420: Maternal Mortality Disparities, Risk Appropriate Care Could Help

Dr. Brannon Traxler, Director of Public Health for the South Carolina Department of Health and Environmental Control, explains why South Carolina is seeing high rates of infant and maternal mortality; Dr. Eugene Toy, Gynecologist and professor of...

Dr. Brannon Traxler, Director of Public Health for the South Carolina Department of Health and Environmental Control, explains why South Carolina is seeing high rates of infant and maternal mortality; Dr. Eugene Toy, Gynecologist and professor of obstetrics and gynecology at the University of Texas Health Science Center at Houston Medical School, outlines how the risk-appropriate care model can reduce maternal mortality rates; Emma Talkington, ASTHO Senior Analyst of Environmental Health, shares the key issues from the 2023 State Environmental Health Directors Annual Meeting; and you can still register to attend ASTHO’s Public Health TechXpo online. 


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This is Public Health Review Morning Edition for Monday, May 15, 2023. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.



We know that we have 14 counties out of 46 in South Carolina that don't have an OBGYN. And so, really looking, one of the things we're doing deeper dives into is whether those areas, for example, are seeing worse mortality rates.


South Carolina public health director Dr. Brannon Traxler thinking about data in a pair of new reports that points to an increase in the number of infants and pregnant people dying in the state.


Both of them show a worsening in regards to not just overall mortality for infants and mothers but also a widening of the gap, a worsening of the disparity, particularly the race and ethnicity, the disparity around that.


Traxler says disparities are driving the numbers higher.


I think we all have to acknowledge that they're there. We have to do the education and make sure that all the providers do know and that we don't just assume that it's understood or that everyone is aware. Then, I believe that it is being very deliberate for every single family, every single patient that they encounter, regardless of race or ethnicity, to do that education component.


The rates, according to Traxler, are a sobering indicator of health in communities around the state.


If we have these high rates of death for mothers and babies, that tells me—and I think it should tell South Carolinians—that overall as a state and in our communities, we're not as healthy as we want to be. These are often preventable deaths. And so, we need to drill down into the data and the information and determine why it's happening, and what can be done, and make those preventive efforts.


You can read more about South Carolina's infant and maternal mortality rates using the link in the show notes.


Risk appropriate care is a model that could help reduce maternal mortality rates. Dr. Eugene Toy with the University of Texas Medical School in Houston says it's all about teamwork and the proper allocation of resources according to the complexity or risk to the patient.


I would say that providers have the largest role in making this all work. And the reason why is because the assessment of the risk is clinical. And although our nurses and other people might be able to elicit some of the risk and be able to make that assessment, it's really at the provider level—and usually at the physician level—where identification and then early identification, prevention, and then appropriate referral.


Toy says more systems need to implement the risk appropriate care model as soon as possible.


I think it just needs to be done yesterday. Our maternal mortality rate is through the roof and it's a major, major problem. I mean, it is a huge problem overall. We also have to remember that it's not just deaths, but for every maternal death then there's at least 100 to 150 near misses, and those near misses also cause problems.


Hear more of our conversation with Dr. Toy in a new episode of the Public Health Review podcast, coming soon everywhere you stream audio.


Also, state environmental health directors have a lot on their agenda these days. ASTHO's Emma Talkington says they met recently to connect and discuss key issues.


We focused on some areas that we haven't focused as much on in the past, though more so recently we've been talking about areas like environmental justice, we had a focus on risk communication, a session on data modernization. So I think they're definitely some areas that we've been focusing more on in some recent years.



Finally this morning, federal experts are on the agenda to offer their thoughts about public health data technology at ASTHO's Public Health TechXpo later this month in Chicago and online. You can see the event schedule and get an online ticket using the link in the show notes.


That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Eugene Toy MD FACOG

Professor, Obstetrics and Gynecology, UT Health Science Center Houston

Brannon Traxler MD MPH

Director of Public Health, South Carolina Department of Public Health

Emma Talkington MPH

Analyst, Environmental Health, ASTHO