The Health Department and the Fund for Public Health in New York City today announced a $1.8 million grant from Merck for Mothers to further bolster the City’s efforts to reduce persistent racial and ethnic disparities in maternal health. The funding will ensure hospitals are including severe maternal morbidity (SMM, or life threatening complications during, or after, childbirth) in their performance review, which will help the Department increase surveillance of these complications. It will also support the work of the New York City Maternal Mortality and Morbidity Review Committee by integrating SMM into case reviews. This information is essential to determine the root causes of the disparities driving poor maternal health outcomes and informing interventions at the individual, community, provider and system levels. Finally, the grant will help the Health Department develop supportive materials for other jurisdictions wishing to replicate the work and create lasting changes in clinical environments and within communities. New York City is the first city in the nation to examine severe maternal morbidity.
This new effort to increase surveillance and enhance care builds on the City’s significant commitment to improve maternal health, including increased screening for maternal depression through the ThriveNYC Maternal Depression Learning Collaborative, which has 30 participating hospitals to screen and treat pregnant women and new mothers for maternal depression. The Health Department also partners with community-based organizations, leaders, residents and providers through the Sexual and Reproductive Justice Community Engagement Group. This group has engaged Birth Justice Defenders (community residents) and providers to advocate for and educate on best practices for respectful maternity care at birth. Other initiatives include: the expanded Nurse-Family Partnership program and Newborn Home Visiting Program; the By My Side program, which provides doula support services through Healthy Start Brooklyn, and new Family Wellness Suites at the Neighborhood Health Action Centers.
Women of color in New York City, especially Black women, are more likely than White women to have a life-threatening complication during childbirth…
“Racial and ethnic disparities in maternal and infant health outcomes are persistent, intolerable and preventable. Women of color in New York City, especially Black women, are more likely than White women to have a life-threatening complication during childbirth, which is why this work is so important,” said Health Commissioner Dr. Mary T. Bassett. “This grant will advance our work with maternity facilities to improve the quality of care across the city and to ensure all families receive respectful and safe maternity care.”
“We are optimistic that generating and acting on better data about women’s experiences during pregnancy and childbirth – both in the hospital and outside the healthcare system – will provide the insights needed to reduce the stark disparities in maternal health outcomes. We are pleased to support New York City’s efforts – a first to integrate survivor perspectives in its response to reducing maternal deaths and disability. This is an important step toward ensuring that women have safer pregnancies and healthier lives,” said Dr. Mary-Ann Etiebet, Executive Director, Merck for Mothers.
Severe maternal morbidity affects approximately 2,500 New York City women a year. Black non-Latina women had the highest rate (387 per 10,000 deliveries), three times that of White non-Latina women (127 per 10,000 deliveries).
This is the Health Department’s second collaboration with Merck for Mothers; the first culminated in the Severe Maternal Morbidity, New York City 2008-2012 (SMM) report released in 2016. Highlights from this report showed persistent disparities in severe maternal morbidity rates across race, ethnicity and income. Severe maternal morbidity affects approximately 2,500 New York City women a year. Black non-Latina women had the highest rate (387 per 10,000 deliveries), three times that of White non-Latina women (127 per 10,000 deliveries). This disparity persisted even when comparing Black non-Latina and White non-Latina women with similar risk factors, such as low educational attainment, neighborhood poverty and pre-pregnancy obesity. The severe maternal morbidity rate was also high among women who were Puerto Rican (272 per 10,000 deliveries) or of other Latina origin (249 per 10,000 deliveries). Several maternal morbidity rates were highest among women living in the poorest neighborhoods, with Brownsville having the highest rate in the city (497 per 10,000 deliveries).
Research shows the driving force behind these disparities is structural racism, also understood as the normalization of policies that foster discrimination and disinvestment in communities of color. Structural racism impacts chronic stress and disease, which markedly increases the risk of maternal mortality, severe maternal morbidity and infant mortality. Communities that have been historically oppressed bear the heaviest burden of negative health outcomes in New York City.
“We know that a woman’s health before pregnancy is a critically important factor in both maternal and infant outcomes. We are proud to be teaming up with partners like Merck for Mothers, local health care providers, hospitals, community leaders and, of course, residents to address this issue,” said Dr. George L. Askew, Deputy Commissioner of Family and Child Health. “We are committed to leading hand-in-hand with communities and health care systems to ignite sustainable change.”
“We are pleased to be partnering with the Health Department and Merck for Mothers to better understand the disparities so that we can develop effective interventions. Childbirth should be a safe and joyous experience for all,” said Sara Gardner, Executive Director for the Fund for Public Health in New York City.
“I thank Merck for Mothers, on behalf of Brooklyn’s mothers, for investing in reversing the ethnic disparities in our borough’s maternal health,” said Brooklyn Borough President Eric Adams. “My administration has been proud to work closely with organizations such as CAMBA and Nurse-Family Partnership to deliver evidence-based services to young families in need, and I appreciate the efforts of DOHMH and the Fund for Public Health in New York City to amplify these critically important programs.”
“The ‘Merck for Mothers’ grant will enable the Health Department to strengthen its ongoing efforts to address racial and ethnic disparities in maternal and pediatric health and ensure that all New Yorkers can obtain critical health care services regardless of their background, neighborhood, or socioeconomic status,” said Assembly Member Richard N. Gottfried, Chair of the Assembly Committee on Health and the author of several State laws to improve the quality of maternal and child health care coverage and services.
“Mothers are the bedrock of their families and their communities, often taking care of all those around them. It’s high time that we took care of them,” said Assembly Member Linda B. Rosenthal, Chair of the Committee on Alcoholism and Drug Abuse. “I applaud the City’s continuing commitment to improving maternal health and better understanding the deep gender- and race-based disparities in care that lead to poor outcomes.”
“Ensuring women of color receive the high quality care they need during pregnancy is critical to reversing the unacceptable racial disparities in maternal morbidity,” said Council Member Robert E. Cornegy. “The funding announced today will serve to further the important work of the Health Department in reducing the unacceptable racial and ethnic disparities in maternal and infant health that continue to affect New Yorkers of color.”
About the Health Department maternal health programs:
- Nurse-Family Partnership: An evidenced-based, nurse home-visiting program for high-need communities. Under the Nurse-Family Partnership, nurses visit women in their homes every one to two weeks during pregnancy and throughout the child’s first two years of life, offering guidance on: breastfeeding; child development; parenting skills; pregnancy planning; preventive health practices; and strategies to attain economic self-sufficiency.
- Healthy Start Brooklyn: The initiative focuses on central and eastern Brooklyn, serving the neighborhoods of Brownsville, East New York, Bedford-Stuyvesant and Bushwick. Healthy Start Brooklyn provides home visiting as well as resources on breastfeeding, perinatal depression, developmental delays and home safety. The program works with the entire family by engaging fathers through the program Fathers Also Matter (FAM), which supports men as parents through referrals to job training and other services. Healthy Start Brooklyn also operates the By My Side support program, pairing doulas (trained childbirth assistants) with pregnant women.
- Family Wellness Suites: Dedicated spaces at the Neighborhood Health Action Centers to promote maternal wellbeing and family health. A key strategy of the Health Department’s Birth Equity Initiative, the Family Wellness Suite offer restorative spaces for parents to breastfeed, rest, exercise, and strengthen their social support networks, which are often missing in communities with poor birth outcomes and high infant mortality rates. Programs offered at the suites will include activities to support breastfeeding, risk-reducing behaviors during and after pregnancy and, healthier eating, as well as resources for referral to medical and social service providers and birthing centers.
- Sexual and Reproductive Justice Community Engagement Group Birth Justice: Initiative to educate about pregnancy and birth using Sexual and Reproductive Justice principles. Through identifying and training community members to become Birth Justice Defenders, the campaign seeks to provide individuals and their communities with the information, skills and support to navigate health institutions, enabling them to confidently self-advocate for respect and full bodily autonomy throughout the course of their pregnancy and afterward. In parallel, a group of provider allies will be engaged with the purpose of increasing knowledge and implementation of best practices for respectful care at birth among providers.