While the Hudson Valley is a great place to live—we have an abundance of outdoor space, fresh food, and beautiful views—we fall short when it comes to healthcare. If you have job flexibility and financial means, you can travel to Albany, Westchester, or New York City to see a doctor, but only some have that freedom. Others wait months, many go without.
Economic status and geographic location are two social determinants of health (SDH), which the World Health Organization says account for between 30 to 55 percent of health outcomes. To help bridge healthcare gaps and eliminate clinical silos, Westchester Medical Center Health Network (WMCHealth) launched the Center for Women’s Health Equity to address the SDH that can result in increased maternal morbidity and mortality among Hudson Valley women.
“The SDH that specifically affect rural populations can be very different from but also similar to those in urban settings, and two of those are healthcare access and healthcare coverage,” explains Ashanda Saint Jean, MD, chair of Obstetrics and Gynecology at HealthAlliance Hospital in Kingston. Dr. Saint Jean leads the Center for Women’s Health Equity and is passionate about leveling the playing field.
Maternal Mortality Rates Are High in New York State
A March 2023 report published by the Centers for Disease Control stated that 1,205 people died of maternal causes in 2021, up 40 percent from 2020 and one of the worst maternal death rates ever recorded in the United States. This uptick can be correlated to both the pandemic and abortion restrictions—in 2021, the mortality rate was 32.9 deaths per 100,000, up from 23.8 in 2020 and 20.1 in 2019. The numbers look even worse when comparing the United States with other high-income countries such as Australia, Austria, Israel, Japan, and Spain, which report two and three deaths per 100,000. Maternal mortality rates are significantly worse for women of color. “Not only are these rates increasing, the survival gap for Black and Indigenous women continues to widen,” says Mary-Ann Etiebet, MD, AVP for Health Equity at Merck and lead of Merck for Mothers. For Black women, the maternal death rate in 2021 was 69.9 per 100,000, 2.6 times the rate for white women.
According to a series of studies published in the journal JAMA, the racial health gap hasn’t improved over the past 20 years, and maternal health is no exception, but it’s even more dire in New York, where Black, non-Hispanic women are up to five times more likely to die of pregnancy-related causes than white non-Hispanic women. “We are seeing more and more deaths occurring in the community after women have been discharged from the hospital,” Etiebet says. “Community-led solutions, like the Center for Women’s Health Equity, address discrimination, systemic and cultural barriers to care that are vital to reversing this trend.”
Cardiovascular complications—such as heart disease, embolism, and hemorrhage—are the leading cause of death among pregnant African American and Latina women, and the New York State Department of Health reports mental health disorders and diabetes as other leading causes of maternal mortality. According to the New York State Department of Health’s report, “78 percent of these deaths were preventable, and 100 percent of the deaths caused by hemorrhage, mental health conditions, and cardiomyopathy were preventable.”
Sean Tedjarati, MD, director of Obstetrics/Gynecology at Westchester Medical Center, says the socioeconomic and racial determinants of health that result in the premature death of women of color across the Hudson Valley is one of the greatest public health challenges we face.
Can We Fix It?
“We know why maternal mortality rates are so high: structural racism, discrimination, and inequities in care access and quality,” says Dipal Shah, chief external affairs officer, Planned Parenthood of Greater New York. “These deaths are largely preventable, and it’s critical we examine these gaps with a racial equity lens,” Shah says. “We applaud the opening of the Center for Women’s Health Equity in the Hudson Valley. This is a critical investment in improving outcomes for pregnant people in our state, especially women of color, who bear the brunt of the burden of skewed maternal mortality rates across New York and the nation.”
In Kingston, Dr. Saint Jean and the WMCHealth team created a strategic approach to meet the needs of patients and assembled their teams accordingly. “What we’re doing differently at the Center for Women’s Health Equity is that we understand the big drivers of maternal mortality and why this impacts women of color disproportionately,” Dr. Saint Jean says. Services include midwifery and mental healthcare services that will be life-saving and critical to Hudson Valley mothers having safe, positive birthing experiences.
Because this center is the first of its kind in New York State, Dr. Saint Jean and her team hope that others will replicate their blueprint and adopt a unified approach that addresses both maternal and infant mortality. “When I first came to work in Kingston, I recognized that I was in a medical desert for women’s health services,” Dr. Saint Jean says. “I didn’t have maternal-fetal medicine, I didn’t have urogynecology, I didn’t have minimally invasive gynecologic surgeons, nor did I have gynecologic oncology,” she explains. “We’ve basically brought water to the desert.”
What Does Health Equity Look Like?
Kingston now has a maternal-fetal medicine specialist who can do high-risk ultrasonography so patients don’t have to travel over an hour away. “When we look at the social determinants that impact rural settings, one of those is transportation, and there may be only one vehicle for the whole family household,” Dr. Saint Jean says, “And if that person who is the breadwinner has to go to work, then our patients are rendered without transportation get their medical needs addressed.”
Instead of making pregnant women travel, the Center for Women’s Health Equity has leveled the playing field by bringing specialists to the patients, and they also provide everything from cardiology to mental health services under one roof so it’s easier for patients. “It’s almost like one-stop shopping,” Dr. Saint Jean says, “We want our patients to get everything they need in one place so that there are no medical deserts anymore, not in Ulster County and not in the Hudson Valley.” Having all the care providers in one place eliminates confusion about the larger healthcare picture for every woman, and this streamlined care and communication will help save lives.
Dr. Saint Jean explains that they’re using a patient-centered medical home model, which means that the care is built around the patient, and it’s not only patient-centered but also high-quality, cost-effective, culturally appropriate, and team-based. “I have so many patients concerned about having a baby or who don’t even want to get pregnant because of concerns around pregnancy and childbirth,” St. Jean says, “I have Black women that come to me saying, ‘I don’t wanna die having this baby.'”
The Center for Women’s Health Equity is supported by a $750,000 New York State grant secured by New York State Assemblywoman Amy Paulin and with the support of New York State Senate Majority Leader Andrea Stewart-Cousins, the members of the New York State Legislature, and Governor Kathy Hochul.
The new HealthAlliance Hospital Mary’s Avenue Campus opened last December with the Family Birth Center that features eight spacious labor and delivery rooms with picturesque views along with midwives, 24-hour anesthesia, 24-hour neonatology, tubs for water births, wireless monitoring, individual refrigerators, and lactation specialists. “We want to optimize the birthing experience so our patients can enjoy the experience and have the best outcomes,” Dr. Saint Jean says, adding that they want to expand to Poughkeepsie and Newburgh. “I have patients who specifically want to see a Black provider because they often feel their voices are unheard,” Dr. Saint Jeans says. “We take care of everyone, and we put the humanity back in medicine for all of our patients across the Hudson Valley.”
While the Center for Women’s Health Equity is a great start, improving health outcomes for pregnant women in the Hudson Valley will take time, sustained effort, and cooperation. “Everyone deserves the right to bring a child into this world safely, with care and dignity,” Shah says, “and we commit to continuing to work with partners across New York to close these gaps in maternal health and sexual and reproductive health care access.”
This article appears in August 2023.
