To best support birthing parents and their families, we must acknowledge how inequities influence maternal health outcomes. Care before, during, and after birth is deeply biased in the U.S., and we need to fundamentally reimagine our approach to maternal healthcare to combat these disparities. Dr. Neel Shah, Chief Medical Officer (CMO) at Maven Clinic and Assistant Professor at Harvard Medical School, was recently featured in Aftershock, a documentary examining the maternal mortality crisis and what needs to be done to enact real change.
We sat down with Dr. Shah to learn more about his work, the film, and his thoughts on how we can provide more equitable care in the United States.
You joined Maven as our CMO a year ago, but you’ve been working in the maternal health equity space for much longer. What motivated you to devote your career to improving health equity?
When I started medical school, I wasn’t planning to specialize in OB-GYN. However, I spent my first week of medical school at Women and Infants Hospital in Rhode Island, which delivers over 10,000 babies a year, and it was a life-changing experience. It’s impossible to be in a labor and delivery room without recognizing how incredible it is. The other part of what drew me in was the kind of people that specialize in OB-GYN. I wanted to work with people that I respected and admired, and providers who go into women’s health deeply care about social justice and wear it on their sleeves.
In my work as an OB-GYN, with my background in health policy, I found myself constantly questioning the status quo: Why aren’t we investing in maternal health like we’re investing in cancer, for example? As I was chasing down those answers, I learned that maternal healthcare suffers from a massive lack of resources, especially compared to other parts of the healthcare system. As I saw that play out through my work, I knew I needed to be a part of the solution.
We hear a lot about the maternal mortality crisis in the United States. Could you provide more detail about what’s causing the high rates of people dying from childbirth-related causes?
There’s no way of understanding the maternal mortality crisis in the U.S. without seeing it through the lens of racial, gender, geographic, and generational inequity. The story in America right now is one of widening inequity, and it manifests in the eroding well-being of Americans.
I strongly believe that maternal health is a bellwether for the well-being of our society as a whole because every injustice in our society shows up in birth outcomes. If you look at racial inequity: Black birthing parents are three times more likely to die in childbirth than their white counterparts. We see generational inequity show up in how people now are more likely to die from childbirth-related causes than their mothers were. Geographic inequity means that if you live in a rural area, you are much less likely to be near someone who can help you through pregnancy.
I strongly believe that maternal health is a bellwether for the well-being of our society as a whole because every injustice in our society shows up in birth outcomes.
Women are expected to put their families first and their own well-being last, and we see that play out during pregnancy and postpartum. The maternal health system is designed to treat women as vessels for pregnancy and forget about them after they’ve had a baby. It’s entirely normative for your only check-up after giving birth to be a 15-minute appointment six weeks postpartum. And many of these parents are sleep-deprived and trying to raise an infant while also working full-time to earn a living wage because there is no mandated paid family leave in our country.
Another factor contributing to maternal mortality is the healthcare system’s acceptance of the status quo, even when the status quo clearly isn’t working. In Manhattan, for example, one in three people get major surgery to give birth and one in 10 of their babies goes to the ICU—these are scary numbers, but we’ve normalized them.
You were recently featured in a documentary, Aftershock, which is now available on Hulu. Could you tell us a little about the film and what made you interested in contributing to it?
Aftershock focuses on two Black families who lost their loved ones—Shamony Gibson and Amber Rose Isaac—to preventable deaths due to childbirth complications. The film sees the families galvanize activists, birth workers, and physicians to reckon with the US maternal health crisis.
I was compelled to contribute to the film because the filmmakers, Paula Eiselt and Tonya Lewis Lee, wanted to focus on solutions. We hear about these preventable deaths, but no one is showing the aftermath—the impact the maternal mortality crisis has on families and communities, and the work that these families are doing. In the film, they converge on a solution: healthcare systems have to be accountable to communities, and we see two bereaved families stepping up, taking leadership roles, and holding the healthcare system accountable. It’s such a powerful film, and since it’s been widely available, we’ve seen it spark a lot of very important conversations across the country.
Aftershock takes a hard look at the maternal mortality crisis in the U.S. that is disproportionately affecting Black, Indigenous, and Latine people. Can you share an example of how systemic racism drives poor outcomes among these groups?
Systemic racism manifests during pregnancy and birth in many ways. The film shows us going to Tulsa, OK, which is where the 1921 race massacre took place. During this massacre, an entire Black neighborhood got razed to the ground in one of the most sordid events of racial violence in our nation’s history. The area was completely divested from following this event. Schools and hospitals in this part of Tulsa systematically received less funding, and Black people from that neighborhood couldn’t receive bank loans to open new businesses.
In the film, we went to the hospitals that serve this community and saw how structural racism still affects the lives of Black mothers in the area, reflected in their high rates of maternal mortality. When you look at death certificates, hemorrhages are generally listed as the leading cause of death, but that doesn’t give the full picture. It’s possible to have a severe hemorrhage and survive, or a moderate one and die. At its core, what increases the likelihood of a mother not surviving is an insidious form of racism.
Fundamentally, what birthing parents are dying of in Tulsa—and across the country—are failures of communication, empathy, and teamwork. Only recently have we been naming these failures for what they are: systemic racism. Aftershock shows this well—for both Amber Rose and Shamony, two Black mothers, their concerns were dismissed over and over again, and they were not heard until it was too late.
One of the stories that resonated in the film was Felicia Ellis’. After seeing the horrible mistreatment that many Black birthing parents receive in hospitals, including Shamony and Amber Rose, watching her peaceful and supportive birth at a birthing center was extremely powerful. What makes birthing centers an important option for BIPOC communities to access?
It makes sense that communities that have been historically mistreated don’t feel safe in certain spaces and seek alternatives–and people deserve to have options.
In many parts of the world, people with low-risk pregnancies go to birthing centers with a midwife, rather than to a hospital with a surgeon. I’m a big fan of birthing centers and they make a lot of sense, and I thought that Felicia’s experience in the film was a beautiful depiction of what we’d want everyone’s childbirth experience to look like, whether they’re in a birthing center or a hospital.
What can employers & health plans do to help more birthing parents receive holistic care and support regardless of where they give birth?
Every person on their family journey deserves and benefits from support, monitoring, and coaching, while relatively few truly need a surgeon like me. However, we’ve designed the system backward: right now, everyone gets the surgeon, and very few people get adequate support and coaching.
What employers and health plans can do is invest in benefits that provide what everyone deserves: support, monitoring, and coaching. This is where Maven really shines—we live in our member’s pockets, and are able to provide consistent care and support on everyone’s path to and through parenthood.
In the film, you say that “affirming a person’s dignity is the way you make them feel safe.” Could you give some examples of how Maven helps affirm our member’s dignity?
The conventional healthcare system rightly follows the principle of “do no harm.” We’re hyper-focused on safety, and we treat people’s experiences as a secondary luxury. However, every story of things going wrong—particularly when looking at the Black maternal mortality crisis—happens when we don’t consider people’s lived experiences. Seeing patients and truly listening to them is how you make them safe—it’s not a luxury, it’s a necessity.
Seeing patients and truly listening to them is how you make them safe—it’s not a luxury, it’s a necessity.
Maven affirms our member’s dignity by making sure we understand their context and speak their language. We follow the principles of care matching, ensuring that our members are matched with providers and Care Advocates who share the same background and have the same lived experiences.
At Maven, we consider trustworthiness a virtue, and we operationalize it in our care model to ensure we’re reliable. When members need our help, we’re there within the hour, no matter what time it is or where they are. And our reliability extends to outcomes, as well—our data proves that we’re caring for our members and making them healthier.
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