A new statewide center led by researchers at Henry Ford Health + Michigan State University Health Sciences in Detroit and Corewell Health in Grand Rapids will study ways to reduce the number of pregnancy-associated deaths and complications, particularly among Black, Hispanic, and rural residents.
The Multilevel Interventions to Advance Maternal Health Equity Center, or MIRACLE, is one of 10 new maternal health research centers funded by the National Institutes of Health (NIH). Backed by a nearly $19 million grant, the center will test multiple community-informed interventions to eliminate the disparities in illness and death that occur during pregnancy and postpartum.
In general, the rate of pregnancy-related deaths is higher in the United States than in other high-income countries, including those in the European Union. While pregnancy-related deaths were decreasing in other industrialized countries, they more than doubled in the U.S. between 1987 and 2016 and increased by one-third between 2018 and 2020.
Black women are three to four times more likely to die of pregnancy-related causes than white women and three times more likely to suffer severe complications, such as stroke or hemorrhaging.
“We’re not focusing so much on theory,” says Jennifer Johnson, one of the center’s principal investigators and a C.S. Mott Endowed professor of public health in the MSU College of Human Medicine. “We’re in the trenches, trying to bring real-world changes to improve the health of pregnant and postpartum people.”
Reducing the rate of pregnancy-related deaths and complications and eliminating racial disparities requires a multipronged approach.
“In the 21st century, those rates should not be that high,” says Critian Meghea, associate professor of obstetrics, gynecology, and reproductive biology in the MSU College of Human Medicine, and principal investigator for the center. “There is no one silver bullet. It takes a village, so to speak, to improve health care and eliminate these racial disparities. It involves everybody.”
The center is built on partnerships among university researchers, doctors, nurses, other clinical practitioners, community health workers, and brings community and birthing persons’ perspectives and voices into all phases of the research.
The partners include Henry Ford Health; Strong Beginnings, a federal healthy start project with Corewell Health as fiduciary; the Flint Community Based Organization Partners; Flint Odyssey House; Hurley Medical Center; Munson Healthcare; MyMichigan Health; the Michigan Department of Health and Human Services; and others.
The center encompasses three projects, each addressing disparity-related issues on multiple levels.
The first uses community health workers, visiting nurses, and social workers to coordinate the community and clinical care of pregnant and postpartum Black and Hispanic women by periodically visiting them in their homes.
The second project expands the use of a digital application developed by Steven Ondersma, a C.S. Mott endowed professor at MSU’s College of Human Medicine. Using the app, Black and rural pregnant women will be able to self-screen for warning signs and chat live with community health workers who can connect them with services.
The third project examines the best ways to scale-up best practices for improving maternal care equity in 12 Michigan counties. Because 83 percent of deaths occur during pregnancy or postpartum (rather than around the time of delivery), the project focuses on quality improvement in community care and the handoff from the hospital to community care.
The center also includes a training program bringing together researchers, practitioners, public health workers, administrators, and many others.
Johnson attributes the disparities to structural racism, including policies that have relegated many Black women to lives of poverty in high-crime neighborhoods without easy access to transportation, medical care, and childcare. Black women are less likely to be taken seriously when reporting pain or other symptoms.
“I don’t think it’s deliberate,” says Johnson. “I don’t think health care providers wake up every day thinking, I’m going to treat these patients differently.”
Improving communication between patients and health care providers and removing the obstacles many women face can help eliminate those disparities, the researchers say.