Dr Veronica Gillispie-Bell on Maternal Health Care: We Cannot Have Quality Without Equity

A recent study published by the CDC found 20% of mothers with children under the age of 18 reported mistreatment while receiving maternity care for their youngest child. The rate increased to approximately 30% when looking at the reports of Black, Hispanic, and multiracial respondents as well as those with public insurance or no insurance.¹

The reports of discrimination rose when respondents described the delivery of maternity care, with an overall rate of 29% and approximately 40% among Black, Hispanic, and multiracial respondents. The research further stated that approximately 45% percent of all respondents reported holding back from asking questions or discussing concerns with their provider, illuminating a gap in care.

Veronica Gillispie-Bell, MD, MAS, the head of Women's Services at Ochsner Medical Center, Kenner, and the director of Quality for Women's Services for Ochsner Health, spoke on the published data and the importance of addressing these racial disparities.

Gillispie-Bell also serves as the medical director of the Louisiana Perinatal Quality Collaborative and Pregnancy Associated Mortality Review for the Louisiana Department of Health.

Transcription

The CDC study addressed the concept of respectful maternity care, how do the findings contribute to the overall quality of care?

Well, let me make it clear, you cannot have quality without equity—they are intertwined. You have to have both, and you can't have equity if you don't have respectful care. And so I think that is probably the most to the point and poignant way to say that. We will not see an improvement in our quality or our health outcomes if we don't address the things that are leading to the disrespect and leading to the bias that we see in our health care system.

Can you discuss any successful practices you’ve seen in mitigating the disparities in maternity care?

Sometimes it's very small things. I can tell you, from our health care system, one of the things that we've implemented in a couple of our facilities, and in the process have implemented across the system, is the Mothers on Respect index. It is a validated survey for us to determine if our patients believe that they've received respectful care during their hospitalization. And we do use those comments to see how we can improve the experience.

One thing in particular—and this wasn't necessarily in the survey, but we ascertained this in a different way: The ASHA (Accredited Social Health Activist) facility where I practice now has a large Hispanic population, Latino and Latina population. And so in talking to our patients, we understood that they felt that the choices we were giving them in the diet that they could order were not culturally appropriate. So we used that feedback to update the menu and to do some other things to help even with the communication from the dietary providers that were coming in to ask what patients wanted for their different meals.

I know that seems very small because we're talking about food, but it is respect. It is showing respect for that individual, respect for that individual's culture, respect for their language, and just respect for what is important to them.

Reference

Mohamoud YA, Cassidy E, Fuchs E, et al. Vital Signs: Maternity care experiences — United States, April 2023. MMWR Morb Mortal Wkly Rep 2023;72:961–967. DOI: http://dx.doi.org/10.15585/mmwr.mm7235e1