by James A. Bacon
Governor Glenn Youngkin has launched an initiative to address disparities in maternal healthcare outcomes, and he’s doing it right. Rather than presupposing what the problem is and what the solutions are, he is resurrecting the Task Force on Maternal Health Data Quality Measures to do a deep dive into the data to find out how outcomes can be improved.
African-American, indigenous and Hispanic women, as well as women in rural and underserved communities, suffer higher mortality rates during pregnancy and in post-childbirth. The question is why. It is commonly said that “systemic racism” is to blame. If so, then part of the solution logically entails subjecting doctors and nurses to bias training, finding physicians for pregnant women who “look like them,” and pursuing other race-based remedies.
But what if the different outcomes are more closely tied to socioeconomic status, distance from medical offices, or the patients’ own behavior?
Youngkin’s Executive Order 32 does not pre-suppose that “systemic racism” either is or is not at the root of disparate health outcomes. The directive does not mention the concept at all. Rather, the goal is simply to ensure that all pregnant women receive “essential prenatal care, including medical and nutritional support, and information and education that improve birth outcomes.”
The task force builds on other maternal- and infant-health initiatives such as participation in the Improving Maternal and Child Health in Rural America Learning Collaborative of the National Governors Association.
The task force, says the executive order, will “monitor progress and evaluate all data from state-level stakeholders, including third-party payers, and all available electronic claims data to examine quality of care with regard to race, ethnicity, and other demographic and clinical outcomes data.” The Secretary of Health and Human Services shall provide a report by December.
There are many unknowns. Do disparities exist because of differential access to the healthcare system? If so, is the problem lack of Medicaid or other medical insurance coverage? Is it a shortage of gynecologists and obstetricians? Are physicians spurning poor patients because Medicaid reimbursements are too low? Are expectant mothers missing medical appointments? If so, why? Are their lives in chaos? Do they need reminders? Do they need transportation to the doctor’s office? To what degree are poor outcomes associated with obesity, diabetes, high blood pressure, substance abuse and other co-existing conditions? Are those conditions being treated?
A rational approach to dealing with disparities in outcomes will seek to identify concrete causes and address them. “Systemic racism” is a meaningless explanation. Doctors, nurses and hospital administrators don’t need bias training. They need to know exactly where the system is falling short so they can apply targeted remedies. Youngkin’s executive order will help them do that.
Update: The Virginia Mercury reports that Youngkin’s executive order is almost identical to a bill, House Bill 781, Del. Charniele Herring, D-Alexandria, and vetoed by Youngkin. The Virginia Mercury suggests that the executive order is somewhat longer than the bill and also deletes the word “birthing person.” Herring accused Youngkin of “politicizing” the bill.