Frequently Asked Questions - Birth Equity

CMQCC is leading this work in partnership with hospitals, CBOs, and state/national and local advisors. CMQCC is a multi-stakeholder group based at Stanford University that focuses on improving hospital-based maternity care in California. CMQCC has previously managed data-driven projects that incorporated best practices, learning collaboratives, and brought together existing and new partnerships in order to sustain and advance maternal health. Through our ongoing efforts and partnerships, CMQCC has helped California to produce one of the lowest overall maternal mortality rates in the country.

Since 1999, the reported maternal mortality data in California show a persistent 3-4x gap between Black mothers and mothers from all other racial groups. Also, maternal mortality rates nearly doubled in California between 1999 and 2006. CMQCC was founded in 2006 at Stanford University School of Medicine together with the State of California. Since CMQCC’s inception, California’s  maternal mortality rate has declined by 55 percent while the national maternal mortality rate continued to rise. The expectation was that widespread adoption of CMQCC’s clinical safety bundles would reduce the gap in the number of maternal deaths among Black women. However, the difference in outcomes for Black mothers compared with all other racial groups has persisted.

Further analysis revealed that clinical safety bundles and social support interventions done in isolation, without an integrated approach, did not produce the desired outcomes. Thus, CMQCC’s Birth Equity Collaborative presents an opportunity to develop QI tools to promptly evaluate and transform birth care, experiences, and outcomes through the integration of clinical and sociocultural interventions and community-hospital partnerships

• Data shows that even in the absence of risk factors such as age over 35 years, lack of health insurance, inadequate or no prenatal care, and less than high school education, the U.S. system of health care is not protecting Black mothers and birthing people from experiencing higher numbers of deaths or life-threatening complications during pregnancy and childbirth.
• Increasing evidence points to racism within and across multiple levels, and not race, as a key cause of these birth disparities.
• Data also show variations in the quality of care and outcomes across hospitals in California, highlighting opportunities for advancing equity in quality improvement.

The success that California has achieved in the significant reduction in maternal mortality rates is a direct reflection of the outcomes that are possible when collaboration exists around a patient safety concern. The existing data and literature evidence has provided the impetus to formalize an action plan to address this racial equity issue. With our California Birth Equity Collaborative pilot, CMQCC aims to transform birth care for Black mothers and birthing people together with Black women-led CBOs and our hospital partners.

We know from our data that many outcomes vary significantly across hospitals in California. We know from our past work that it is possible to address this variation. We fully recognize that the origins and effects of mistreatment and disrespect impact Black mothers and birthing communities far before, during, and after pregnancy and childbirth. As a start, our intent is to focus this work on a discrete, manageable setting (the hospital) where we believe we can make a significant impact in birth care and outcomes.

Hospitals are a critical, nearly universal site of maternity care; more than 98% of births occur there nationally. Hospital providers need to provide holistic, culturally congruent care that is both evidence-based and personalized to the needs of individuals and communities within the context of their lived experiences. Hospitals are an important setting in which it is possible to significantly impact birth care and outcomes. Additionally, CMQCC has the expertise, existing data tools and relationships focused on improving clinical care in the hospital setting. However, we anticipate that most if not all of our approaches will also be applicable to the outpatient setting in the future.

Black women clinicians, social scientists, and public health scholars with institutional affiliation outside of our key community areas will serve as mentors to support the overall pilot goals, activities, and measures of success in our state/national advisory group.

CMQCC will facilitate partnerships between participating hospitals and local advisory groups including patient representatives, community members and hospital staff whose role is to address the specific pilot goals, activities and measures at each of the three pilot hospitals.

We envision this project will have three key steps:

• Mobilizing partners to work together in collaboration with community members to care and advocate for Black mothers and birthing people
• Utilizing hospital-level data to inform the quality improvement initiative
• Implementing multi-partner, large-scale pilot interventions (see below) that integrate hospital clinical providers and the community with public health, community health, and perinatal  services

Three hospitals are participating in the pilot. Once finalized, we will share the names and locations. These hospitals were chosen based on the following criteria:

1. At least 150 births per year by Black women
2. A commitment by the hospital’s leadership to addressing birth equity
3. Engagement with CMQCC in prior quality improvement efforts
4. Data indicating an opportunity for improvement in their maternal outcomes for Black mothers and birthing people
5. Representation of three diverse geographic areas within the state

Yes. Our intention is to create a toolkit with evidence-based quality improvement resources for hospitals that can be scaled up for implementation across the state. We will be working with the three pilot hospitals to develop and test approaches and materials. If we identify approaches that are impactful, our intent is to spread them widely to all hospitals in California.

It will only be possible to achieve the aims if we, the Collaborative and our partners, successfully:

• Develop and utilize a shared language and understanding about what birth equity means, and appreciate the medical and social context of birth care, experiences, and outcomes in the U.S. and California
• Acknowledge and amplify the resilience and community-informed knowledge of Black childbirth expectations, needs, experiences, and outcomes
• Establish strategies to create and assess sustainable and respectful community-hospital partnerships
• Identify opportunities in orientation and ongoing education for clinicians and staff in advancing a culture of birth equity in hospital births
• Develop community-informed meanings and measurements of respectful and dignified culture and care during hospital births