The Missouri Department of Health and Human Services (DHSS) recently released A Multi Year Look at Maternal Mortality in Missouri, 2017-2019 Pregnancy-Associated Mortality Review. The annual report is calling on community-based organizations to reduce maternal mental health stigma and substance use disorder, and provide assistance to resources for these conditions. It also recommends educating the community about domestic violence and intimate partner violence while helping women and birthing people find support. Additionally, it encourages the use of doulas and community health workers in prenatal and postpartum care to reduce adverse maternal and infant health outcomes.

One community-based organization, Altruism Media, Inc., is positioned to meet these recommendations.

Serving both rural and urban communities, Altruism Media, Inc.’s mission is simple: to empower communities to thrive equitably by equipping them with information and resources that advance whole-person care. Its vision is to create healthy communities sustained by a continuum of whole-person care through strategic partnerships with health care, mental health, and social care organizations. And its purpose is to reduce preventable deaths through targeted programs, outreach, and education in a manner that actualizes dignity, equity, and compassion.

A new nonprofit, Altruism Media has launched its flagship program, called The MaIH (maternal and infant health) Project. With the help of grant funds from REACH Healthcare Foundation and Kansas Health Foundation, the program aims to equip birthing people in Kansas and Missouri with maternal health care and social care services, educational resources, and even opportunities to allow their lived experiences to be a catalyst for employment. The need is evident and studies conclude that racial disparities and systemic barriers are directly correlated with the rate of infant mortality and maternal mortality. 

Pregnancy-related deaths (during pregnancy or one year after pregnancy) in Missouri are four times higher for Black pregnant people than for white pregnant people according to a report from the Missouri Department of Health and Senior Services (DHSS). An average of 61 Missouri women died while pregnant or within one year of pregnancy each year. The pregnancy-related mortality ratio for women of color is more than three times greater than the ratio for white women, and 9 of the 10 Missouri counties with the highest infant mortality rate are considered rural. As for areas with access to maternal care, other challenges like poverty, limited transit, lack of insurance, and systemic racism increase poor maternal and infant health outcomes.

While these facts may be sobering, the Missouri DHSS report also finds that 75 percent of all pregnancy-related deaths are preventable. With the goal of reducing preventable deaths, Altruism Media has a partnership with Unite Us, a social care technology platform that assesses birthing people to determine social care, health care, and maternal mental health needs. With help from Altruism Media’s community health worker (CHW), after eligibility is determined, birthing people are connected to health care providers and enrolled in the appropriate programs in the form of a collaboration of services to assist with food, utility bill assistance, transportation – as well as other health care and social care support. The project’s mission is crystal clear, that maternal and infant health can be improved in our communities with early intervention, advocacy, and community collaboration.

The Role Doulas Play

An adjunct to the work of The MaIH Project is the recognition of the value of doulas in the birthing process and the need to increase the use of doulas in clients’ childbirth experiences. A doula is a trained professional who provides physical, emotional, and information support to their client before, during, and after childbirth to help them and their baby achieve healthy outcomes. Recognizing the crucial role doulas play, The MaIH Project pairs doulas and CHWs to help women and birthing people mitigate adverse maternal and infant health outcomes.

Doulas in Missouri are not currently covered by insurance nor by Medicaid, yet research from the Journal of Perinatal Education points to the following positive indicators for doula-assisted pregnancies and births: better birth outcomes including lower health care costs, fewer preterm births and cesarean sections, a lower likelihood of low birth weight infants, and a significantly higher instance of the initiation of breastfeeding. 

While doulas do not make decisions for birthing people, these individuals can stand in the gap between medical jargon communicated by health care providers and patients who may or may not understand their options, consequences, or their course of treatment. If a birthing parent has committed to a non-medicated birth, a doula may be there to gently remind them of that decision but also to help interpret and guide the birthing person in every aspect of their birthing experience side by side.

Shifting the Power Differential with Maternal Health Literacy

According to the World Population Review (2022), one in four Missouri residents struggles with illiteracy.  While literacy is a term painted with a wide brush, when it applies directly to the ability of birthing people to access, understand, process, and apply information, it could be the difference between mitigating or exacerbating risk factors for maternal and infant mortality.

To this end, The MaIH Project is in the planning stages of a Maternal Health Literacy Advisory Council to improve maternal health literacy. Tonia Wright, president and CEO of Altruism Media, describes the Maternal Health Literacy Advisory Council project as a program “developed by birthing people for birthing people.” The ultimate goal is to dismantle the power differential between the patient and the health care provider, and  to create a spirit of continuity as it relates to the overall birthing experience.

“Too often women and birthing people are at a disadvantage when it comes to expressing their needs, desires, and concerns,” Wright said. “Equipping them with the tools to understand and consume maternal health literacy will build confidence, embolden self-advocacy, and shift the power differential from the provider to the patient.”

The DHSS report also underscores that in Missouri, the ratio of pregnancy-associated deaths for women on Medicaid was more than 8 times greater than the ratio for those with private insurance. Wright says that’s a problem. “Inherently, we are looking to close access barriers to care by moving uninsured birthing people to Medicaid. But the stats say that the mortality rate is higher for those who are insured by Missouri Medicaid. If that’s the case, we need to fill the void. This includes providing wraparound services to hopefully get birthing women and people seen earlier, addressing social determinants of health, providing family planning and birthing classes, as well as other programs like Count the Kicks to help mitigate adverse outcomes – coupled with health literacy. These are among the assets that should be added to the equation to make Medicaid less of a liability.”

Maternal mortality happens most often around 43 days after delivery. Missouri Medicaid is effective only two months postpartum in spite of efforts earlier this year to extend coverage 12 months after delivery. This is especially crucial as mental health conditions were the leading underlying causes of pregnancy-related deaths, followed by cardiovascular disease. Substance use disorder, renal failure, and sepsis also ranked higher according to the DHSS report.

With collaborative support from CHWs, doulas, social service agencies, and health care providers, marked improvements can be made in maternal and infant health. The MaIH Project is just one of several incredible nonprofits looking to improve outcomes.

“What makes us different is that we will leverage the nearly 16 years of expertise as a communications firm on the for-profit side to message women and birthing people in a way that disarms and encourages engagement,” Wright said. “We will then deploy our CHW-doula teams to rural, suburban, and urban areas where the need is great and provide wraparound support. For those who opt in to our educational programs, they will be equipped with maternal health literacy to build confidence and effectively engage with health care providers. Last but not least, we will intentionally seek out individuals who come through our program who we think would be great community health workers and doulas, and pay for their certifications. Their lived experience makes them more than qualified.”

Wright said this trifecta coalesces its mission, vision, and purpose by addressing unmet needs, shifting the power dynamic from the provider to the patient, and celebrating and rewarding lived experiences through employment opportunities. “I can’t thank REACH Healthcare and Kansas Health Foundation enough for not only seeing our hearts, but also seeing the substance behind our mission. We are so grateful for their support,” Wright said.