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Warren Lewis is looking at a photo collage that he has created for the memorial service for his cousin Somesha Ayobo (left in the photo montage) and his baby Phoenix Carpenter, right on the screen. Ayobo died on June 24, 2017, and her baby died four days later on June 28 at the United Medical Center in D.C. Medical errors in this case resulted in the closure of the hospital's obstetrics department. (Photo by Michael S. Williamson / The Washington Post)
What is clear is that D.C. is one of the worst maternal mortality rates in the country. What is clear is that if you are a black mother in British Columbia, you are twice as likely to have a premature birth as a white mother.
What is less clear is how to modify these results.
On Wednesday, health care providers, policymakers and community organizations came together to achieve this goal at the district's first ever maternal and child health summit at the Walter E. Washington Center.
Welcomed by DC Mayor Muriel Bowser, a few days after introducing the world to her 4-month-old daughter, the summit focused on sharing best practices among local and national stakeholders, including the mayors of Flint, Mi The event comes at an urgent time for the district, where maternity wards in two hospitals on the east side of the city have been closed during the year, leaving many pregnant women in poor neighborhoods by bus.
After investigation, many treatment errors were detected by the D.C. Somesha Ayobo, a pregnant woman who died shortly after admission to the hospital. It was weeks after the Providence Hospital in the northeast also closed its maternity ward.
But one of the main dilemmas faced by conference actors is not access to hospital delivery rooms, but rather the months of pregnancy of a woman leading to childbirth. According to the 2018 DC Report on Perinatal Health and Infant Mortality, about half of black women and over one in three Hispanic women do not enter prenatal care before their second or third trimester or do not receive no treatment.
The question is not insurance, said Bowser, since 97% of DC residents are covered by insurance. "It means more people need to be connected to the right people at the right time," she said. "Why do people avoid the doctor the first three months of their pregnancy?"
Asked about concrete steps to fill these gaps, Bowser and LaQuandra S. Nesbitt, Director of Public Health, spoke in broad terms about how to reach women more proactively from the time of pregnancy. Bowser suggested using technology to connect pregnant women to healthcare providers.
"If people can slide to the right to find dates, why can not they find better access to our service," she said. "We can not continue to do only what we have done in the past."
According to a report published Wednesday by the association, a key solution lies in what is called "centering". The report's researchers conducted 31 in-depth interviews with medical providers and low-income women of color in developing countries.
The "centering" involves a recommended schedule of ten prenatal visits, each from 90 minutes to two hours, in groups of eight to ten pregnant women, all at the same stage of pregnancy.
Centering encourages the education of pregnant women to play a role in their own medical care, for example by engaging them to take their own weight and blood pressure. More importantly, it provides a support system, said Tamara Smith, President and CEO of DCPCA.
Pregnant women, especially women of low-income color, "often feel lonely," Smith said. "There is no one with whom you speak at the same stage of your pregnancy with the same fears."
"Word of mouth is very powerful in these communities," said Robyn Russell, DCPCA member, who worked on the report. "It's almost like a tipping point."
In DC, centering is currently offered in two organizations, the Mary's Center and the Community of Hope, which covers only a small segment of the population. But all the current providers who offer it said they were counting on grants that were due to expire. DCPCA recommends that the city expand the program to more community centers, particularly Unity Health, and invest in the staff needed to coordinate and facilitate group classes. Such an expansion, including the hiring of six people to coordinate programs, could cost less than $ 1.5 million, according to DCPCA estimates.
According to the DCPCA, the cost estimates would allow for six new centering programs, reaching up to 1,200 women.
Ebony Marcelle, director of midwifery at Community of Hope, helps coordinate and facilitate the centering course and says the program is essential to empower women, especially African American women, in a relaxed environment .
"There is a lot of generational mistrust, with medicine and health care," Marcelle said. "We recognize that, we honor that, we respect that and we try to meet them where we are."
According to the analysis of CDC data conducted in 2018 by America's Health Ranking, about 36 women die per 100,000 live births in developing countries, compared with 20.7 nationally. Only four states have the lowest rates.
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