America is in the midst of a Black maternal health crisis, and it is getting worse, not better. According to the most recent data from the CDC, in 2020, Black maternal mortality increased a shocking 26% and has persisted at a rate of at least three-times that of white women for decades. Let’s be clear: It’s racism, not race, that is putting Black women at risk. These data belong to a damning body of research showing how Black women and birthing people go unseen and unheard as they navigate the healthcare system, for the simple reason that it was never built with them in mind. (This is precisely why Chidiebere Ibe‘s medical illustrations went viral earlier this year: Black bodies have never been treated as standard.) This history of exclusion, bias, and even outright harm has had a devastating impact on Black women and families. And as we have seen over the past two years of the pandemic, it has exacerbated deeply rooted mistrust in historically marginalized communities. Today, more than half of Black adults say they don’t trust the healthcare industry, the lasting legacy of generational neglect. But as much as the pandemic has reinforced the shortcomings of our system, it’s also accelerated the use of digital technology to drive better care. It’s no secret as to why. The devices that most people carry in their pockets have become increasingly powerful tools to share information, create community, and access services—and they are only becoming more ubiquitous, expected to outnumber humans 3 to 1 by next year. And where traditional healthcare is synonymous with complexity and cost, digital health has the potential to be defined by its intuitiveness and accessibility, making it a powerful new competency for healthcare as a whole. The 3 principles of digital health equity We also believe that digital technology can make healthcare more equitable and help address the Black maternal health crisis—and if it is to prove worthy of the monumental investment over the past few years, it has to. Principle #1: Make care more accessible A core tenet of trustworthiness is showing up when called upon. The traditional system is defined by significant gaps in care—half of U.S. counties lack obstetric services, including large metropolitan areas. Digital technology can make healthcare more accessible, not only by offering care that is unconstrained by a patient’s location, but that can more easily fit into the 24/7 nature of healthcare with faster response times. These technologies can also deploy multiple modes of delivering that support, including through both video visits and text messaging, as well as asynchronous channels, like on-demand classes and community forums. Principle #2: Make care more accountable Recent research revealed that Black patients are more than twice as likely as white patients to be described negatively by their healthcare providers in electronic medical records, adding to a significant body of research showing how implicit bias affects healthcare outcomes. Digital technology is uniquely able to amplify the voice of patients, particularly from those whom the industry has historically overlooked, tapping into the power of community to bring much needed transparency to the healthcare system. Principle #3: Make care more affirming Digital health can point the way toward new industry standards regarding excellence in care. We see particular promise in incorporating cultural competency into care delivery. Just over 20% of Black adults have healthcare providers of the same race, compared to almost three-quarters of white adults. Dr. Rachel Hardeman and her team at the University of Minnesota have done path-breaking research documenting the promise of so-called “care matching,” finding that maternal and infant health outcomes improve when Black mothers are paired with Black birth workers. Given the concerning lack of diversity in the healthcare workforce, digital platforms can play a key role in connecting patients with providers who share their lived experience. The ‘Momnibus’ and what’s next We have no doubt that the private sector will continue to innovate and push healthcare forward. But to truly turn the tide on the Black maternal health crisis, we also need our elected officials to step up. This week is Black Maternal Health Week in the U.S., and on Capitol Hill, a set of bills collectively known as the Black Maternal Health Momnibus Act of 2021 awaits a vote. Among the many components of the legislation is a specific push to invest in digital tools to expand access to quality care, measure and report on health outcomes, and combat implicit bias, among other essential upgrades. We have heard many times that it takes a village to raise a child. The state of our crisis suggests, in fact, that it takes a country stepping up for the most oppressed and improving our system at the patient level where it’s really lived. We urge Congress to pass these bills, ushering in a new era for maternal health in America. Kimberly Seals Allers is the founder of Irth, a doctor and hospital review and recommendation platform for Black and brown women and birthing people. Dr. Neel Shah is the chief medical officer of Maven Clinic.
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