June 23, 2023

By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP President

The death of track star Tori Bowie from complications of childbirth was a tragic reminder of the devastating impact of maternal mortality and morbidity in the United States. Family physicians know a great deal about the many factors that contribute to deaths during pregnancy and childbirth — just as we know only too well that hundreds of American women this year who should deliver healthy babies without consequence to their well-being will either not survive pregnancy or will die postpartum.

Bowie was an Olympic medalist, one of the fastest humans on the planet, an elite athlete. Bowie’s talent and the fame it rightly earned her made her singular. What makes her loss resonate with me, however, isn’t her uniqueness. It’s what she shared with other victims of maternal mortality: being Black, the potential lack of care she may have received, and the many ways in which her death might have been prevented.

Black women who develop preeclampsia are three times more likely to die of it than white women. Severe preeclampsia forced Allyson Felix, one of Bowie’s Olympic teammates, to have an emergency C-section. Black women are nearly twice as likely as white women to receive late or no prenatal care before delivery. But as Omare Jimmerson, executive director of the Tulsa Birth Equity Initiative, wrote in a June 21 Stat opinion post, the overall health care system — with its implicit biases and what she argues might be an overemphasis on social determinants of health — must be held to account, not the individual patient.

And it is our individual patients I want to talk about as we’re confronted with such a high-profile example of this country’s unacceptably high, and climbing, maternal mortality rate. The numbers I just linked you to are as shameful as they are daunting. But family physicians — one practice at a time seeing one patient at a time, as well as staying united within the AAFP — are vital to addressing this crisis.

I believe this because I’ve devoted time and energy to this issue for a long time, including as chair of the Maternal Morbidity & Mortality Task Force led by the AAFP. I believe this because I know that we, as family physicians, remain dedicated to providing maternity care, especially in rural areas and for underserved populations. And I know our Academy shares this dedication.

The Academy’s investment in overcoming disparities in maternal morbidity and mortality is longstanding and considerable. We recently won a long advocacy fight to make permanent the state option to extend Medicaid postpartum coverage for a full year; we continue to call for such coverage to be required nationwide. The AAFP consistently backs legislation supported by the Black Maternal Health Caucus. We were pleased to see the Protecting Moms Who Served Act signed into law in 2021. This is the steady path we walk as we try to achieve birth equity and solve for the health disparities that pregnant Black, Indigenous and other people of color experience.

There’s something new we can do at the practice level, too. 

The Academy has just released an on-demand, multisession CME program that focuses on the care birthing people require in the first few months postpartum. It’s called “4th Trimester: Optimizing Postpartum Care,” and its 20 sessions and panel discussions include detailed modules on topics such as coordinating mental health, optimizing breastfeeding support and an osteopathic approach to the fourth trimester.

I’ll remind you here as well of the resources assembled by the AAFP’s Center for Women’s Health, and of the Academy’s development of the Advanced Life Support in Obstetrics curriculum. The latter educates and equips family physicians, and all members of the maternity care team, with the tools and skills they need to effectively manage obstetric emergencies and several of the leading causes of pregnancy-related death, as identified by the CDC.  

Beyond this, the AAFP offers

• American Family Physician’s AFP by Topic collections on labor, delivery, and postpartum issues and prenatal care;
• patient care pages on maternal health and breastfeeding; and
• links to more than two dozen clinical recommendations and guidelines on maternity care.

The Women’s Preventive Services Initiative, a longstanding Academy partner, has also published numerous recommendations and resources for timely, high-quality patient care during and after pregnancy.

I mourn Tori Bowie and her infant daughter, but I remain optimistic because we are already treating many patients who would otherwise be at risk. Yet, I know we can reach still more. Maternal care, including fourth-trimester care, is part of the continuous, person-centered, deeply rewarding care all family physicians deliver.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is president of the AAFP.