St. Louis is first stop in federal effort to address maternal health crisis

ST. LOUIS — Federal health officials on Wednesday will visit St. Louis, the first stop on an 11-city tour across the country, to harness together the multiple efforts underway to combat poor maternal health outcomes.

Leaders at the Health Resources and Services Administration will meet with local researchers, health providers, community workers and patients at the St. Louis University Center for Excellence in Maternal and Child Education, Science and Practice — one of 13 research centers in the U.S. funded by HRSA.

The tour is part of the agency’s yearlong Enhancing Maternal Health Initiative to accelerate and maximize the work being done to address the dismal U.S. maternal mortality rate, which consistently ranks the worst among developed nations.

The hope is to foster collaboration among recipients of federal funds addressing the issue, said HRSA Administrator Carole Johnson.

“We want to focus on states and localities where we’ve made significant investments,” Johnson said. “We think there’s a real opportunity to bring all those grantees together and try to leverage the work we are doing.”

Missouri currently receives about $30 million from HRSA for programs addressing maternal and child health, she said.

Those programs include home-visiting programs for new moms such as Parents as Teachers, scholarship and loan repayments to medical providers who work in underserved areas, and funding for health clinics that care for patients regardless of their ability to pay.

The University of Missouri was recently awarded a five-year $3.4 million grant from HRSA to launch the Maternal Health Access Program, which virtually connects primary care providers such as obstetricians and family doctors to mental health experts for help with patients at a moment’s notice.

In addition, SLU was named one of HRSA’s regional centers for excellence in 2020 and awarded more than $1.7 million over five years to strengthen and diversify the maternal and child health public health workforce across Missouri, Kansas, Nebraska and Iowa.

“We have lots of grantees doing really exciting work, and part of what our initiative is really focused is making sure that the whole is greater than the sum of the parts,” Johnson said, “and we are collaborating across these lines of work to best serve the women of Missouri.”

The latest statewide report on maternal mortality, looking at years 2018 to 2020, found that an average of 70 Missouri women died while pregnant or within year of pregnancy. Only six states had worse rates.

Among Black women, the mortality rate was three times that of white women. Nearly all maternal deaths in Missouri — 84% — were determined to be preventable.

Mental health conditions, including substance abuse disorder, were the leading cause of pregnancy-related deaths, followed by cardiovascular disease and then homicides.

In September, HRSA officials announced nearly $90 million in awards to continue to support the Biden administration’s strategy to improve maternal health.

Efforts include ensuring hospital have equipment and safety protocols in place, expanding screening and treatment for maternal depression and substance use disorders, growing the maternal care workforce to improve access and expanding social supports needed for healthy pregnancies.

Missouri Gov. Mike Parson has also made improving Missouri’s maternal health outcomes a priority. In 2023, the governor requested, and the Missouri General Assembly authorized, $4.3 million in new funding towards the effort, and a plan was unveiled in December.

The plan includes developing quality care protocols, training providers, standardizing mental health screening of new moms and improving data quality and accessibility.

“There’s a real opportunity for state, local, federal coordination to tackle a critical problem that makes a difference to families across the state,” Johnson said.

Dr. Richard Bolanos, an obstetrician for Family Care Health Centers in St. Louis, said patients often come there after experiencing long waits — four to five weeks — at other clinics or their first prenatal appointment.

“You could be missing a pretty bad condition,” Bolanos said. “Early access to care is important to prevent and treat whatever specific conditions a patient has so you can improve outcomes for mother and baby.”

Sabel Bass, program manager within SLU’s center for excellence, said maternal health cannot be improved without addressing the racial disparities in outcomes.

“Just providing an environment in which people live, work and interact in that does not predispose them to harm or risk to their health and well-being,” Bass said.

Yet, research has shown that affluent and under-resourced ZIP codes just a few miles apart in St. Louis can have up to an 18-year difference in life expectancy.

“That tells us we’re not doing a good job in providing that environment,” she said.