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Maternal Health Equity

By February 19, 2018July 22nd, 2025No Comments7 min read

Editor’s Note: This month’s feature written by Dr. Lisa Marie Jones, DBH, is installment 2 of a 3 part series by CGI Faculty was written in response to the article that follows. Reading Death By Birth: Bearing the Burden of Maternal Mortality first will undoubtedly provide some context and insight. Thank you.

Goodman, B. (2017, November 20). Death By Birth: Bearing the Burden of Maternal Mortality. Retrieved November 16, 2017.

Maternal Health Equity

By Lisa Marie Jones DBH, M.Ed, HS-BCP

With the United States leading the world in healthcare research and spending twice as much on healthcare than any other developed nation, Americans should be the healthiest people in the world; yet, we are not. Health is the multidimensional relationship between social environment, mental health, physical well-being, functional needs, quality of life, and the ability to adapt, self-manage, and recover; it is the holistic state of well-being and maternal mortality rates are a good gauge in determining of the overall health of a population (Huber, 2011) (Wilson & Cleary 1995) (WHO, 1948).  Tragically, 700 women in the United States die annually of preventable pregnancy or delivery related complications (CDC, 2017). Global pregnancy-related deaths have decreased significantly over the past few years; however, the maternal mortality rate in the United States has increased by more than 25% and has even doubled in certain states like Texas (Carroll, 2017). Goodman (2017) described a perfect example of this disheartening statistic in a recent article about the preventable pregnancy related death of a Black-American mother living in Texas. Health disparities of specific vulnerable populations result in the U.S. having worse health outcomes than any other developed nation, with ethnic/racial minorities and low-income populations being the most susceptible. For example: the maternal mortality among Black American women is three times higher than the national rate for all women (Kane, 2013).

Goodman (2017) attributed fragmented healthcare systems, lack of access to quality maternal care, and unequal treatment of the under-insured as possible causes of the maternal mortality increase in the United States but health challenges faced by women are complex and there are many contributing factors. These factors are called Social Determinants of Health and they directly impact quality of life, functioning, and health outcomes of women and their infants and children. Many determinants of maternal health are not related to individual biology or genetics and are outside of an individual’s control or personal choice. Along with the factors suggested by Goodman, access to quality reproductive and lifespan healthcare, provider bias, poverty, racism, founded patient mistrust of providers, availability of transportation, neighborhood safety, and access to physical activity and fresh fruits and vegetables are highly correlative to maternal health outcomes (Braveman, 2011).

The same healthcare system that relies primarily on female healthcare providers is deficient in caring for the needs of these same women (WHO 2016). Along with U.S. healthcare system’s focus on providing insurance coverage for and attending to the medical needs of newborns at the expense of the mother’s healthcare needs (Goodman, 2017), other systemically oppressive and politically motivated factors lead to maternal health disparities. For example: in an attempt to defund Planned Parenthood, the family-planning budget in Texas was reduced and many of the clinics providing reproductive health services were closed or forced to reduce their services (Carroll, 2017). Physician or provider bias is another pervasive source of the system’s unresponsiveness to the healthcare needs of women. This bias is usually unintentional and unconscious but it drives differences in treatment related to race, gender, and social class. Inequality in treatment of pain, referrals to specialists, and unnecessary surgical removal of body parts has been well documented. Viewing female reproductive organs as “potentially disease-producing and useless after childbearing age”, providers show a preference for saving diseased male reproductive organs over non-diseased female reproductive organs. Male reproductive organs are removed as a last resort; yet, medically unnecessary total hysterectomies are recommended even when disease is not present (Hensling, 2017).  Hysterectomies are the second most common surgery among women in the United States with the most common surgery being childbirth by cesarean delivery (C-section). While C-sections have successfully treated rare birthing complications, profit and convenience have motivated the increase of iatrogenic risks by medicalizing routine healthy childbirth with procedures, like unnecessary cesarean deliveries (Kapinos, 2017).

Maternal health begins where a mother is “born, lives, learns, works, plays, worships, and ages” (Healthy People 2020). Maternal health does not begin when a mother receives her first prenatal check-up or even when she finds out that she is pregnant; it is shaped by a life time of experiences that begin with the earliest exposures to social conditions. Chronic exposure to these conditions causes the body to continuously adapt to psychosocial changes and antagonistic environments which wreaks havoc on the body. The cumulative embedding of the negative effects of chronic stress over a life time is called allostatic load. Allostatic load is highly correlated to low societal status, perceived racial discrimination, and poverty; it impacts the health of the mother and shapes the health of an infant before she/he is even born. (APA, 2017).

Improving maternal health is a social and political imperative that would benefit the economy and overall health of society (Africa Progress Panel, 2010). Health systems have focused primarily on the physical aspects of maternal care during pregnancy, which is too-little-too-late. Cost-effective life-span interventions can be identified by understanding how specific risks related to age, gender, and race at each phase of life contribute to maternal health. The implementation of culturally informed biopsychosocial interventions in integrated health and community settings at each stage can reduce health disparities in infant and maternal mortality, benefit the economy, reduce healthcare expenditures, and improve the overall health of the U.S. population.

All women in the U.S. deserve clinically and culturally competent quality care with equal health decision opportunities regardless of their gender, level of income, education, occupation, or ethnicity. Investing in maternal health should be a U.S. policy decision making priority.

References:

Africa Progress Panel (2010) Maternal Health: Investing in the Lifeline of Healthy Societies & Economies. Policy Brief

American Psychological Association (2017) Health Disparities and Stress

Braveman, P. (2011) Social Determinants of Health: Coming of Age.  Annual Review of Public Health 32: 381-398

Caroll, A. (2017 Why Is US Maternal Mortality Rising? Jama Forum. Retrieved from https://newsatjama.jama.com/2017/06/08/jama-forum-why-is-us-maternal-mortality-rising/

Center for Disease Control and Prevention (2017) Pregnancy-Related Deaths. Reproductive Health. National Center for Chronic Disease Prevention and Health Promotion. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm

Goodman, B. (2017, November 20). Death by Birth: Bearing the Burden of Maternal Mortality.

Healthy People 2020 (2017) Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Washington, DC: U.S.

Henslin, J. M. (2017). Social problems: A down-to-earth approach. 12th Edition. Pearson Higher Education.

Huber, M., Knottnerus J., Green L., Horst, H., Jadad, A., & Kromhout D, et al. (2011) How should we define health? BMJ. 2011; 343: d4163.

Kane (2012) Health Costs: How the U.S. Compares with Other Countries. PBS. Retrieved from https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries

Kapinos, K., Yakusheva, O., & Weiss, M. (2017). Cesarean deliveries and maternal weight retention. BMC Pregnancy and Childbirth. 17

Raine, R. (2000) Does gender bias exist in the use of specialist health care? The Journal of Health Services Research & Policy, 5, pp. 237-249

Wilson, I., Cleary, P. (1995 Linking Clinical Variables with Health-Related Quality of Life: A Conceptual Model of Patient Outcomes. JAMA. 273(1):59–65. 

World Health Organization (1948). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946 and entered into force on 7 April 1948. Geneva, Switzerland: World Health Organization.

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As a member of the AAPI community, I’m very familiar with the barriers to mental health services and the need to break through the glass wall of cultural stigma that prevents many from receiving potentially life–saving treatment. I was the only Asian American person in my master’s cohort, the only Asian American person in many of my clinical work settings, the only Asian American person to walk into many of the professional settings that I pushed myself to show up to. In my current practice, I’m constantly reminded by my patients of how difficult it is to find an Asian American mental health provider, though this reminder constantly informs me that more needs to be done for my community. Day after day, I read stories of Asian American people who die by suicide as a consequence of our culture’s avoidance of mental health topics. As a DBH, my biggest goal is to use my expertise in whole–person care to amplify the conversation around mental health and help my community understand that mental healthcare is not a privilege that we are not entitled to, it is a crucial part of our healthcare that will manifest differently in us than what many Western psychology or psychiatry textbooks will describe, and that our unique experience of mental health issues are valid, important, and is time to be part of the larger conversation.

Willam Chum, LMHCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 16, 2022

The Doctor in Behavioral Health (DBH) program has changed my understanding of the subject and career path. Before this academic journey, my knowledge of behavioral health was primarily theoretical, including essential ideas and methods. However, the DBH curriculum combined intense academic research with practical application, helping me understand behavioral health from multiple angles. Recognizing mental health as part of total health changed my perspective. The biopsychosocial model, which showed how biological, psychological, and social variables affect mental health, was stressed in the DBH curriculum. This comprehensive approach made me realize how complex human behavior is and how important it is to address mental health issues. Effective interventions must target the individual’s surroundings, relationships, and life experiences, not just symptoms. The curriculum also gave me enhanced evidence-based practice training to execute successful solutions. Studies methods and data analysis classes improved my critical thinking and allowed me to evaluate and apply behavioral health studies. This gave me the confidence to contribute to the field’s knowledge base through practice and research.

Dr. Rhea Hill, DBH, LPCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - February 17, 2025

This program will change how you present to the world, not just as a professional but as an individual. Understand this is work but the work is worth it and the journey is undeniably transformative. If you are seeking a doctorate for the title, this is not the program for you. If you are seeking a doctorate to interrupt and disrupt the course of healthcare, then this is the program for you. You won’t find a more supportive program with professors who are dedicated to your success and your education. This program is not about the regurgitation of information. It is about the appropriate applied application of knowledge and information to push forward and become an advocate for equitable and quality care for all.

Brandy K. Biglow LMHC, CCTP, QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 5, 2024

The Doctor of Behavioral Health (DBH) program has definitely transformed my understanding of behavioral health. Understanding the links between physical and mental health has taught how to make better treatment decisions. The DBH program has also given me insights that otherwise would not be possible and allows me to view individuals through a lens that I was previously ignorant of. This program has helped me grow into a more confident individual, provider, and parent.

Cory H. Cannady, BCBA, LBADBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 13, 2024

The DBH program has reinforced my vision of viewing behavioral health (BH) as an integrated component of the healthcare system rather than a siloed service. As a practitioner in the focused BH realm of substance use disorder (SUD) treatment, I observe on a regular basis how identifying and serving SUD patients is often missed, ignored and stigmatized in primary healthcare, despite the fact that early intervention at these check-points often has the potential to intervene earlier and lessen the negative SUD outcomes frequently seen by the time a patient reaches specialty SUD services. Reinforcement received in my DBH program has motivated me to promote integration as a leader in my workplace and is a primary factor in considering the long-term trajectory of my individual career path.

Kenneth L. Roberts, MPS, LPCC, LADCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - November 5, 2024

Graduating from the DBH program has influenced and enhanced my approach to addressing behavioral health challenges and making a difference in the field by preparing me to become a serious business owner. Through the DBH program, I understand now that becoming a business owner not only assists me in reaping the financial benefits of working for myself, but the program also offers me a sense of freedom to make a difference in an individual’s life.

Dr. Rebecca K. Wright, DBH, LBA, BCBA, QBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - December 18, 2024

I have always wanted to pursue a higher degree but never found a program that met my needs. When I investigated the DBH program, I can honestly say I was excited. It was a program that would expand my knowledge in behavioral health but also how it relates to physical health. The philosophy of treating the whole person was exactly what I was looking for.

Elizabeth Nekoloff, M.Ed., LPCC-S, NCCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - January 16, 2025

Prior to obtaining my DBH, I practiced behavioral health within the boundaries of behavior analysis. The DBH degree has given me the ability to broaden my scope of competence allowing me to provide a higher quality of care to my clients through a person-centered approach, while still staying within my scope of practice. I was in the beginning stages of opening my business when I enrolled in the DBH program which set my trajectory towards being a stronger leader. The program equipped me with essential healthcare leadership and entrepreneurial skills, allowing me to ensure high-quality services for my clients and foster a supportive work environment for our staff. It has also given me the confidence to expand my business and pursue other healthcare ventures, reaching a broader range of patients in need.

Dr. Pauline Tolentino Pablo, DBH, BCBA, IBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - January 21, 2025

Although I have worked with many patients who have mental health diagnoses, or behaviors which make managing their medical diagnoses and day to day life difficult, the DBH program at CGI is broadening that knowledge and providing a deeper understanding of behavioral health and how best to help these individuals manage their health and improve their quality of life. This will allow me to provide and advocate for more meaningful and seamless integrated care, providing new tools for my intervention toolbox, and the confidence and skills to collaborate within and lead whole person focused interdisciplinary teams. I also anticipate building upon my knowledge as a nurse case manager and long time caregiver, as well as my personal passions and professional vision, learning about processes and operations, to be in position to start up and lead my own company one day, offering the services and care I know every person should have access to.

Hollie Wilson, MSN, RN, CCMDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 11, 2025

The DBH program will open opportunities for me to contribute to healthcare system innovation, particularly through trauma-informed care and integrated behavioral health settings. I will be better positioned to advocate for and implement holistic care models that improve health outcomes for underserved populations. Ultimately, this program will help me transition into higher-level roles, such as a director or consultant in behavioral health, where I can influence broader system changes and contribute to the future of healthcare delivery.

DeKyn Rashad Peters, MPH-CHES,BSW/BA,APCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 4, 2025

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