Women’s reproductive rights have always been topics of contentious political and legal debates in the United States. And in the wake of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Org.—which held that the federal Constitution does not confer a constitutional right to abortion—reproductive rights will continue to have polarizing political salience for years to come. But there is an inescapable scientific and public health fact that lies at the heart of this debate, one which has no political allegiance: the alarming rates of maternal morbidity and mortality. To alleviate this disturbing issue, a new maternal health care model has been announced. The model has been dubbed the “Transforming Maternal Health Model,” or TMaH Model for short.
Data from the U.S. Centers for Disease Control and Prevention (CDC) speak to the sad state of affairs regarding maternal health in the United States. In 2018, the maternal mortality rate was 17.4 deaths per 100,000 live births. However, as of 2021, the rate had climbed to a shocking 32.9 deaths per 100,000 live births. Compared to other wealthy nations, the United States ranks last when it comes to maternal mortality; a perplexing acknowledgment given the cost and sophistication of the U.S. health care system. Many of these deaths were preventable, of course. According to data from Maternal Mortality Review Committees—”multidisciplinary committees that convene at the state or local level to comprehensively review deaths that occur during or within a year of pregnancy (pregnancy-associated deaths)”—an estimated 80% of pregnancy-related deaths in the United States between 2017 and 2019 were preventable. Disparities between racial and ethnic groups are especially worrisome. For example, based on 2021 data, non-Hispanic Black women had 2.6 times the rate of pregnancy-associated deaths than non-Hispanic White women. Nevertheless, amidst all these horrendous trends and statistics, not all hope is lost.
On December 15, 2023, the U.S. Department for Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), introduced the new model for maternal health care. The goal is to combat the maternal health crisis for those enrolled in Medicaid and Children’s Health Insurance Programs. CMS announced that the Biden Administration is focusing on maternal health disparities as well as the improvement in the postpartum health outcomes of mothers and the infants. This model could be a promising start to addressing maternal morbidity and mortality in the United States, however, many issues will require careful attention.
A CMS overview of the Model explains the ten-year plan to address the high rate of negative pregnancy results. The first three years of that plan will be dedicated to pre-implementation, and the remaining seven are dedicated to implementation and proper execution. The complete Model addresses three main pillars: access, quality improvement, and delivery.
Pillar I – Access to care, infrastructure, and workforce capacity: Many mothers do not have proper access to health care, both pre- and postpartum. Proper access for these mothers may include regular visits to doctors, prenatal care (such as prescribing of prenatal vitamins), and postpartum check-ups. In considering the previously discussed statistics, Pillar I displays the proposing parties’ hope that the rate of complications will decrease with the introduction of the proper access to maternal health care, and it may be likened to a gateway to the success of the overall Model.
Pillar II – Quality Improvement and Safety: The TMaH Model will be state-based. Participating State Medicaid Agencies will be collaborating with their local hospitals and health systems to implement the goal-based protocols, which will be “evidence-informed”. In reviewing the quality and safety protocols, which have been labeled “patient safety bundles,” it appears that the key to Pillar II is consistency.
Pillar III – Whole-person care delivery: Pillar III aims to provide customization and specialized care based on the mother and child. Each pregnancy is unique in nature and Pillar III aims to ensure that complications do not occur due to the failure of the health care system.
Data from 2019 provided by the National Library of Medicine offers that 98.4% of women in the United States gave birth in a hospital. Given that a vast majority of births occur in this setting, it makes sense that the procedures may be standardized. However, the mother and child would be at a disservice if these procedures were not tailored to the patients undergoing them.
The TMaH Model seems to show an understanding that a case-by-case approach may not be practical. However, it also demonstrates the desire by federal and state health authorities to utilize the data obtained to address the systemic failures at hand, while providing the specialized care needed for each patient.
Adjusting the procedures to each mother’s unique needs provides them the best possible chance at survival without complication. For example, one birth may require closer attention postpartum due to mother’s hypertension or history of substance use than another. This “closer attention” may take the form of increased postpartum check-ups or more careful prescription of medications for a mother that has known substance abuse issues.
The TMaH Model should be praised for its holistic approach to each pregnancy, keeping firmly in mind the “physical, social, and mental health needs” of the patients. In a time where women are losing control over whether they should be mothers, it is encouraging to see the health system try to provide those that are expecting with accessibility to proper care. One may argue that this overall goal is far-fetched given the increasing rate of complications. While this is a lofty goal, it is far from unattainable. The proposed pillars, timeline, and overall Model are all feasible if they are combined with the proper funding.
Funding opportunities for the TMaH model will be announced to state Medicaid agencies beginning Spring of 2024 and which hopefully provide the Model with the means to enact change.