When Brandi Perch, 29, got a fever and chills about two months after giving birth to her son in 2022, she called the Dimock Center, the Roxbury-based community health center she went to for OBGYN care during her two pregnancies.

A specialist quickly called back and told Perch that what she was experiencing sounded like mastitis, an inflammation of breast tissue that can occur in the first few months of breastfeeding. They correctly reassured Perch that the discomfort would end naturally in a few days if she kept breastfeeding.

“If I didn’t call, I wouldn’t have known what to do. I wasn’t waiting around trying to figure it out or feeling like I needed to go to the hospital.” 

Brandi Perch

Community health centers like the Dimock Center provide convenient access to high-quality, low-cost health care that might not otherwise be available. The Dimock Center serves residents of some of Boston’s underserved neighborhoods — including Roxbury, Dorchester, Mattapan, and Jamaica Plain — and welcomes everyone, including those who are uninsured. 

Access to quality care like this is an example of a social determinant of health (SDoH) — a non-biological influence that can affect health outcomes, including maternal health outcomes. Other SDoH include economic stability, education, neighborhood, and community. 

Improving maternal health and maternal health equity is increasingly critical. The Center for Disease Control and Prevention (CDC) reported that the United States maternal mortality rate rose for the third consecutive year in 2021, increasing by nearly 40 percent compared to 2020. Inequities in maternal mortality also remain high, according to the report. In the United States, mortality rates for Black women around the time of pregnancy are more than two times higher than for white women. 

Structural and social factors impacting health

To improve maternal health and health equity, local communities must understand the wide variety of factors that affect health outcomes. 

“Our research has found numerous connections of social determinants with maternal and child health,” says Dr. Emily Oken, vice chair of the Harvard Pilgrim Health Care Institute and the Alice Hamilton professor of population medicine at the Harvard Pilgrim Health Care Institute. “Air quality is one determinant that often differs across neighborhoods. We have done work showing that poorer outdoor air quality, such as fine particle pollution and neighborhood traffic patterns, can increase risks for pregnancy complications and childhood diseases.”

Other work by the Harvard Pilgrim Health Care Institute — a research and teaching collaboration between Harvard Pilgrim Health Care, a Point32Health company, and Harvard Medical School — has linked factors like access to food sources and social support for new mothers to birth and maternal health outcomes. 

Differences in these kinds of structural and social factors between groups can result in health and maternal health inequities of many kinds, Dr. Oken notes. “Institute investigators are also actively working to identify and ultimately eliminate inequities in sexual and reproductive health by sexual orientation and gender identity.”  

To take action, Point32Health is also partnering with Boston Medical Center (BMC) to improve maternal care and increase the quality of care for mothers negatively impacted by social determinants of health. Specifically, Point32Health is helping to add additional quality measures, implement a different payment model to incentivize better maternal outcomes, and provide additional funding to BMC’s Health Equity Accelerator through incentives to increase maternal health care quality.

Local organizations taking action

Addressing SDoH on a large scale — ensuring everyone has access to quality care, nutritious food, clean air, and other essential services at every life stage — means addressing the root causes of maternal health inequity. Local organizations are working both to do this and to bridge the gap for those who could already be negatively affected by SDoH. 

There is growing recognition that doula support during pregnancy and birth is an evidence-based practice shown to improve maternal and child outcomes. However, women in lower-income populations do not always have access to doulas.

One organization addressing this gap is Boston-based Accompany Doula Care. Accompany Doula Care partners with Accountable Care Organizations and certain hospitals that refer members or patients with complex medical or social risks to be matched with a doula to support them throughout their pregnancy at no cost to the patient or member. 

In addition to being patient advocates, doulas can help flag immediate SDoH challenges someone might be facing. 

“If a doula recognizes a need for things like housing, food, supplies, or behavioral health services,” says Christina Gebel, co-founder and interim executive director at Accompany Doula Care, “the doula can elevate that concern quickly to the care manager or provider, who helps navigate the member or patient to needed services or resources.” 

Doula support is also a no-cost benefit offered to members of Point32Health company Tufts Health Plan who receive health coverage through Medicaid in Massachusetts or Rhode Island, as well as eligible non-Medicaid members in Rhode Island.     

“Access to doula care is one piece in closing the gaps in outcomes among communities in Massachusetts,” Gebel says. “The more people and organizations we can have working together with a unified goal of addressing SDoH needs, the better the well-being of our families.”

New state policies are also aiming to improve maternal health by addressing SDoH. Recognizing the importance of the postpartum period, in April 2022 MassHealth extended its postpartum coverage period to provide 12 months of coverage after pregnancy, an increase from the previous duration of 60 days. 

“Such coverage is critical for the physical and emotional health of the entire family,” Dr. Oken says. “Institute investigators are planning to study how this change in policy will affect health care utilization and health outcomes.”

Improving generational health
The evidence is clear: Care for families in the United States has a long way to go. But the efforts of local health care organizations are already making a real difference for countless families. 

“I’m a Black woman. This is my first time having a child. What is my experience going to be like?” Perch remembers wondering during her first pregnancy. “But I also just knew that I was in good hands [with the Dimock Center]. I wasn’t worried.” 

Helping individual mothers thrive — before, during, and after pregnancy — may have more far-reaching consequences than many realize. “It is remarkable to me to see the extent to which experiences years before pregnancy can affect maternal health,” Dr. Oken says. “Adverse childhood experiences, including abuse, neglect, and household challenges, can have repercussions for women’s health and well-being many decades later. Thus, interventions to improve social determinants of health may pay dividends over many years, not only for the women but also for their children and perhaps even their grandchildren.”

Point32Health is a nonprofit health and well-being organization, guiding and empowering healthier lives for all. We are committed to improving health outcomes and providing access to affordable, quality health care regardless of race, ethnicity, socioeconomic status, orientation, gender identity, or ability. Together, our family of companies — Harvard Pilgrim Health Care and Tufts Health Plan — help our members and communities navigate the health care ecosystem through a broad range of health plan offerings and tools.