Even in the best of times, the U.S. health system has not always been delivering for all women. Maternal mortality rates have increased over the last decade and racial disparities in maternal health outcomes have persisted.
Today, we are witnessing in real time the ability of our health systems to build and flex capacity in order to meet the demands of an unprecedented surge in patients. With health systems shifting resources to care for the onslaught of patients infected with the novel coronavirus, hospitals are understandably being asked to delay elective procedures.
However, childbirth will not wait for the pandemic to ease, testing the resiliency of health care systems across the U.S.—and the world. Our health care systems must be agile enough to ensure women have a safe pregnancy and childbirth even under the pressures of a pandemic.
There are three immediate areas to focus our energy on to address pregnant women’s needs:
Create connections for women to learn from each other and from trusted health providers. Even in normal times, pregnancy and early motherhood is a period of great expectation and anxiety. The COVID-19 pandemic elevates that anxiety. Routine prenatal care visits are limited as providers turn to the most urgent cases and strive to reduce the risk of healthy women becoming infected.
There is also a gap in reliable information about how COVID-19 affects pregnancy and childbirth. Credible online platforms, like the recent live chat hosted by the March of Dimes, are needed to ask questions, provide answers and create connections among providers, pregnant women and new mothers. We must create up-to-date repositories of emerging evidence about SARS-CoV-2 and provide understandable information so that women can make informed choices about maternity care.
Build on the strength of communities to meet women where they are. Necessity is the mother of invention, and the pandemic underscores that efforts to improve maternal health in the U.S. must go beyond medical settings. New resources are being deployed faster to allow for physical distancing and limit the burden on health facilities. We also have to challenge the usual ways of doing things to ensure women get the care they need, even in the face of government requirements to shelter in place.
Essential pre- and postnatal community outreach programs across the U.S., like those led by various organizations in large urban areas throughout the country, are testing out new models of conducting virtual home visits to safeguard critical lifelines of care and support while at home. We might find these models make sense even once the pandemic is over and may serve to address some of the broader factors that impact maternal health outcomes.
To be impactful, these community-outreach efforts around pregnancy and childbirth must be properly resourced and augmented. If done right, and equitably, these programs can relieve some of the pressure on the health care system and become fully integrated and valued as an indispensable part of the system.
Equitably accelerate the use of technology. Community factors and the social determinants of health—access to health care services, health literacy and social support—directly affect maternal health outcomes. In a country where black women are three to four times more likely to die from complications during pregnancy and childbirth, we must pay special attention to the impact of race.
COVID-19 is accelerating the pace of technological innovations to provide quality health care remotely. Some of these innovations may have long-term potential to break down barriers to accessing care beyond the immediate crisis of COVID-19. We must ensure that these innovations do not exacerbate already wide disparities in maternal health outcomes.
The economic, social and geographic barriers that have limited access to high-quality prenatal, delivery and postpartum care may also hinder access to technological solutions. Online education, telehealth services and virtual support require devices, internet connectivity and resources that not all pregnant women and new mothers have at their disposal—especially now.
When the health system is stressed, the most vulnerable fall through those cracks. This pandemic demands that we target efforts so that we do not inadvertently worsen inequities.
To support healthy pregnancy and safe childbirth, Merck for Mothers is committing $3 million focused on care during the pandemic as part of our long-term efforts to address preventable maternal mortality. Our investments will be directed towards both U.S. and global programs and will respond to immediate maternal health needs.
Ultimately, we recognize that the coronavirus pandemic will permanently change some aspects of the maternal health landscape, as it will likely change the way we live. By providing critical investments for our health systems to keep women at the center of solutions, expand how quality care can be provided and enable new technologies to reach everyone, we can make our health systems more resilient, now and in the future.
