How patient-centered communication can address maternal health inequities

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The United States is one of the most dangerous among wealthy nations for women to give birth.

Disturbingly, it’s even more dangerous for women of color. Black women are about three times more likely to die from pregnancy-related complications than white women, while maternal mortality rates among American Indian and Alaska Native (AIAN) women are two times higher. The COVID-19 pandemic only exacerbated these issues.

Maternal mortality rates underscore this country’s deep-rooted health inequities. Although this problem is endemic, it’s not intractable. In fact, more than 80% of pregnancy-related deaths in the U.S. are preventable.

The healthcare system must work to address all of the factors that contribute to maternal health disparities, including barriers to care, systemic inequities, and the way health plans communicate with consumers. By breaking down these barriers and improving communication, we can ensure that all women have access to high-quality maternal care.

How poor health communication adds to maternal risk

There are myriad factors that contribute to the disproportionate rates of maternal deaths among Black women and women of color. They include structural racism and biases within the healthcare system, limited access to quality providers and facilities in marginalized communities, and socioeconomic barriers (such as lack of insurance coverage and financial constraints). And these are only a few of the challenges.

Inadequate communication exacerbates many of these problems. For example, marginalized communities often have lower rates of health literacy and higher levels of distrust of health providers, which can make it difficult to navigate our complex healthcare system.

Or consider someone with limited transportation options. They may be more likely to delay or miss prenatal check-ins or obtain necessary interventions, treatments, and prescriptions that providers recommend. It does little good for a health plan to send follow-up reminders or other messages that don’t take into consideration this barrier. Instead, messages should prompt follow-up conversations that urge people to arrange other transportation options, if necessary.

Likewise, if educational materials and content don’t provide clear, accessible, and culturally relevant information, health plans will struggle to connect, engage, and build trust with vulnerable populations. That includes addressing language barriers and offering materials in different languages, along with interpreters and translation services that are readily available. Without these supports, marginalized communities may be more susceptible to misinformation and less likely to understand all of the facets of prenatal and postpartum care, whether it’s the stages of pregnancy, warning signs of potential complications, birthing options, or more.

Building a better communication strategy

The stark disparities in maternal health outcomes for marginalized populations highlight the importance of intervention. Targeted health communications and engagement in particular are tools that can help to overcome the socioeconomic barriers associated with prenatal and postpartum care, reduce health risks, and empower pregnant individuals to actively participate in their healthcare decisions.

Consider taking the following steps to build a patient-centered communications strategy that will address the needs of marginalized populations and improve maternal healthcare outcomes for all patients throughout your health system:

1. Promote cultural competence throughout the organization

Cultural competence that respects and understands the diverse backgrounds and experiences of all communities should be the standard for all health plans today. To start, health equity should be prioritized as a strategic goal and a central component of your mission. Leaders need to acknowledge existing disparities and build a clear plan to address them.

It’s encouraging that many health plans have created roles specifically to focus on health equity issues, but these initiatives must also be backed by tangible action and dedicated resources organization-wide. Developing cultural competence and addressing implicit biases through routine training and ongoing education for all employees should be part of your larger DEI goals. These efforts are the first step toward building the right internal culture throughout your organization and ensuring all touchpoints — whether digital or in-person — will be informed by cultural competence.

2. Actively collaborate with impacted communities.

The best way to ensure your digital experience resonates with marginalized communities is to collaborate directly with impacted community members. Key community stakeholders can help identify specific needs, cultural preferences, and barriers to care that your organization may overlook or fail to understand.

For example, one client at mPulse — a healthcare engagement and communications provider where I lead behavioral science — is a medical system that serves low-income populations and individuals struggling to access care. This medical system worked directly with pregnant mothers to develop a prenatal texting care program. Members of the group came up with key phrases and terms to avoid, such as messages in an overly authoritative voice that could trigger psychological resistance to information. By actively involving community members in the planning and implementation of healthcare programs, as our client did, you can build rapport and develop tailored approaches that connect with the populations you aim to serve.

3. Incorporate behavioral science principles.

Behavioral science has become a crucial component of health engagement programs. Incorporating behavioral science into maternal healthcare communications can directly impact health outcomes during your members’ pregnancies.

For example, mPulse worked with mothers and maternal care experts to develop a prenatal engagement campaign that incorporates the behavioral science principles of “social proof” and “storytelling,” with videos of mothers from various communities sharing their stories and experiences. By highlighting the experiences and stories of pregnant individuals within the community, health plans can foster greater trust, dispelling many common concerns from mothers and increasing the likelihood that they would engage and respond to outreach materials.

4. Prioritize data-driven decisions.

Health plans collect an abundance of data about their members — so it’s important to use that information. Data enables you to better understand the barriers and needs of marginalized populations so you can tailor interventions and outreach efforts to address barriers more effectively and build more personalized, relevant experiences that resonate with consumers. For example, knowing that someone recently joined Medicaid can inform which educational materials and content you send them, like how they can navigate insurance throughout their pregnancy.

Data analytics can also help in deploying behavioral science methods. For instance, cognitive overload often causes members to become overwhelmed and tune out vital information. Analyzing viewership and engagement with online videos can inform the length and substance of those videos. If you find a majority of members stop watching content about the risks of aspirin during pregnancy, you may start to develop shorter, quick-hit videos optimized for Facebook, TikTok, or other social media platforms.

5. Use multiple communication channels.

In today’s digital landscape, consumers interact with health plans through a variety of touchpoints, whether online, on their phones, at telehealth visits, at the clinic, or in a provider’s office. You should leverage a variety of communication channels to reach marginalized populations no matter how they interact with your organization.

Beyond traditional channels like phone and email, you can broaden reach and engagement through community events, social media, and partnerships with trusted community leaders and influencers. Multiple avenues for engagement are particularly important when addressing underlying social determinants like homelessness or unstable housing—these members may not have access to a single, consistent communication channel.

Improving maternal healthcare among marginalized populations demands a multifaceted approach centered on cultural competence and active engagement with communities. And today’s advanced digital tools offer new opportunities to put these tenets into practice within your health plans.

By embracing these approaches and adopting a patient-centered mindset, health plans can begin to bridge the gaps in maternal healthcare disparities and achieve better outcomes for all. Together, we can work toward a future where every pregnant individual receives the care and support they need to experience a healthy pregnancy and childbirth.

Eden Brownell is director of Behavioral Science at mPulse Mobile