Comprehensive Action Plan Aims to Improve Maternal Health

The plan follows up on the Biden administration’s Blueprint for Addressing the Maternal Health Crisis, a government-wide approach to battling maternal morbidity and mortality, particularly among racial and ethnic minorities, as well as in rural communities.

“This plan recognizes the importance of continuity of care and social supports as critical aspects of healthy pregnancy and newborn care, and names ways to measure, promote and reimburse best practices to help reduce health disparities,” said AAFP member Nicole Chaisson, M.D., M.P.H., an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School in Minneapolis and associate medical director of Planned Parenthood North Central States.

“Family physicians understand and provide comprehensive care across the life course — including comprehensive reproductive health care such as contraceptive, preconception, perinatal and postpartum care,” she said. “We are also the largest providers of this care in underserved — particularly rural — communities. This plan helps support the work we do, in partnership with communities, to address disparities and work toward birth equity.”

Significant disparities in maternal mortality between white patients and those from racial and ethnic minorities have been recorded since the 1930s, when all states began reporting maternal deaths based on race, geography and other factors. In 2020, the most recent year for which data is available, the maternal mortality rate for Black women was roughly three times higher than those for non-Hispanic white and Hispanic women.

Plan Details

CMS identified key gaps in the five areas of maternity care that the agency wants to address through technical assistance, as well as efforts to reduce disparities, increase workforce diversity and improve health equity. Those areas, and examples of planned work that family physicians are invited to comment on, are:

Coverage and access to care. CMS is planning work to secure access to legally required, no-cost contraceptive coverage and to help people understand their coverage options if they lose Medicaid eligibility after pregnancy.

Data. Beginning in 2024, the agency will require states to report a set of quality measures related to children’s health.

Quality of care. CMS has proposed creating a “birthing-friendly” hospital designation that indicates a hospital’s commitment to improving maternal health outcomes through care quality activities.

Workforce. The action plan seeks to help patients access to a diverse maternity care workforce that includes doulas, midwives and community health workers.

Social supports. CMS is considering expanding efforts to improve outreach and eligibility on nutrition assistance programs by working with state agencies.

Family Physician Perspective

Chaisson noted several ways that the agency’s efforts could impact how family physicians provide maternal care.

“This plan encourages and supports partnerships with an interprofessional maternity care workforce, including doulas and community health workers, whose involvement in care has been proven to help reduce disparities and improve pregnancy outcomes,” said Chaisson. “It also acknowledges that wraparound services such as housing and nutrition supports are necessary for whole-person care of pregnant and postpartum patients.”

She encouraged family physicians to give CMS feedback on its Maternity Care Action Plan to spur systemic policy changes.