May 2023 - INbetween -- Maternal & Child Health -- Recognizing Disparities and Debunking Stigma

In this INbetween episode, host Mighty Fine shares with listeners his thoughts about disparities within maternal and child health. Factors related to drug overdose, COVID-19 and quality of care are having a negative effect on mothers and babies that needs increased attention and focus among injury and violence prevention professionals.

Transcript

Mighty Fine: 0:09

Welcome to the injury and violence prevention INdepth podcast. My name is mighty fine, and I'm the host of this Safe States lions production. In this space will engage in dialogue with IVP professionals on a variety of issues to help inform our listeners on the latest trends and hot topics injury and violence prevention. This in between episode will focus on maternal and child health, the in betweens or episodes where I get to talk directly to you, our audience in between our episodes when I normally engage in dialogue with leading experts in injury and violence prevention. Today's episode is sponsored by faegre drinker, which is a firm designed for clients. With more than 1200 experienced attorneys, consultants and professionals in 21 locations in the United States, London and Shanghai. They have the strength to solve complex transactional litigation and regulatory challenges where ever needed. They partner with clients ranging from emerging startups to multinational corporations, delivering comprehensive and customized advice that advances ambitious business objectives. To learn more about them, be sure to visit www.faegredrinker.com. So as we celebrate Mother's during the month of May, and we really should be celebrating them 12 months out of the year, right. They do great work and, and they're just such an instrumental part of our lives. I do also feel that when we have this dedicated time to observe and celebrate them, it serves as a moment for us to sit back and reflect on the beauties of motherhood and being a parent. And to also address some of the challenges one of which I'll be talking about today. A recent study published by the Journal of the American Medical Association found that drug overdose deaths particularly deaths involving synthetic opioids like fentanyl, reach record highs, and 2020 and 2021. And there's a consensus among some researchers and practitioners that this was exacerbated by social, economic and health care disruptions, which were associated with the COVID 19 pandemic. Ultimately, the study found that pregnant and postpartum persons are at high risk for fatal overdose. This research track trends in the overdose mortality rate from 2017 to 2020, among both pregnant and postpartum people, and compare that to others of reproductive age, which are 15 to 44. They found that the overdose mortality rate among pregnant and postpartum people has been lower than the rate for others of reproductive age, but it's increasing faster for those who are pregnant or within one year of giving birth. Additionally, the paper noted that in 2020, there were about 12 pregnancy associated overdose deaths for every 100,000 births, a 46% spike in one year and an 81% increase since 2017. There were about 20 deaths for every 100,000 People in the broader reproductive age group, but the rate grew more slowly increasing 38% in 2017. This study further demonstrates the need for us in injury and violence prevention to continually address overdose with urgency and intent. I mean, we know that opioid misuse and overdose can have a detrimental impact on mothers and infants during pregnancy in even the first year after birth. To continue to address overdose, it will undoubtedly require collaboration and coordination across sectors. In fact, CDC is Division of Reproductive Health, also known as DRH is collaborating with states, federal partners and national organizations to take on this public health challenge. They're working to better understand opioid use and risks among pregnant and postpartum women, maternal overdose deaths and related state needs. They're exploring how best to support health systems to improve the care of pregnant and postpartum women with opioid use disorder in infants with neonatal abstinence syndrome. You know, Dr. H really recognizes that building State, Tribal, Local and Territorial capacity is essential to tackle the overdose problem. So with that, I'd like to highlight three of their initiatives they're employing to address this public health challenge under the umbrella of capacity building. The first is the opioid use disorder, maternal outcomes in neonatal abstinence syndrome initiative. It's a mouthful there. It's also called Omni for short. It's a learning community that supports state teams to implement policies and programs to address opioid use among pregnant and postpartum women in infants prenatally exposed to opioids. Then there's the perinatal quality collaboratives, or the PQ C's, which are state or multi state networks of teams working to improve the quality of care for mothers and babies. identifying areas for improvement, making changes as quickly as possible and monitoring uptaken impact. CDC finds 13 PQ C's to improve the quality of perinatal care and their states including efforts to improve outcomes related to maternal opioid use disorder and neonatal abstinence syndrome. And the third one I like to mention is CDC is Maternal and Child Health epidemiology program. This is where they assign epidemiologists and, and fellows to state, local and tribal agencies to support epidemiologic research, and provide scientific information to strengthen maternal child health activities. These assignees work on a wide range of issues including maternal opioid use disorder, and neonatal abstinence syndrome. So that's what CDC is doing in this area. In addition to the efforts that I just mentioned, I'd like to share some reflections that I have, I think we must work to reduce the stigma associated with substance misuse and get comfortable talking about it without judgment so we can save lives. NIH knows that stigma is a dynamic process in which individuals and structures continuously engage in exchanges mediated by power control and domination. It's important to note that stigma can influence the care of people at the individual intrapersonal and institutional level, and can vary based on the condition that the stigma is applied in the incidence of substance use disorder, stigma frames addiction as a personal choice, reflecting moral failing and deficiency in willpower and can vary by substance. So NIH is really challenging getting us to think about the impact that stigma has on substance use disorder, and help us to ensure that folks are receiving this information, not as a moral failing, but really thinking about it from a systemic issue, and recognizing the role that substance play in our lives, and particularly the lives of pregnant or postpartum people. So addressing stigma is critically important. So we can get folks the care that they need. But I'd like to believe that stigma also plays a role in the type of care that they receive. So recognizing that stigma can be impactful in our family, in our social networks, but also plays a role in the type of care we receive with our medical providers. So let's work on tackling stigma. The other thing that I'd like to elevate is really thinking about screening for substance use and making it a part of a comprehensive care for pregnant women. And it really should be done at the first prenatal visit in partnership with the pregnant person. Screening base only factors such as poor adherence to prenatal care or prior adverse pregnancy outcomes can lead to miss cases and may add to stereotyping and stigma. Therefore, it is essential that screening be universal. And lastly, I think we have to be sure to make the connection between maternal overdose and other issues regarding maternal and child health. This will enable us to have a more comprehensive approach to this issue and address challenges facing women and children. And this can include of course, tackling root causes and the underlying factors of substance use, or other related reasons for substance use initiation in the first place. So these are some of my thoughts on this matter, and I implore you all to continue to explore how best we can work together to prevent overdose broadly, and specifically for postpartum in pregnant people. As always, thanks for listening to IVP in depth. Feel free to subscribe and listen to us on Apple podcasts Spotify and Google podcasts. You can also follow safe states on Twitter at Safe States, also on LinkedIn. And don't forget to check out our website at safe states that org for more injury and violence prevention tools and resources. Again, I'd like to thank our sponsors faegre drinker for supporting Safe States and helping us to create space for programs such as this. This is your host mighty fine signing off and until next time, stay safe and injury free.