National Governors Association Remarks on Maternal Mortality

Thank you for your leadership First Lady Tammy Murphy and thank you National Governors Association for providing a platform for an issue that everyone in this room – and everyone outside this room – cares deeply about. 

Thank you for consistently tweeting about doulas and midwives and (while I’m here) as a proud New Jerseyian, I want to thank the Murphy administration for wielding the power of the NewJersey.gov Twitter handle to tell Delaware to delete their account.  

This section of the program is titled “maternal health lived experience” so you might be wondering why I’m speaking. 

I’m not a mother. I don’t have a uterus. I’ve never been pregnant. 

But for the last 15 years I’ve dedicated all of my professional energy to caring for people who are.

The first time I did CPR on a pregnant person I was a newly minted doctor, just one month into my intern year. One moment she was speaking to her husband. The next she turned blue.

I started chest compressions while my senior resident did an exam to check how close her baby was to delivery. From there my memory is honestly a blur. What I know is that we rushed to the operating room. We restarted her heart. She and her baby survived.

We later learned that the cause of her heart stopping was something called an amniotic fluid embolism. A catastrophic but very rare event that requires a heroic rescue. And so, my initial understanding of maternal mortality was exactly that: catastrophic but rare events that require heroic rescues.

But the more experience I gained in the practice of medicine the more I observed that most catastrophic events are actually preventable. I observed that short of these catastrophic events were many near misses, and that beyond my immediate field of view some people were at far greater risk than others–in many cases this was not at all because of the biology I had learned medical school, but because of the ways in which our society had made them more vulnerable.

My instinct to widen the aperture on maternal mortality led me to first become a researcher, and then an advocate, and then–of all things, a technology executive.

Let me explain.

As a professor, I analyzed reams of data. I learned that a person in the United States today is 50% more likely to die in childbirth than her mother, 3-4x more likely if she is Black or Native American. For every death, there are tens of thousands of people who experience major injury or morbidity, and for each person who experienced major injury, there are tens of thousands more who suffer from undertreated illness, social isolation, and economic disempowerment.

As a scientist I firmly believe that you cannot fix what you do not see and you cannot see what you do not measure. In 2018, a coalition of stakeholders helped pass the Preventing Maternal Deaths Act to at least make sure that in the United States of America we are tracking maternal mortality systematically. But here’s the thing. Science helps us be confident that what we think we are observing is true. But it does not lead to change without advocacy.

In 2018 the CDC believed that 3 out 5 of these deaths were preventable. In 2022 they changed their definition of preventability. Because of powerful advocacy, we now believe that 4 out of 5 are preventable. We now no longer think of prevention in terms of the medical diagnosis on the death certificate. We realize that the plurality–if not the majority–can be addressed upstream.  We realize that not only does racism impact maternal health, but that maternal health is one of the leading indicators of the clear and present danger of racism in the United States. We realize that at least 10% of maternal mortality is due to struggles with mental health – thank you by the way for your focus on that later today.

COVID-19 took every inequity in our society and threw them into a pressure cooker. And it placed into stark relief the degree to which maternal health is a bellwether for the wellbeing of society as a whole. That is why every injustice in our society shows up in the wellbeing of mothers: gender inequity, racial inequity, geographic inequity – even generational inequity.

This realization compelled me to step outside the ivory tower and work alongside people who know these injustices in their bones – people like Wanda Irving, Charles Johnson, Bruce McIntyre, Shawnee Gibson – who in the memory of their lost love ones – Shalon Irving, Kira Johnson, Amber Isaac, Shamony Gibson – persisted in holding power to account and launching a movement to correct these injustices.

What I learned along the way is that every system is perfectly designed to get the results that it gets. If the system is unjust it was designed that way, and must be redesigned. I also learned that a bad system will beat a good person every time.

18 months ago I gave away all of my grants and took a leave from the university to address the system as the Chief Medical Officer of Maven Clinic, a digital health company that enables people to use their phones to access to expert care and support for birthing people and their families no matter what time of day it is, no matter where they are. The purpose of a startup should be to meet an unmet need sustainably and at scale. Maven currently operates in all fifty states, serving millions of people. We serve people who are commercially insured and people who are publicly insured. We serve people in retail, in manufacturing, in education, in every industry and sector. 

From my current vantage over the American health system, the opportunities to do better are clear.

We need to amplify community based organizations who are best positioned to surface solutions. We need maternal mortality review committees and perinatal quality collaboratives to create accountability back to the communities most impacted. We need look to opportunities beyond the four walls of our brick and mortar clinics and hospitals by investing in digital technologies that enable clinicians to meet people where they are, rather than expecting them to take three city buses to meet us in the middle of the workday.

In this room of red states and blue states, we must appreciate that whether you are team “Make America Great Again” or team “Build Back Better” there is a cross-cutting sentiment in the United States that opportunities to thrive in our country are eroding. The observable evidence is that the health of our mothers is declining.

This need not be the case – I am proud of my home state of New Jersey as well as the work here in California to take meaningful strides. I look forward to learning from the expert panelists to my left and from all of you as we work together to build a country where every person can choose to grow their family with dignity. 

One final piece of advice: in our sharp focus on maternal mortality, let’s not forget that survival is the floor of what mothers should expect during childbirth. If we are aiming to design a better system we should set our sights higher and aim for the ceiling.

Thank you very much.