A $9.5 million grant from the Health Resources and Services Administration will help the University of Illinois at Chicago and the Illinois Department of Public Health improve maternal outcomes in Illinois.
According to the U.S. Centers for Disease Control and Prevention, pregnancy-related mortality has increased steadily over the last 30 years. The number of deaths has more than doubled since that time, moving from 7.2 deaths per 100,000 live births to 16.9 in 2016, the latest available data.
In Illinois, about 73 women die each year within one year of pregnancy and black women are six times more likely to die of a pregnancy-related condition.
With the five-year funding, multidisciplinary researchers from UIC will work with the IDPH Illinois Title V Program and others to launch a series of new systems-level statewide efforts. Efforts include establishing a maternal health task force and improving methods for collecting data and training health care providers.
The funding also will facilitate the design and implementation of a first-of-its-kind, two-generation postpartum clinic and research and training center at UIC. The clinic will serve postpartum women and their newborns simultaneously. Nationally, more than 90% of newborns receive routine care. However, postpartum women are much less likely to receive postpartum care, particularly women with low incomes. Implementation of the two-generation clinic is expected in late 2020.
The clinic's medical home model will enroll hundreds of women and their newborns for at least two years and provide comprehensive care including psychiatric support and behavioral pediatrics. The model also will include efforts to address the many social determinants of health that affect women's ability to be healthy.
"Our health care system needs to work better for women, especially vulnerable postpartum mothers," said Dr. Rachel Caskey, UIC associate professor of internal medicine and pediatrics at the College of Medicine and co-principal investigator of the grant. "By offering personalized care to moms during well-baby visits, we can reach women without adding to their burden or taking time away from other competing priorities.
"We think this can significantly impact women's health, including reducing rates of unwanted rapid repeat pregnancies, reducing postpartum depression and its many health risks, and improving access to preventive care for a range of conditions unrelated to pregnancy and motherhood," said Caskey, who is also chief of academic internal medicine.
Last year, Illinois released its first Maternal Morbidity and Mortality Report, which highlighted the need for maternal health care awareness, causes for increased morbidity and mortality, and disparities that exist.
Not only did the Illinois Maternal Morbidity and Mortality Report focus a needed spotlight on the tremendous impact social factors have on maternal health, but it also provided pivotal recommendations to help prevent maternal deaths. This five-year grant from HRSA will directly assist in the implementation of several of these key recommendations. We are excited to be working in collaboration with the University of Illinois at Chicago to improve maternal health outcomes for all women, but in particular, to help narrow the disparity that exists between black and white women."
Dr. Ngozi Ezike, IDPH Director
Co-principal investigator Stacie Geller is part of a team in Illinois that reviews causes of death among recently pregnant or postpartum women. She said the two-generation clinic and other efforts with IDPH can help fill gaps in care and prevent unnecessary deaths, which account for "far too many deaths in Illinois."
"I believe this grant gives us an opportunity to fundamentally change the way we deliver care to pregnant and postpartum women," said Geller, the G. William Arends Professor of Obstetrics and Gynecology and professor of medicine at the College of Medicine. "Some maternal deaths are harder to prevent due to severe pregnancy and delivery complications. We are focused on stopping preventable death and poor outcomes, which can be indirectly caused by violence, limited access to health care or a lack of trust in care providers, and a number of other system-level factors."
According to IDPH, 72% of deaths among recently pregnant women and 93% of violent pregnancy-associated deaths are preventable.
While the numbers are stark, Illinois is actually ahead of many other states, Geller said.
Arden Handler, director of Center of Excellence in Maternal and Child Health at UIC and co-principal investigator, said that a key aspect of this grant is to build upon the university's prior work with the state to advance programs that address maternal mortality using a population approach.
"By partnering with IDPH to establish a maternal health task force and implement statewide initiatives, we have the opportunity to impact health across the state," said Handler, who is also professor of community health sciences at the UIC School of Public Health.
Handler said these initiatives include activities like improving emergency room intake processes to include routine screening for recent pregnancy or childbirth, providing women's health training to home visit care providers, supporting rural providers' ability to screen and treat postpartum depression, and launching and augmenting other training programs for maternal health care providers.
"Ultimately, the task force will review the issues, study the data -- including the data we will collect from the two-generation clinic -- and advocate for legislation or other guidelines that safeguard vulnerable pregnant and postpartum women," said Geller, who is also director of the Center for Research on Women and Gender.
"The greatest predictor of a child's health is the health of his or her mother," Handler said. "Healthy women means healthy families and healthy communities. This is an opportunity of a lifetime to improve the health of countless women, infants and families in Illinois."