Director's Messages

Addressing the Maternal Health Crisis

Dr. David Murray is joined in this message by Dr. Janine Clayton, Director of the NIH Office of Research on Women's Health (ORWH); Dr. Diana Bianchi, Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Dr. Eliseo J. Pérez-Stable, Director of the National Institute on Minority Health and Health Disparities (NIMHD); and Dr. Gary Gibbons, Director of the National Heart, Lung, and Blood Institute (NHLBI)

The United States is experiencing a maternal health crisis with rising rates of pregnancy-related complications and deaths, also called maternal morbidity and mortality. While many research efforts have focused on understanding pregnancy and newborn outcomes, the majority of severe pregnancy-related complications and maternal deaths occur during the year immediately after pregnancy, also known as the postpartum period. More than 80% of these complications and deaths are preventable.

To identify gaps in research on postpartum health and support evidence-based improvements in maternal health care, our five institutes and offices came together to organize a Pathways to Prevention (P2P) Workshop on Identifying Risks and Interventions to Optimize Postpartum Health. Our hope is that this will be a catalyst for rapid changes and greatly broaden the research lens.

Speakers at the workshop included researchers, health care professionals, and people impacted by pregnancy-related health complications. They spoke about the need to consider women’s health across the lifespan, including long before and long after pregnancy. They also highlighted how structural disparities, like differences in local infrastructure and access to care, increase the risk of morbidity and mortality experienced by Black or African American and American Indian/Alaska Native women. A theme that permeated the workshop was the need to listen to patients and their families and engage them in research efforts. 

Each of us brings a different perspective and set of resources to addressing this crisis:

  • As outlined in our new strategic plan, ODP seeks to promote and support preventive intervention research that addresses risk factors for illness, injury, and the leading causes of death, many of which also lead to poor postpartum health outcomes. Our office is also working to mobilize collaborative NIH-wide efforts to enhance prevention research that addresses health disparities. 
  • ORWH promotes the life course perspective—the consideration of how biological, social, and environmental factors intersect and interact with each other over a woman's entire life—when studying the health of women. Not only is pregnancy a stress test affecting women’s health later in life, but the postpartum period is also a time of considerable stress and health concerns. As Dr. Clayton said during the workshop, we need to “bridge the chasm,” where entering the postpartum period should not mean leaving maternal care, but rather entering postpartum care. Extending holistic team-based care with wraparound services to the postpartum period and aligning research with women’s lived experiences is necessary to improve postpartum health.
  • NICHD is interested in disparities in maternal health including those for people with disabilities and those stemming from limited access to high quality health care including mental health. NICHD will use the outcomes of the P2P workshop to inform the NIH-wide Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative
  • NIMHD-supported research explores how bias infiltrates so many aspects of medical care. African American and American Indian/Alaska Native women have maternal death rates that are nearly four times that of White women in the United States; these death rates stem from many different social and structural disparities arising from less access to high quality care rather than from intrinsic, biological, or behavioral health differences.
  • NHLBI is focused on advancing health equity through the improvement of maternal cardiovascular health. Cardiovascular factors are a leading cause of death, both during and after pregnancy. Bias and structural disparities clearly affect psychological and biological risk factors and directly impact maternal illness and death. Identification and treatment of these factors need to be considered in any efforts to improve not only maternal health but also future cardiovascular health. The Chronic Hypertension and Pregnancy (CHAP) Trial showed that treating chronic hypertension during early pregnancy reduces adverse pregnancy outcomes, informing clinical guidance and representing a pathway toward prevention of maternal morbidity and mortality. The CHAP study will inform future implementation and dissemination efforts centered on improving maternal health.

We encourage you to review the following workshop publications to identify ways you or your organization can help address the postpartum health crisis.

There is an urgent need for a national effort to support research, dissemination, and implementation of postpartum health initiatives. By taking a life course perspective, curbing bias, and elevating the voices of patients and their families, we will move toward making the United States the best country in the world to give birth.