Rae Woods:
Hey, it's Rae. This week I want to take a look back at our episode on maternal health. This one's from the archives. We actually released it in 2021, and at the time we discussed the worsening maternal health crisis and how newly tightening abortion laws and COVID-19 were exacerbating disparities. I would love to tell you that things have gotten better since then, but that would be a lie. We're going to be playing this episode almost in its entirety, though you are going to hear me interject a handful of times to address a few of the things that have changed. And then I'll be back at the end of the original episode with brand new bonus content to discuss what's driving poor maternal outcomes today and why there needs to be a massive shift in how the industry thinks about maternal health moving forward. But for now, here's the original episode from 2021.
From Advisory Board, we are bringing you a Radio Advisory. My name is Rachel Woods. You can call me Rae. We spend a lot of time talking about racism and equity on this podcast. In fact, we have an entire playlist dedicated to it that I'll link in the show notes. But today, I want to talk about a specific component of health equity, one where the United States is actually woefully behind, and that's maternal health. To do that, I brought back advisory board health equity expert Darby Sullivan. I also asked Callie Chamberlain to join us. She's the Co-Director of Social Responsibility at Optum, the co-host of their podcast Until It's Fixed, and she's a trained birth doula. Hey, Darby. Hey, Callie.

Darby Sullivan:
Hi Rae.

Callie Chamberlain:
Hi.

Rae Woods:
Darby, are you sick of coming on Radio Advisory yet?

Darby Sullivan:
Not at all. I love coming on and chatting with you about this stuff.

Rae Woods:
And Callie, you are our first time guest and we've had a few clinicians on the podcast before, but you are our first doula to come on, which is so cool.

Callie Chamberlain:
I love it. Thank you for having me.

Rae Woods:
Callie, you have a very interesting role. You actually co-lead social responsibility for Optum, which has this broad focus on health equity, but you yourself kind of had this a-ha moment. You realized somewhere along the line that organizations like Optum weren't actually doing enough for maternal health equity specifically, when did you have this personal a-ha moment?

Callie Chamberlain:
In my doula training, learning more about the experience of being pregnant and going through labor and delivery and postpartum, it really became clear to me how many gaps are in the system and also what the lived experience are of birthing people. And so being on the other side of that and training to essentially fill those gaps and work against some of what the system has set up, amplified for me the opportunity to really do something different here. So learning about the training and then also recognizing that Optum provides services to one in 10 children that are born in the United States, it just became clear there was a major opportunity for us to actually change the way we do business.

Rae Woods:
And I think a lot of folks end up coming back to this firsthand experience, although not many actually go to the point of saying, I'm actually going to train to be a birth doula. But other people say, when I had a child or when my partner had a child or my sister or my brother, that's what made me realize that maternal health is actually a problem here in the United States. And I want to spend some time just talking about how big of a problem this is. Darby, help level set for me.

Darby Sullivan:
So the US has the highest mortality ratio for pregnancy related deaths compared to all other similar nations.

Rae Woods:
Wow.

Darby Sullivan:
We're also the only country where our rate is actually increasing over time. So it's gotten 60% worse since the year 2000.

Rae Woods:
Since the year 2000?

Darby Sullivan:
Yeah, 60% worse. Most people know that maternal mortality, they've heard by now that it's a problem in the US, but I don't think many people realize how preventable the majority of these deaths are. So 60% of pregnancy related deaths that are measured could have been prevented with things like proper delivery at the point of care, proper care delivery during birth, prenatal care and more.

Rae Woods:
And you're speaking specifically about maternal mortality, but where do we stand when it comes to maternal health more broadly or maybe even what does that term encompass?

Darby Sullivan:
Maternal health encompasses, at least when we talk about it here at the advisory board, the mortality and also the morbidities that happen related to pregnancy. And so the mortality is really, really bad, but morbidities are also pretty severe. So I think every year between 60 or 80,000 patients in the US have a near miss or some severe pregnancy related morbidity, which does not lead to death, but can have really severe clinical, emotional implications. And the rate of those near misses are getting worse over time as well. And some folks are increasingly familiar with the paternal health problem, but what I think not as many folks realize is the disparate outcomes between racial groups in the US.

Rae Woods:
Ah. Well, let's go there. Let's give it the platform that it deserves. What do we see when it comes to disparities within groups?

Darby Sullivan:
Yeah, so I guess first to zoom out, I want to emphasize that no matter who you are in the US, you are at risk of having a negative outcome just because you live in this country. But the problem is a lot more severe for specifically black and Native American patients. So Native Americans die at a rate of 2.5 times the rate of white people and black patients die at more than triple the rate. And really notably, these disparities hold true when you account for education, when you account for income. One of the most striking facts that I've heard is that black women with a college degree are more likely to experience these morbidities than white women that don't have a high school education.

Rae Woods:
Callie, Darby, I normally have a lot to say on these podcasts, and I normally am quick to follow up with a question, but I actually kind of just want to pause on what you just said.
At this point in the original episode, we discussed how COVID-19 would disproportionately impact pregnant people and worsen maternal mortality. I'm going to skip past this part of the original episode for now, but know that in the bonus segment, we are going to talk about how the newest data shows just how much COVID affected women's health writ large.
Okay, let me force myself to go to a slightly more positive place. This is a huge, huge problem, but the good news is that people like Callie and organizations like Optum have kind of realized with this spotlight that COVID has put on maternal health, that we actually need to do something about it. So Callie, my question for you is what advice do you have for organizations that are looking at this problem and saying, we need to take a bolder stance on maternal health equity?

Callie Chamberlain:
First of all, yes, absolutely. Just to underline something that Darby had mentioned earlier, when we think about equity in this context, the baseline is also not good. Nobody wants to be there, outcomes are terrible. Care, there's a lot to be desired for everyone regardless of what your race or ethnic background is. It's especially bad for people of color. And so I think that being able to center around that, to go into communities that are representative of your most vulnerable populations and asking them to help you solve the problems, and being humble in that approach, being willing to amplify their voices and put resources behind them to ensure that you're truly understanding the complexity of the problem is so important.

Rae Woods:
This is really nuanced advice because you're saying on the one hand, this problem is bad for everyone, but we know that these disparities exist. But when it comes to the action steps that an organization takes, you actually want to orient your efforts at the portion of the population that has the worst outcomes because you know ultimately it will benefit everyone. And that's a really specific nuance that I want to make sure people hear.

Callie Chamberlain:
Yes. Thank you for calling that out. And our belief is that when you solve for that group of people, you actually end up solving for everybody.

Rae Woods:
Exactly.

Callie Chamberlain:
Yeah. A lot of our work is centered around looking at pregnant people who are experiencing domestic violence, pregnant people who are incarcerated, pregnant people who never have their voices come into research that actually informs clinical practice. And so by wrapping our arms around those communities and ensuring that we're supporting people who come from those groups and working from behind them and integrating their insights and learnings into our organization and the way that we think about equity, I think that's the approach to be taking regardless of what you're focused on, but specifically around maternal health.
The other thing I'd add here is that it's not just maternal health. When I have conversations with providers about how we got here, they'll also say things like, well, we don't talk about women's health and in this country we don't prioritize women's health and therefore it's not possible for actually us to have reduction in maternal morbidity and mortality. And then you think about social determinants of health and how bad they are across this country, it's built on a foundation of race. And so kind of going back to something that was said earlier when I was in doula training, we learned about the hospital gown for black women being the great equalizer. It doesn't matter how smart you are, it doesn't matter how much money you make, those things actually can work against you. And so we have to also, in this context, talk about race.

Rae Woods:
I completely agree, and I want to get to these root causes in a moment, but I want to stay on practical advice for organizational leaders. As somebody who's actually advocated for change, what are the biggest things that you needed to armor yourself with? Were there people in the room? Was there specific kind of data that helped you kind of lobby in your own efforts? And how did you deal with the inevitable pushback that anyone who's dealing with a challenge like health equity will ultimately get?

Callie Chamberlain:
Yeah, I think in the answer that I just gave, which is very multidimensional, it really was looking at how the organization had oriented itself around those different topics and then pulling them together to say, we have a real opportunity here and this is what we can live into. We say that we're about health equity, we can actually lead in this space. Isn't that amazing from a branding perspective, from a thought leadership perspective, isn't that where we want to go? And because this issue sits at the intersection of race and gender, there's a real opportunity for us to learn about our patient populations in a way that is not happening across the organization today.

Rae Woods:
So this is a real practice what you preach moment.

Callie Chamberlain:
Yes, exactly, and I think that really helped us get the right people in the room. We said, look, we've done work in this space before. We're just building on the legacy of what has happened before. And I think that also helped us to get some momentum.

Rae Woods:
And I think that same practice what you preach principle can help you not in just making sure that an organization is advocating for optimal patient outcomes, but also so that we're actually addressing the root causes in the community. Which Callie, to your point, is where we actually need to go if we are going to make progress. Let's make sure we understand why this problem exists. Darby, explain to me some of the root causes of maternal health inequity in the United States.

Darby Sullivan:
Yeah, sure. So according to the research, we see this crisis in part because of the intersection of two forces. So on the one hand, the legacies of structural systemic racism that we've been talking about for the past year and a half more and more. And on the other hand, like Callie mentioned, the sort of systemic deprioritization of women's health across the lifespan in favor sometimes of fetal outcomes. So those two things together, I think, have uniquely led to the maternal health equity crisis.

Rae Woods:
Darby, those are two... They're humongous challenges to solve. And so part of me is thinking no wonder folks focus on quick wins or low hanging fruit, or aren't able to actually get to these root causes because you are talking about upending the structure of the United States. My question is how can organizations of all kinds start to chip away at these underlying issues?

Callie Chamberlain:
We are just beginning here, to be clear. I think two things are really important. One is that each of our philanthropic organizations that we're supporting, which is out there in the world, not necessarily about us as the second-largest healthcare company in the world changing our business practices. Each of these grant partners has an executive sponsor. The intent of that is for the sponsor to serve as a senior advisor to the organization to look for opportunities for Optum to even more deeply support their work, and also to think about the relationships and the communities, the insights that we're learning from our work to pull back into how we think about creating products and services within our organization. So that's one of the ways in which we're advancing, I think, equity and deepening relationships with communities. That's really important because it's not just, again, out there, it's like coming into the organization as well.
The second thing is thinking about how you align your priorities to what you say that you care about. One of the biggest things that I would love to see Optum do is to have really incredible, best in class paid parental leave policies. I would love to see us lobby in ways that actually prioritize the things that we're doing externally and the things that we say that we care about internally. There's a gap there for a lot of organizations because we're in a capitalistic society, for-profit environments. And also there's so much space to walk the line, and I'd love to see us move closer to that in the future.

Rae Woods:
And this is not just a lesson about one organization or one major healthcare company. Every single person who is listening to this podcast needs to think, what am I doing now to make progress, and how can I think bigger? How can I do more? How can I address every aspect of equity, not just my patient outcomes, but also my own people, my own workforce, as well as my community? And frankly, that's the message of equity period. I think it just plays out really, really specifically when we talk about maternal health. Darby, what do you think? How can organizations, again, from across the industry, address some of these root cause issues?

Darby Sullivan:
Yeah, I think on the one hand, leaders from organizations can sort of say, I'm actually making a change to my benefit structure in a way that will have far-reaching impacts. That's relatively an easy step to make compared to the other complex changes that orgs have to make. To stay at the high level, we recommend tactics that fall into three key categories, the first being primarily for provider organizations. So those are the ones that are actually owning that patient interaction. We recommend that they start with sort of these no regrets, safety protocols, because too often the standard evidence-based OB protocols that vastly reduce the instances of never events, those are not being used in a standardized way.

Rae Woods:
Meaning they're only used for say, white pregnant people.

Darby Sullivan:
Or not. Or maybe some care teams know how to do it, some care teams don't.

Rae Woods:
So just the basic way that we have care variation in general, we're not focused enough on it in this particular space.

Darby Sullivan:
Exactly. And that's sort of like do that immediately. After those are in place, then I think you can start to build those feedback mechanisms to try to get a sense of, okay, what are the broader causes of this beyond just sort of the care variation that we might see? That means expanding and existing maternal mortality review board to make it more of a perinatal review committee so that you catch problems that happen prenatal and postpartum as well as during the delivery, in addition to sort of the basics of gathering data stratified by race to see where disparities pop up.

Rae Woods:
And I would say that's the best practice for the patient outcomes piece. And then you pair that with what Callie was saying, which is how do we support our own workforce? How do we address this problem in the community?
At this point in the original episode, we talked at length about a Texas law in 2021 that effectively outlawed abortion after six weeks of gestation. This was a huge topic of discussion at the time, but we all know that this wasn't the end of the story. The Dobbs v Jackson decision in 2022 deeply restricted access to safe and legal abortion. We're going to talk more about this in the bonus segment at the end of the episode, but if you're looking for more information, we just wrote a piece reflecting on the year since the Dobbs decision. I'm going to add that to the show notes for you.
Which is that to have a conversation about maternal mortality or maternal health, we just have to talk about women's health. And you can't talk about women's health without addressing the fact that safe and legal access to abortion is a necessary part of women's health, and we need to be willing to have that conversation if we're actually going to get at some of these structural root causes that ultimately improve outcomes for pregnant people in this country. You both work with organizations of all different kinds about this issue. What's the biggest thing that those organizations tend to get wrong when it comes to addressing maternal health?

Darby Sullivan:
What a lot of organizations get wrong is that they think too narrowly both about the scope of the problem, but also about who should be involved in the solution. So we talked kind of specifically about the provider organization's role, but we know that health plans, life sciences companies, tech companies can also play a role. And so each stakeholder across the industry has to really think strategically about how they can partner within our own industry and also even sometimes with competitors in order to sort of raise the bar for each other.

Rae Woods:
Do you have an example of that kind of partnership really playing out?

Darby Sullivan:
Yeah. So for example, we've been talking with health plans that are trying to think through how to hold provider organizations accountable for equitable care delivery in quality scorecards. And we are also seeing providers who are trying to work with plans to one day get reimbursement for referring patients to social care, those things that actually have a measurable impact on downstream outcomes.

Callie Chamberlain:
And I would add onto that and just say that I think being able to think about this issue more expansively is helpful for everybody. So like we're talking about with maternal health, it's also about women's health, it's also about reproductive justice and family planning. When we talk about birthing people, it's using that term birthing people, which is more inclusive. It's also talking about people of color, looking at who's experiencing the worst kinds of disparities, looking at how our research is not inclusive enough because it doesn't encompass lived experience as a part of what's informing clinical practice.

Rae Woods:
Which comes back to those life sciences companies who are developing drugs and creating the technologies and all of that upstream work. Exactly.

Callie Chamberlain:
Yeah. And one of the things that I think was important for us at Optum was to recognize that we did not have relationships with the communities we wanted to work in. And so it required us to partner with uncommon allies and people who maybe we wouldn't have partnered with before to be able to rebuild that trust and work within communities to address this issue. Because it is complex, it's multidimensional, and thinking that we can just focus on providers or patient education, it's not enough to get us where we need to be.

Rae Woods:
I want to make sure that our listeners don't feel overwhelmed by the enormity of the problem here, or that they feel, let's say, appropriately overwhelmed by the task at hand that every single person who's listening to this podcast needs to act on. And that's where I want to end our conversation. When it comes to maternal health, what is the one thing that you want to make sure our listeners do differently as a result of this conversation?

Darby Sullivan:
I've said this before on Radio Advisory, so I'll be a broken record, but it's really important that we understand we can't fix structural problems without structural solutions. So while we should be meeting patients in communities where they are, while we should be impacting our workforce, I also want folks to think even further, especially those that have government affairs arms, which is most organizations. How can you say, for example, I'm going to weave in my maternal health equity goals into my advocacy agenda, whether it's I'm going to expand Medicaid coverage for pregnant people, or I'm going to try to advocate for funding and reimbursement for non-traditional providers like doulas? What are the different policy choices that we already know will impact maternal health in a positive way that should be added to your agenda? And also what needs to be taken off your agenda? So in what ways are we actually perpetuating the same problem that we're trying to address?

Callie Chamberlain:
Yeah, and I think to support that, is my recommendation, which is to get closer to the ground all the time. It was so important for me to have the experience as a doula to work side by side with people while they were in labor and delivery to understand how broken this was. And I'm not recommending that everyone becomes a doula, although I think that would be amazing, there needs to be much more of us, but it's just being in conversation to the people who are most vulnerable and thinking about how you leverage your power, your influence, your privilege, which all of us have in some sort of realm to think differently about the work that we're doing and to say what it is that needs to be said and make sure that our actions are aligned to that. It's not enough to say that we care about health equity. It's not enough to say that we really want to do something around maternal health. Get lower, figure out how you do that and how you do that in community with the people that need to be most supported.

Rae Woods:
And you don't need to be a pregnant person or know a pregnant person specifically in order to have that more on the ground connection.

Callie Chamberlain:
Yes, that's right.

Rae Woods:
Well, Darby, Callie, thanks so much for coming on Radio Advisory.

Darby Sullivan:
Yeah, thanks again.

Callie Chamberlain:
Thanks for having us.

Rae Woods:
Hey, it's Rae again. It's been almost two years since we released that original episode. And in the time since maternal health has continued to degrade in the United States, that's why I've brought back advisory board health equity expert Darby Sullivan and women's health expert Gaby Marmolejos, to discuss how maternal health has been shaped by the remnants of COVID-19 to talk about the impact of the Dobbs decision and the dire mental health crisis we're seeing in the US. Hey, Darby. Hey, Gaby. Are you ready to talk about this again?

Darby Sullivan:
Let's jump in.

Rae Woods:
In the original episode, the data that we were talking about was all pre-pandemic, and now the CDC has released new data. That data, I want to remind our listeners, is from 2021, so right in the middle of the pandemic. What's changed since the last time we had this conversation?

Gaby Marmolejos:
Yeah, as you mentioned, since the data from 2021, it is partially influenced by COVID-19. If you remember, that's when the Delta and Omicron variants were still leading to a lot of hospitalizations and deaths. So it kind of shows how the pandemic, frankly worsened a lot of disparities unrelated to pregnancy, but also worsened disparities related to pregnancy. As we saw, historically in the past, black, American Indian and Alaskan native women had the highest rates of pregnancy related mortality and morbidity. After COVID, we saw that maternal deaths among black women increased by 57% from 2019 to 2021.

Rae Woods:
Wow.

Gaby Marmolejos:
So now black women are 2.6 times more likely to die from pregnancy related complications compared to white women.

Rae Woods:
So the disparity really got worse. And again, when we had this original conversation, we were talking about how bad the disparities were when it comes to maternal mortality. Yes. And Gaby, is it worth reminding our audience why we're going to continue to use the term maternal mortality?

Gaby Marmolejos:
Yes. The data that the CDC releases that I think everyone's usually talking about is maternal mortality, which the definition of maternal mortality is a little bit different than pregnancy related mortality. The most recent data we have on pregnancy related mortality, I think is from 2018 or 2019 or something like that.

Rae Woods:
This is also how countries outside of the US are measuring this data. And it's helpful to then keep that comparison across international lines.

Gaby Marmolejos:
Yes.

Rae Woods:
Darby, what did you think when you saw this new data come out?

Darby Sullivan:
What struck me was that the data we're talking about, again, is showing not what's going on right now, but what's going on in 2021. And now we're in 2023, the world is very different because of Dobbs, and I hope this is not the case, but in two years when you invite me back on the podcast to give another update, and we're finally talking about what's going on in 2023 today, we'll almost certainly see that we have a rise in pregnancies carry to term. We also have a rise in maternal morbidities and mortality because of that. And unfortunately, I think we'll see higher rates of poverty for women and their families who otherwise would've gotten abortions. And so we know the ripple effects that poverty has and the social determinants of health have on women and their families and their ability to be healthy across their lifespan.

Rae Woods:
And that's a really good caveat that I am, of course, not saying that we should not pay attention to the data and the very, very just terrible numbers that Gaby just shared. But it's also important for us to not get lost in the details and look at practically what's happening on the ground right now because we know that we live through data lags like this, whether we're talking frankly about maternal mortality or other issues in healthcare.
On that note of making sure that we don't get lost, I have found that over the last few years, over the last few months, frankly, last few weeks, there's been a lot of attention placed on really terrible, tragic cases of maternal deaths. And they tend to be ones that happen during childbirth or right after. And I don't want to discount how tragic those stories are, but I get worried that we're focusing on childbirth alone or maybe even the first six weeks postpartum. And I think that's hiding a potentially even more tragic story that the data is showing us that a larger and larger proportion of pregnancy related deaths are happening in the year after birth. What is driving that trend?

Darby Sullivan:
That is completely true. When we last spoke, our best understanding was that deaths were kind of evenly spread across three different periods. So a third of maternal mortality or pregnancy related deaths were happening in the pre-partum period, a third were happening at the point of delivery, and a third were happening in the postpartum period. That has completely changed, and that's the piece that shocked me. It didn't shock me that we were getting worse in our performance overall, unfortunately, but it shocked me that now over half of maternal mortality in these deaths happened in the postpartum period between six weeks to a year after delivery.

Rae Woods:
And what is driving this shift to this period that's long after kind of childbirth?

Darby Sullivan:
Yeah, COVID was big driver, as Gaby said, but another primary driver was and continues to be, I would imagine, the behavioral healthcare crisis. So that's specifically suicide and substance use in the postpartum journey.

Rae Woods:
I just kind of want to take a minute and let that sink in for our listeners, the 2021 data, so not accounting for the post-ops reality showed a shift in the rate of pregnancy related deaths in the year after birth, and most of that is coming from overdoses and suicides. If that's the case, how should the industry be thinking differently about maternal health knowing that it is now very, very linked to the behavioral health crisis?

Darby Sullivan:
I think a lot of folks will need to look at the maternal health strategy if they have one. Hopefully they do have one.

Rae Woods:
Good reminder.

Darby Sullivan:
And make sure that they're realigning it to map to where the most pressing crisis is happening. So are you putting special focus, is your investment reflecting that over 50% of deaths are happening in that postpartum area? So there are certain things we can do and folks are doing right now to address this particular population and try to stem the crisis at hand. So those are things like making sure we have universal screenings for behavioral health issues from the pre-partum period all the way to the postpartum period.

Rae Woods:
Through a year. We should probably define what we mean because I'm hearing different definitions. A lot of folks talk about six weeks, some folks say 12 weeks. We really need to be talking about at least the first year.

Darby Sullivan:
Yeah, good push. Advocating for things like equitable parental leave, that has been shown to be associated with a lower risk of postpartum depression. These are things we can do. I've done research in the behavioral health space more broadly, we're so focused on standing the tide in front of us that we're not able to have a longer term strategy and think about the things that would stop the crisis from growing in the first place. So Rae, you know I could talk about this forever. You'll probably interrupt me. I have talked about this on the podcast, but those are things like, hey, if you're a health plan, maybe rethinking the reimbursement rates you have for behavioral healthcare services and for different providers. If you're a provider organization, how are you upskilling, not just your PCPs, but every single clinician across service lines to I notice the signs of behavioral health needs, screen for them, and then refer to services?

Gaby Marmolejos:
And honestly, when you mentioned that, I recently talked to a provider that had an interesting approach. They were telling me how they, during preconception counseling, so they actually do screenings for people and they assess a lot of different chronic conditions that someone might have, so behavioral health conditions, they also screen for hypertension, they might screen for diabetes and things like that, and they intervene early. And they were saying how this is an effort to frankly prevent a lot of high risk pregnancies in their space. And I just really appreciated how they were thinking ahead and thinking about, okay, let's not just intervene when that person is pregnant. Let's think earlier than that. So I think there's a lot of interesting and innovative ways to address the behavioral health crisis across specialties.

Rae Woods:
I love that example, Gaby, because it starts before a person is actually pregnant, because I'm really sensing that the problem that we're facing here goes deeper than maternal mortality, frankly, probably even goes deeper than maternal health. This is a women's health issue. As a health equity leader, as a women's health leader, what's the biggest thing that the industry needs to kind of change in terms of its thinking, it's framing around women's health and maternal health?

Gaby Marmolejos:
Yeah. There's a lot of focus on maternal mortality, and rightly so. It is tragic leading cause of death for a lot of women. But women are more than just reproductive engines. Women have other needs and other circumstances that impacted their pregnancies. It's interesting to me because I actually used to just focus on maternal health entirely and when I was studying maternal health, I realized that so many of the drivers, so many of the leading causes of maternal health are actually related to chronic disease. I'm thinking of hypertension, I'm thinking of diabetes, I'm thinking of depression. And there are just so many different things that women experience outside of pregnancy, yet when we talk about women's health, it's really specific to pregnancy.

Rae Woods:
When in fact, those are the things that are driving their outcomes and even their mortality.

Gaby Marmolejos:
Yes, for sure. And it's one of those things where if you truly want to make a difference in maternal health, you would want to think about women's health more broadly. And I think it's a more comprehensive and probably more effective strategy to think about it in that way.

Rae Woods:
And if we're going to talk about women's health beyond pregnancy, we have to talk about abortion. Darby just brought this up. And when we originally ran this episode, it was a very different time here in the US. And Darby, I don't know if you remember what you said in the initial episode, but you said something along the lines of the fact that any restriction on abortions would worsen outcomes for patients, especially for patients of color. And you're saying now you don't even need to really wait for the 2023 data to know this is something that we are going to see. My question is, why are you so confident in that prediction for the future, and what does this reality mean for women's health?

Darby Sullivan:
A lot of what makes me confident in this prediction is the data that we already have about really restricted laws like the one that we talked about in Texas a couple of years ago.

Rae Woods:
In 2021, yeah.

Darby Sullivan:
In 2021. So at this point, we're actually many years into abortion restrictions, or now it's much more national, but we have data that shows that abortion restrictions lead to worse outcomes for maternal health and for women in general. We already are hearing anecdotal evidence from providers and from OBs that these restrictions are leading to outcomes for their maternal health patients. And we know that unwanted pregnancies can directly impact a woman and her family's socioeconomic status, and the rest of their social determinants of health.

Rae Woods:
This is why we're talking about deeply rooted challenges in the way that women's health works, in the way that behavioral health works, in the way that health equity works. And if I'm honest, I think our listeners might be feeling a little bit overwhelmed right now, especially because we would've hoped that in the time since we released this first episode, things would've gotten better when in fact things have gotten much worse. And I want to make sure that our leaders that are listening to this don't feel paralyzed by this reality. What do you want to see the healthcare industry do to support pregnant people, to invest in behavioral health and to shift their mindset to focus on women's health writ large?

Gaby Marmolejos:
Well, we're about to release a whole series just about this, so be on the lookout for that, but a sneak preview. There's so much that can be done. I don't think this is something that we should feel defeated by. I think there's so much opportunity. We're seeing so many different leaders think about women's health more differently. We didn't even study chronic diseases in women until the last couple decades. So I think there's so much that can be done to research conditions among women specifically. There's so many conditions that impact women specifically that are understudied and underfunded. So there's so much that we can do from just a clinical research standpoint. But from just thinking of a provider, I've seen a lot of organizations think about chronic disease and think about their specialties a lot more differently. Some organizations have women's heart programs. So one great example of this is Parkview Heart Institute's Her Heart program.
I really love this program because it's very comprehensive. They have a yearly expo that offers women resources and education related to heart health. At this expo, they even will screen for different conditions., They take your blood pressure, they'll do some other biometric screenings, which is great. And they also have a Her Heart Challenge, which is a free program that offers a group of women personalized support from experts across the system to reach personal weight loss, blood pressure, and cholesterol goals. And I just love how they are really embracing women's health and thinking about it in a different way because the leading cause of death for women is actually heart disease, and I think people see heart disease as a men's disease, but it actually has a profound impact on women's health as well.

Rae Woods:
I love that story. Darby, what's your takeaway for our listeners?

Darby Sullivan:
My takeaway would be how is your health equity strategy going? If you were one of the folks that in 2020 said, okay, it's time to get serious, it's time to put together a strategic plan, it's time to make some investments, how does that look today in a time where the financial climate is a lot trickier for a lot of healthcare organizations? Is this something that has fallen by the wayside or is this something that we're three years in and we've made some meaningful, measurable progress? Those are the same types of approaches that we always recommend around health equity, of investing in the community, and investing in addressing the social determinants of health. Those are the same things that will help women's health and maternal health improve.

Rae Woods:
Well, I want to thank you for having a very difficult conversation, and I hope that two years from now when you've come back, we have a different story to tell our listeners.

Darby Sullivan:
I hope so too.

Rae Woods:
Thank you both for coming on Radio Advisory.

Gaby Marmolejos:
Thank you for having us.

Darby Sullivan:
Thanks.

Rae Woods:
Look, the worst thing that all of us can do is reflect on this data and think there's just no way out of this problem. Gaby gave an excellent example of an organization that is starting to change the way that we think about women's health. And Darby's call to action is a good one. Take a look in the mirror at what you've said you would do to help support maternal health, to help support women's health, to help support health equity. If you don't feel like you are making progress, we've added a lot of material in the show notes. And please, please remember, as always, we are here to help.
If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Katy Anderson, Kristin Myers, and Atticus Raasch. The episode was edited by Dan Tayag, with technical support by Chris Phelps and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, and Erin Collins.
Thanks for listening.