While there has been a slight decline in maternal mortality rates in the United States, the disparities faced by Black birthing individuals remain alarming, as they are still twice as likely to succumb to complications arising from pregnancy or childbirth compared to their white counterparts. This jarring statistic highlights the urgent need for transformative changes in maternal health equity nationally. In response to this critical issue, a groundbreaking initiative at the University of Indiana is striving to make substantial advancements through innovative telehealth-based medical education alongside robust clinical peer support networks.
Known as the Black Maternal Health ECHO program, this initiative seeks to unite healthcare professionals to delve into clinical best practices and innovations that can significantly reduce Black maternal morbidity and mortality. The program adopts the Project ECHO (Extension for Community Healthcare Outcomes) model, originally created by a physician at the University of New Mexico Health Sciences Center. This model was initially crafted to offer virtual training and telementoring for primary care physicians by leveraging audio-visual technology, but it has since been adapted for numerous contexts.
The Black Maternal Health ECHO program’s overarching goal is to utilize this framework to improve outcomes in Black maternal healthcare, and since its inception in 2023, it has not only attracted participants from across Indiana but has also extended its reach across state lines, creating a wider network dedicated to the cause.
Understanding Black maternal health in the U.S.
Addressing Black maternal health disparities in America is an entrenched challenge. Research shows that from 1999 to 2019, the maternal mortality rate in the U.S. more than doubled. Alarmingly, during this timeframe, the average Black maternal mortality rate surged from 26.7 deaths per 100,000 live births to a staggering 55.4 per 100,000 live births.
In 2021, the Black maternal mortality rate peaked even higher at 69.9 deaths per 100,000 live births, before experiencing a decrease to 49.5 per 100,000 live births in 2022, still representing a troubling reality.
Moreover, Black birthing individuals who are American-born endure heightened risks of preeclampsia relative to Black women who immigrate from other nations. This disparity illustrates that race is just one of the many factors contributing to the gaps in Black maternal healthcare, intertwined with various social determinants of health.
Jasmine D. Johnson, M.D., an assistant professor specializing in obstetrics and gynecology at Indiana University School of Medicine, emphasizes that improving Black maternal healthcare presents significant challenges, primarily due to the fragmented strategies currently in place across various healthcare systems.
“The work is not synchronized,” remarked Johnson, who is also integral to the hub team of the Black Maternal Health ECHO program, during a recent interview. “For instance, the Maternal Mortality Review Committee lacks a standardized approach regarding membership, structure, and reporting frequency. This discrepancy represents a substantial missed opportunity for collaborative improvement efforts.”
At the health system level, the absence of collaboration remains evident, she further explained. Healthcare provider organizations are implementing a variety of strategies to tackle racial disparities in maternal healthcare services, which include expanding digital health applications, addressing implicit biases among medical professionals, and establishing telehealth-based prenatal and postnatal programs. However, these organizations often operate in isolation, resulting in inadequate sharing of quality data and best practices aimed at reducing Black maternal morbidity and mortality rates.
Exploring the Black Maternal Health ECHO program
The Black Maternal Health ECHO program was specifically designed to dismantle these silos of healthcare communication and collaboration. It launched as a dynamic partnership between the Indiana University (IU) Fairbanks School of Public Health and the Indiana Minority Health Coalition.
We got some grant funding to create a space where basically that siloed communication could be eliminated, and we could somehow connect people from around the state who felt passionate about ending health disparities and focusing on equity.
Jasmine D. Johnson, M.D. Assistant professor of obstetrics and gynecology, Indiana University School of Medicine, and hub team member, Black Maternal Health ECHO program
“We successfully secured grant funding aimed at creating a platform that would effectively eliminate siloed communications, allowing us to connect like-minded individuals across the state who are dedicated to addressing health disparities and championing equity,” Johnson shared.
Johnson detailed that the hub team comprises an array of maternal health professionals, including doulas, public health experts, and community health workers, who collaborate to organize bi-monthly virtual sessions.
These sessions concentrate on critical issues surrounding maternal health mortality, delve into data reflecting adverse outcomes, investigate the systemic drivers behind care gaps, and share cutting-edge research and resources designed to improve maternal health outcomes.
“What we discovered is a significant gap in knowledge around essential issues such as the latest treatments for eclampsia, procedures for managing severe hemorrhaging during and after childbirth, and the challenges of postpartum depression—all areas where new information continues to evolve that is vital to reducing mortality risks,” noted Velvet G. Miller, Ph.D., a fellow member of the Black Maternal Health ECHO program’s hub team and director of the Not 1 More Project, in a recent interview.
What we’ve found is that there’s a dearth of understanding about issues like what’s the latest treatment for eclampsia? What do we need to do for major hemorrhaging during and post-delivery? What about postpartum depression? And there’s new and evolving information about that that helps address the potential for mortality.
Velvet G. Miller, Ph.D. Black Maternal Health ECHO program hub team member
Additionally, implicit bias among healthcare providers plays a significant role in exacerbating maternal health inequities, Miller pointed out. A particularly troubling bias is the perception that Black individuals possess a higher pain tolerance than other racial groups—a notion that must be critically challenged and dismantled.
“We are uncovering that this bias arises consistently throughout our discussions,” Miller remarked. “‘They didn’t hear me. They didn’t pay attention to me. My partner kept saying she was in pain, and they dismissed it, leading to her death. The recurring theme is the need for healthcare providers to be fully present and attentive during the delivery process to avoid tragic outcomes.”
The ECHO program is instrumental in addressing these damaging attitudes among healthcare providers, facilitating essential conversations to rectify them. According to Johnson, the program invites a diverse range of speakers with profound expertise—from trauma-informed care to culturally competent approaches—to enrich the virtual sessions. Moreover, participants gain access to valuable resources and social services for birthing individuals facing challenges such as postpartum depression or other social determinants of health, including housing and food insecurity.
The attendees are not limited to healthcare professionals providing reproductive and maternity care for Black individuals; they also include community supporters, lactation specialists, and stakeholders from health insurance organizations.
“Our intent is to also engage those situated in rural regions beyond the metropolitan areas who might lack opportunities for continuing education. By bringing them into the fold, we can inform them of the latest trends and procedures, empowering them to deliver the highest quality of care possible,” Miller elaborated. “Indiana is riddled with healthcare deserts, particularly regarding OB-GYN services.”
Examining the program’s progress
Since its inception, the Black Maternal Health ECHO program has experienced notable growth, nearly doubling participant attendance and attracting attendees from various states across the nation.
Miller highlighted that attendance surged from an initial 30 to 40 participants to approximately 70 to 80, indicating strong interest and engagement. Furthermore, the collaboration and learning initiated during these sessions extend far beyond just the meetings.
Attendees have begun reaching out to each other, forming a rapidly expanding network of support and shared expertise. “I refer to this as network weaving, an unexpected yet welcome outcome of the program,” she stated. “Connections have formed between individuals in North Carolina and those all the way in California, all united by shared interests and goals.”
Feedback from participants has been immensely positive. Johnson noted that the program’s hub team conducts surveys to gauge attendees’ impressions, and a substantial majority report that the information presented will significantly enhance their practice.
While the current metrics for the program’s success focus on attendance and participant feedback, Johnson aspires to establish a more standardized evaluation approach to gauge how the ECHO program ultimately influences maternal healthcare outcomes within Black communities.
The journey toward attaining maternal health equity is undoubtedly complex, yet initiatives such as the Black Maternal Health ECHO program play a crucial role in progressing towards this essential goal. These telementoring ECHO programs can facilitate spaces—albeit virtual—where stakeholders can collaboratively share strategies, resources, and medical knowledge necessary for achieving urgently needed improvements in Black maternal health outcomes.
“I remain hopeful, but we must recognize that barriers are still prevalent. Our commitment to advocacy must be unwavering. I draw inspiration from Angela Davis’s timeless words: ‘I’m no longer accepting the things I cannot change. I am changing the things I no longer accept,'” Miller shared, emphasizing the need for continued action and vigilance.
Anuja Vaidya has covered the healthcare industry since 2012. She currently investigates the virtual healthcare landscape, encompassing telehealth, remote patient monitoring, and digital therapeutics.
What are the key goals of the Black Maternal Health ECHO Program as described by Dr. Johnson and Dr. Miller?
**Interview with Dr. Jasmine D. Johnson and Dr. Velvet G. Miller on the Black Maternal Health ECHO Program**
**Interviewer:** Thank you both for joining us today to discuss the Black Maternal Health ECHO program at the Indiana University. Dr. Johnson, could you start by telling us what inspired the creation of this program?
**Dr. Jasmine D. Johnson:** Thank you for having us. The inspiration came from a significant need to address the alarming disparities in maternal health, particularly for Black birthing individuals who face a much higher risk of complications and mortality. We realized that there was a lack of coordinated efforts among healthcare providers, so we pursued grant funding to create a platform to connect passionate professionals across the state and beyond, eliminating the siloed communication that has historically hindered progress.
**Interviewer:** That’s an important step. Dr. Miller, can you explain how the Project ECHO model has been adapted in this program to serve its goals?
**Dr. Velvet G. Miller:** Absolutely. Project ECHO was initially developed to provide virtual training for primary care physicians, and we’ve adapted it to focus on Black maternal health. The program brings together a diverse group of experts—doulas, public health professionals, and medical providers—through bi-monthly virtual sessions. During these sessions, we delve into clinical best practices, share the latest research, and discuss systemic issues contributing to maternal health disparities.
**Interviewer:** You mentioned clinical best practices. Can you share some of the trending topics discussed in your sessions that participants find valuable?
**Dr. Johnson:** Certainly! We’ve found there is a significant knowledge gap around critical issues such as eclampsia management, addressing severe hemorrhage, and postpartum depression. Our discussions aim to ensure that healthcare providers are aware of the latest advancements and treatment strategies, as well as the importance of recognizing and addressing implicit biases that can affect care.
**Interviewer:** Implicit bias sounds like a crucial topic. Dr. Miller, can you elaborate on how these biases impact Black maternal health and how the program addresses them?
**Dr. Miller:** Implicit bias significantly impacts how pain and symptoms in Black individuals are perceived by healthcare providers. There is a troubling belief that Black individuals have a higher pain tolerance. This misconception can lead to dangerous dismissals of patients’ concerns, ultimately resulting in tragic outcomes. Our program actively creates a space for open dialogue about these biases, inviting experts who can enlighten providers on the importance of culturally competent care and engagement with their patients.
**Interviewer:** The program appears to be expanding rapidly. Dr. Johnson, can you share some of the progress made since its inception?
**Dr. Johnson:** Yes, since we launched in 2023, we’ve nearly doubled our participant attendance—from 30 to 40 participants to about 70 to 80, which includes attendees from several states. This growth reflects a strong commitment to addressing these disparities. Additionally, we’re witnessing the formation of a supportive network where attendees are collaborating and sharing resources beyond our sessions, which is what we refer to as “network weaving.”
**Interviewer:** That’s encouraging to hear. What are the next steps for the Black Maternal Health ECHO program, and how can more healthcare professionals get involved?
**Dr. Miller:** Our next steps include expanding our outreach, particularly to rural areas where access to care is limited. We want to ensure that professionals from these regions can benefit from our resources and education. Healthcare professionals interested in participating can find more information on our website, and we encourage everyone committed to improving maternal health equity to get involved.
**Interviewer:** Thank you both for shedding light on such an important initiative. Your work is vital in addressing health disparities and improving outcomes for Black birthing individuals.
**Dr. Johnson & Dr. Miller:** Thank you for having us!
