On January 27th, Merck for Mothers, Merck & Co.’s $500 million global initiative with the sole purpose to “create a world where no woman has to die while giving life,” announced this year’s cohort of grant designations. These grants total an impressive $9 million allocated to their Safer Childbirth Cities program, the community-action coalition fighting the rising rates of preventable maternal death in the US.
After requesting a second round of grant proposals in June of 2020, Merck for Mothers narrowed down the proposals depending on their eligibility and proposed initiatives for addressing the maternal health disparities within their cities. The chosen communities will be provided with up to $1 million in funding to apply their own evidence-based interventions. On top of the 10 cities from the first cohort of grants released to Safer Childbirth Cities in 2019, cities included in the newly accepted grant proposals are Brooklyn, NY; Detroit, MI; Norfolk, VA; San Francisco, CA; St. Louis, MO; Tampa, FL; Tulsa, OK; Trenton, NJ; and Washington D.C.
According to the Center for Disease Control’s Pregnancy Mortality Surveillance System, between 1987 and 2017 rates of “pregnancy-related deaths” rose from 7.2 per 100,000 to 17.3 per 100,000. The seemingly intangible 17.3 per 100,000 statistic actually means around 700 women die and nearly 60,000 almost die from maternal complications every single year in the US. About 60% of these deaths are preventable. Yes, preventable. Although shocking, these figures are what drive philanthropic organizations like Merck for Mothers to take matters into their own hands.
Merck for Mothers-A Global Leader in Maternal Health
Their multi-sectoral, innovative approaches towards local solution implementation have reached over 13 million women globally. This newest influx of funds to assist US communities in the direst need comes at a valuable time when the COVID-19 pandemic is directly affecting social determinants of health. Increased isolation and reduction in seeking care are on the rise, alongside their immense mental health impacts. At the start of the COVID-19 pandemic, increased funding was allocated to ensure a continuation of the work started during the first cohort of Safer Childbirth Cities, as well as a partnership with the March of Dimes.
Currently, Merck for Mothers is joined by a collective coalition from the private sector including Foundation CHANEL, the Burke Foundation, the George Kaiser Family Foundation, and the Yellow Chair Foundation. Vital collaborators include Ariadne Labs, the Association for Ariadne Labs, Maternal and Child Health Programs (AMCHP), and the National Birth Equity Collaborative (NBEC). To say this organization, alongside their community-based and private partners, are prepared to tackle the rising maternal mortality rates in today’s context is an understatement.
The Data Speaks for Itself-US Healthcare is Failing its Mothers
The Every Mother Initiative research conducted by Merck for Mothers and AMCHP between 2013 and 2016 addressed the lack of data available to fuel evidence-based interventions, highlighting the need for these current community-based programs. Every city involved surfaced with different ways forward, ranging from “tackling the problem of pregnancy-related depression” to “implementing evidence-based practices to manage hypertension and hemorrhage.” This specific focus on the US raises concerns as to why rates are rising in a country seemingly overrun with healthcare options. The harsh reality is much more complicated than this superficial assessment. The US holds a multi-faceted and historically-driven relationship to maternal health and healthcare in general for that matter. It’s clear that maternal mortality is complex, and yet one particularly important factor specific to the US has the largest impact on maternal mortality.
The Why Behind It All
Dr. Mary-Ann Etiebet, Lead and Executive Director of Merck for Mothers, was gracious enough to share her expertise on the US-specific context surrounding this crisis, starkly emphasizing the need for increased funding, awareness, and innovative integration. She explains, “even when you account for other factors, whether it’s differentiated access to health, education, or poverty, you still see differences according to race.”
The main factor specific to the US is the systemic racism demonstrated time and time again within the healthcare system. It’s about more than what one may think of immediately when racism is discussed. It’s not just face-to-face bias and prejudiced interpersonal interactions. It has to do with access to and quality of care born from socioeconomic and racially-defined constructs that unjustly determine health outcomes. It has to do with generations of constructing untrue perceptions of women of color, completely disregarding how they define their own well-being.
For example, and as previously mentioned, Brooklyn is included in this second cohort and rightfully so, as it’s, unfortunately, an exemplar of this racial inequity. Black women in NYC as a whole are 8-12 times more likely to die during and up to a year post-pregnancy. This can be seen all across the US, with Black, Native American, and Alaska Native women’s maternal mortality rates 2-3 times higher than those of white women. They remain significantly higher even in comparison to Hispanic, Asian, and Pacific Island women. Dr. Etiebet explains that these disparities require an “increasing amount of attention and awareness of the issue.” The United States is a land of diversity, one it claims it’s proud to be. Yet, these inequities of care hold a different truth.
Local Interventions Inspiring Hope for the Future
All is not lost thanks to several philanthropic organizations like Merck for Mothers. Diving into the outcomes of the first round of grant proposals, Dr. Etiebet explains that the connections made and ties created at the local level were nothing short of inspiring. The organic strength many of these community-based coalitions demonstrated in the beginning stages of their local change emphasizes this need for a complete overhaul of maternal care, this “vital sign of society,” as Dr. Etiebet says.
The answer to the maternal mortality crisis is a complicated one requiring clinical and community-based integration, innovative funding, private sector involvement, locally researched and crafted interventions, and governmental involvement. Only within recent history has US maternal mortality and morbidity been researched to the extent necessary to identify the correlations and causes of its rising rates.
Now that the data is clear, the way forward lies within these scalable, community-based initiatives. The necessary change will happen from the ground up, inspired by the women themselves and crafted in spite of the unfair and unjust treatment they’ve received thus far. Listening to their experiences, as was done with Maternal Mortality and Morbidity Advocates (MoMMA) Voices Coalition, the recent CDC Hear Her campaign, and on a smaller scale in New Orleans with their local initiative, Equity Action Labs, is the first of many steps forward. Progress cannot solely rely on racial bias and multicultural awareness training anymore. It has to be deeply rooted, experientially-driven change spoken from the mouths of mothers themselves.