To Address Sharp Disparities in Maternal Health, a Foundation Turns to Local Groups for Solutions

The United States lags behind other wealthy countries in many areas, but when it comes to taking care of mothers and newborns, we’re doing a particularly abysmal job.

The statistics are dismaying. For every 100,000 live births in the U.S. in 2018, there were 17 maternal deaths—more than double that of most other high-income countries, according to research by the Commonwealth Fund. “In contrast, the maternal mortality ratio was three per 100,000 or fewer in the Netherlands, Norway and New Zealand,” the report concluded.

The Centers for Disease Control (CDC) also identified sharp racial disparities in maternal outcomes, pointing out that Black, American Indian and Alaska Native women were two to three times more likely to die from pregnancy-related causes than white women. These women’s infants are also at higher risk: Another report cited by the CDC found that Black women were twice as likely as white or Hispanic women to have stillborn babies. And the trends are heading in the wrong direction, as pregnancy-related deaths more than doubled between 1987 and 2017.

The Anthem Foundation recently launched an initiative that aims to reverse these trends—or at least chip away at them some. In an investment that has the potential to impact as many as 100,000 women, the foundation will provide more than $14.5 million in grants to 17 organizations working to boost the health of mothers and babies.

The Anthem Foundation is the philanthropic arm of Anthem Inc., one of the largest health benefits companies in the country. Maternal health is one of the foundation’s four main focus areas, along with encouraging food as medicine, reducing substance use disorder, and disaster relief.

According to Anthem program manager Katie Heenan, the foundation has always been dedicated to health equity, but recent events have increased that commitment. “Racial inequities and health disparities have been impacting our communities for many years, but between COVID and social unrest, 2020 shined a light on just how bad things were,” she said. “At the foundation, we saw an opportunity and a responsibility to ensure that we were doing our part and playing a role in advancing health equity.” She pointed out that 90% of the participants in the programs funded by the new Anthem grants are women of color.

“Not only will these grants help ensure women and their babies can achieve optimal health and well-being,” said Shantanu Agrawal, Anthem’s chief health officer, “they will put us at the forefront of improving maternal and infant health, especially in communities of color, where health disparities have a dramatic impact on outcomes.”

Systemic racism and social determinants

Why are maternal health outcomes in the U.S. so dismal, particularly for women of color? A Center for American Progress report puts it bluntly: “Racism is the driving force of disparities in maternal mortality. Income and education level are not protective factors when it comes to these disparities in maternal health outcomes, further reinforcing the central role of racism in these trends.”

Social determinants of health linked to systemic racism play a role, including access to healthcare, nutrition, housing, transportation and environmental conditions. Discrimination itself is considered a social determinant of health, since it has been shown to increase stress and contribute to other health conditions.

Systemic racism also impacts the quality of medical care that women of color receive. Many women report that their physical pain and other concerns are dismissed or overlooked in healthcare settings. “Implicit bias within the healthcare system as it relates to maternal care is a big issue,” Heenan said. “Black women often feel like their concerns or their preferences are discounted or disregarded.”

Grand Slam tennis player Serena Williams’ experience illustrates this point. In 2018, the day after Williams gave birth to her daughter by Cesarean section, she began to have trouble breathing. She was convinced that the problem was caused by blood clots, which had almost killed her in 2011. She alerted her nurse and doctor, and even told them what treatment she needed. They initially assumed that Williams was confused because of the painkillers she’d been given, and didn’t examine her for clots. It wasn’t until she insisted that she was given a CT scan, which revealed clots in her lungs, and she finally received the treatment she needed.

Doulas, midwives and high-touch care

Under its new initiative, Anthem will provide more than $7.4 million to 16 local organizations over the next three years to improve maternal health. The organizations all approach maternal health slightly differently, but emphasize at least one of the following themes: access to care (including doulas and midwives to provide both hands-on and advocacy support); “high-touch” supportive care that addresses individual needs; support for health-related social needs (like nutrition, housing, and other social determinants of health); and mental health support. (See a complete list of grantees here.)

One local grantee, Birth in Color RVA, based in Richmond, Virginia, provides community-based doula training and home services like nutritional and lactation consulting. It also offers racial bias training for medical centers to help them identify their own implicit biases. The grant from Anthem will allow the organization to expand these efforts and offer doula training in under-represented communities in Virginia. Doulas and midwives, who provide support and advocacy before, during and after a woman gives birth, have been shown to improve maternal health outcomes.

Anthem also provided $7.1 million to Creating Healthier Communities (CHC), a national organization, to overcome disparities in preterm birth rates among Black women. The Anthem grant will support CHC’s development of a tool that will screen Black expectant mothers for factors that threaten their maternal health and put them at risk for preterm birth. The mothers will be provided support—a doula, community health worker, or mental health services, for example—to address those needs.

Where philanthropy can make a difference

Anthem’s Katie Heenan is hoping that the new grants will be effective in increasing the number of healthy mothers and newborns—and offer models that can be scaled. “What we really hope to do through these grants is to identify the programs that are successful in moving the needle, and seeing if there’s an opportunity to replicate these types of programs in other places,” she said.

Maternal health is clearly an area that could use more philanthropic support, and given the stark discrepancies in maternal outcomes, it’s an area where funders with a commitment to racial justice can make a real difference. Fortunately, a number of foundations have stepped up in support of maternal health in recent years, as IP reported. In 2021, the Ballmer Group invested $525,000 in Los Angeles-based Black Women for Wellness; the grant will support expansion of doula and home visiting services for Black families. And just last month, Blue Cross of California unveiled an initiative to support maternal and infant health in underserved communities.

But there’s much more to do. Heenan says that when Anthem put out its request for proposals, the organization received a large response. “There is a lot of good work going on out there,” she said. “Community-based organizations can make a big difference because they have more of that trust factor than many traditional medical settings. They are meeting people where they are and understanding not only individual needs, but the communities they come from. And I would say by the volume of interest that we received through the RFP, there’s obviously a need and an opportunity to do some great, great things in this space.”

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