HJAR Nov/Dec 2024

46 NOV / DEC 2024 I  HEALTHCARE JOURNAL OF ARKANSAS NURSING COLUMN NURSING experience adverse pregnancy outcomes, which puts them at risk for developing long-term cardiovascular disease. These facts remain even when controlling for education, income, and health status. An- other factor contributing to the maternal health crisis in Black women is the nega- tive health impact caused by lack of patient trust and confidence in the care offered by healthcare providers. When Black women report incidents of feeling unwell or of be- ing treated unfairly and unprofessionally by care providers, they frequently report that they are not heard, seen, nor taken seriously. Women have reported negative, aggressive, and even threatening respons- es by providers to their requests for con- sideration and support in some instances. Promoting the utilization of doulas to provide support to all women during pregnancy and postpartum is gaining momentum in the fight to ramp up the cadre of providers available to support pregnant women. Doulas, trained in child- birth and emotional and physical support techniques, help women to have a more empowered, safer birthing experience. Al- though they do not provide medical care, they are knowledgeable about medical aspects of labor and delivery and contrib- ute to their clients’ understanding of these events. The American Medical Association and other professional organizations recom- mend implicit bias training for healthcare professionals with the goal of reducing patient distrust and increasing patient uti- lization of healthcare services. In addition, THE UNITED STATES OF AMERICA has one of the highest maternal mortality rates among highly industrialized nations at 22 deaths per 100,000 live births. Arkansas has the highest maternal mortality rate in the United States at 44.5 deaths per 100,000 live births. The risk is even great- er for women of color. Black women in the Arkansas Delta are 1.8 times more likely to experience perinatal death than white, non-Hispanic women. Over 33% of these deaths occur between one week and one year after childbirth. It is believed that 90% of these deaths are preventable according to the Arkansas Center for Health Improvement. Limited access to comprehensive healthcare — before, during, and after preg- nancy — and the closure of delivery sites are contributors that enhance the problem of maternity deserts across the state. In addition, long-standing policies and prac- tices that produce unequal access to social determinants such as education, housing, transportation, employment, and food contribute to the crisis. On top of these factors, the growing body of scientific ev- idence asserting that discrimination due to race and ethnicity can worsen health conditions such as cardiac disease, hyper- tension, and diabetes must be weighed in when efforts to address this burgeoning crisis are developed, assembled, and dis- seminated. Black women are more likely to have preexisting cardiovascular morbidities that increase the risk of maternal mortal- ity. Black women are also more likely to with expanding ef- forts to train amore diverse healthcare workforce caring for pregnant wom- en, midwives and doulas are promis- ing practices being promoted in the effort to address the maternal health crisis inAr- kansas and in our nation. Health inequity is not a historical acci- dent. Rather, it is a result of policies and practices structured and maintained over time. The 1985 Department of Health and Human Services Heckler Report and sub- sequent research made it clear that health disparities cannot be reduced by targeting individual clinical conditions. Research- ing the role that structural factors play in keeping individuals in segregated com- munities, limiting opportunities for health and well-being, is essential to arriving at strategies that lead to advancing health equity and improving health status of pregnant women. Economist Raj Chetty has illustrated how people who live in communities with more upward mobility have better health outcomes and longer life expectancies than those living in communities with less upward mobility. Social cohesiveness, educational opportunity, a strong middle class, and little racial segregation all lead to improvements in health equity. Arkansas is taking action to address the Maternal mortality crisis in a variety of ways. Gov. Sanders assembled a materni- Addressing the Maternal Health Crisis in Arkansas