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Promoting Maternal Health With Safety Bundles, Creative Leadership

Analysis  |  By Christopher Cheney  
   August 17, 2018

The Institute for Healthcare Improvement is launching a three-year effort to help decrease maternal mortality and morbidity.

The Institute for Healthcare Improvement (IHI) has launched a three-year initiative to address alarmingly high rates of maternal mortality and morbidity.

IHI, which launched the effort this month with support from the Merck for Mothers $500 million program, is focusing first on designing an approach to improving maternal health, says IHI Executive Director Jill Duncan, RN, MS, MPH.

"It is our commitment to build partnerships with those whose life work is to address women's health—specifically the racial disparities that exist around maternal mortality and morbidity. We are doing outreach and building partnerships," she says.

Among high-resource countries, the United States has the highest maternal mortality rate, according to the Washington, D.C.–based Alliance for Innovation in Maternal Health (AIM). Worldwide, only Afghanistan, Sudan, and the United States are experiencing rising rates of maternal mortality, AIM says.

Best practices

One of the top priorities of IHI's maternal health initiative is promoting the adoption of maternal safety bundles, Duncan says.

"There are safety bundles that organizations are adopting to address hemorrhage, hypertension, C-section rates, and blood clots. They are part of the AIM initiative and have been adopted by several states."

AIM's maternal safety bundle has 11 elements:

  • Maternal mental health: depression and anxiety
  • Maternal venous thromboembolism
  • Obstetric care for women with opioid addiction
  • Obstetric hemorrhage
  • Postpartum care basics for maternal safety
  • Prevention of retained vaginal sponges after birth
  • Reduction of peripartum racial and ethnic disparities
  • Safe reduction of primary Cesarean birth
  • Severe hypertension during pregnancy
  • Severe maternal morbidity review
  • Support after a severe maternal event

IHI is building on Merck's efforts to promote maternal safety bundles, Duncan says.

"Part of our interest is to work with partners who have found some success in spreading those bundles. We want to tie the bundles with our work in scaling best practices with improvement methodologies and accelerate the spreading of those bundles at the state level and at health systems."

Tackling disparity

Racial disparity is among the most vexing problems associated with maternal health, with black women experiencing mortality and morbidity at rates three to four times higher than other mothers, according to IHI.

There is a complex mix of medical and social reasons for the racial disparity, Duncan says.

"Black women are more likely to be uninsured. We are also recognizing the urgency of health systems and other organizations to grapple with unconscious biases—both institutional and structural racism—and the impact that has on black women in this country. It impacts the care that they get and the outcomes they experience."

She says there are several strategies that can be pursued to address the racial disparity in maternal health:

  • Improving treatment of health conditions and pregnancy complications
  • Adopting evidence-based methods to decrease complications
  • Advancing the understanding of the experience of black women
  • Reducing risk factors
  • Increasing protective factors such as the support women receive before, during, and after pregnancy

Addressing racial disparity in maternal health will take inspired leadership, Duncan says.

"It takes bold, courageous, and creative leaders in health systems and communities to act in new ways and radically redesign the way they think, the way they work, and the way they connect."

Christopher Cheney is the CMO editor at HealthLeaders.


The United States has the highest rate of maternal mortality among high-resource countries.

Maternal safety bundles are a primary solution strategy, with focal points such as mental health and obstetric hemorrhage.

The risk is three to four times higher for black women, so racial disparity is a key challenge.

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