Rice360 Global Health Seminar: African American Maternal Health Outcomes

This spring, Rice360 hosted a panel discussion on how bias and racism impact maternal healthcare, the status of African American maternal health in Texas/the U.S., and how healthcare providers and innovators can advance meaningful change, titled, African American Maternal Health Outcomes: Transcending the legacy of racism and bias impacting healthcare quality and medical technology design.

Panel participants included:

• Dr. Carey Eppes, the chair of the Texas Collaborative for Healthy Mothers and Babies (TCHMB), presented an overview of the Texas Department of Health and Human Services (DHHS) report: “Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report 2022”

• Dr. Anne Gill, from the Baylor College of Medicine, spoke on “Addressing implicit bias among healthcare providers - trainings and use of implicit association testing.”

• Dr. April Lovelady, from Texas A&M University, School of Engineering Medicine, addressed “How innovation education can advance inclusive design of medical technologies.”

Dr. Eppes began the panel by discussing highlights from the Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report produced by the Texas DHHS in 2022, including key findings that showed critical health disparities for Black and Hispanic maternal patients in Texas. Examples of these disparities included data showing a 12% increase in pregnancy-related deaths for Black women, demographic and geographic differences in severe maternal morbidity rates related to in-hospital deliveries that affect non-Hispanic Black women and Hispanic women disproportionately, and severe maternal morbidity associated with COVID-19 disproportionately impacting Hispanic women.

Dr. Eppes explained that the data shows improving the quality of care without improving equity has not made enough of a difference in the outcomes for maternal patients, especially Black patients. The data in this report when compared with the same report from previous years show that the best quality improvement efforts, such as work to standardize care for obstetric hemorrhage, fail to improve health outcomes for Black and Hispanic populations when those efforts do not address equity in care. Therefore, the most recent report’s recommendations include a focus on improving quality with equity.

In the 2022 report, there is a call to address the causes of maternal mortality and morbidity and the role discrimination and inequity play in outcomes. Statewide efforts to improve maternal and women’s health will focus on engaging with Black communities and those who support them in developing maternal and women’s health programs for Texas. Additionally, statewide programs will aim to increase access to comprehensive health services during pregnancy, the year after pregnancy, and preconception and interpregnancy periods to facilitate continuity of care, which could help improve relationships between healthcare workers and the communities shown to experience the worst health outcomes. Statewide maternal health and safety initiatives will include equity principles. And public awareness and community engagement initiatives will foster a culture of maternal health, safety, and disease prevention. Dr. Eppes touched on the importance of educating healthcare workers to understand the implications of discrimination and racism in making it possible to meaningfully improve healthcare for all populations in Texas.

Dr. Anne Gill, with the Department of Pediatrics at Baylor College of Medicine, spoke on educating health providers to recognize how implicit bias can affect patient care and equity. Dr. Gill developed an unconscious bias workshop that is now part of the Baylor College of Medicine’s curriculum for medical students and has written about the efficacy of this training.

She said the workshop's goals are to acknowledge that bias is inherent in a physician’s perspective, which can influence health outcomes. The course teaches medical students how to verbalize the impact of stereotyping and personal bias in medical decision-making, recognize self-reflection as one method for understanding one’s biases, and strategies to manage physician biases in patient care.

. April Lovelady, from Texas A&M University, School of Engineering Medicine, discussed how biases can affect medical technologies and technology development.

She said, “There is a crisis within healthcare technology research and development, wherein historically marginalized groups are under-researched in preclinical studies, under-represented in clinical trials, misunderstood by clinical practitioners, and harmed by biased medical technology.”

She pointed to examples of health technologies that fail to work on darker skin tones as examples: pulse oximeters and vein finders. She explained that these widely used medical technologies demonstrate the importance of involving people of color in development trials to avoid designing devices with such limitations that affect marginalized populations. Texas A&M School of Engineering Medicine teaches students to design with mindfulness about implicit and explicit biases.

Dr. Lovelady closed the session with her reflections on her perspective and how she teaches about the historical and social implications of health inequity. She said that in her teaching she goes beyond teaching historical events, such as the Tuskegee experiments.

“I want to say that there’s history and then there’s history. So, the Tuskegee experiments are something that we hear about all the time – infamously. But I think within my own community, we talk about history like our mothers, so not what happened with the Tuskegee airmen. My own mother passed away in 2018 of a heart attack, and I’m convinced that if I could have gotten her to a doctor that maybe we could have saved her.

But she’d had such negative experiences with doctors until then, I could not get her to go. So, there is history and then there’s history and we in the minority communities talk about things that happened to our moms, aunts, grandparents—not that long ago.

So, while I do talk about the infamous historical aspects [like the Tuskegee experiments], history is still in the making right now. And even though we talk about some of these infamous historical events, broadly, within our own communities, we talk about the things that continue to happen. I continue to share my own stories of things that happen with my family and things that happen to me just so students know these are not ‘days gone by’ – that this is today, and we still need to address these issues today.”

The full panel discussion can be viewed here.