related chronic illnesses. The program lets qualified residents exchange “produce prescriptions” for fresh produce at the only full-service grocery store in Ward 8. Produce Rx gives patients $20 per week to spend on produce and store tours and nutrition education from the grocery store’s in-house nutritionist. All of the speakers at the panel on nutrition discussed the importance of using benefit programs like SNAP and WIC to promote healthier food choices. In addition, Dr. Beverly Wheeler of DC Hunger Solutions praised Washington for being the first jurisdiction in the United States to guarantee that all children attending public school get breakfast.

Breastfeeding Benefits Mothers and Infants

Speakers also discussed the importance of breastfeeding. It is not just a lifestyle choice, said Dr. Sahira Long, a pediatrician and lactation consultant with Children’s National Health System, but rather a public health decision with countless benefits for both the mother and infant. Breastfeeding can reduce a mothers’ risk of developing several non-communicable diseases such as cardiovascular disease, breast and ovarian cancer, and Type 2 diabetes.

It is important to reduce the barriers to breastfeeding, especially for black women, who have the lowest breastfeeding rates in Washington, said Dr. Long. Some of these barriers include the lack of diversity among lactation consultants, lack of access to paid family leave, and workplace environments that do not support breastfeeding. By investing in increasing breastfeeding rates, the United States could save $3 billion on maternal and child health costs, said Dr. Long.

Racial disparities of care in maternal health were our “dirty little secret before,” said Dr. Esther Gamuchirai Madzivire, an OB/GYN at Atrium Health, but now we are talking about it.

Read More:

• In the United States, nearly 60 percent of all maternal deaths could be prevented but are not.
• A woman’s “lived experience” may affect her pregnancy.
• Midwife-led care models can improve maternal and newborn health outcomes.
• Non-Communicable Diseases account for 65 percent of female deaths worldwide and can contribute to maternal and infant death.