Reducing Maternal Morbidity in Connecticut: A Q&A With Marcella Nunez-Smith, MD

Marcella Nunez-Smith, MD, MHS: When compared with other states, Connecticut is often ranked near the top of the list for health outcomes. It can be a surprise to learn that on some measures, such as severe maternal morbidity, we rank in the bottom half of states. And when we consider disparities, or group-level differences in health outcomes, we still have significant work to do.

It was an honor to serve as chair of the advisory committee that gave rise to the blueprint. The Global Health Leadership Initiative at Yale School of Public Health and the Equity Research and Innovation Center at Yale School of Medicine collaborated to facilitate the work of the advisory committee and the engagement of myriad perspectives across the state. Once the advisory committee evaluated the data that our Yale team and other subject matter experts shared, they decided to focus the blueprint and its recommendations on addressing severe maternal morbidity in our state.

Severe maternal morbidity is a significant public health issue. We now have the opportunity to increase visibility into this challenge and to target resources appropriately to narrow the gap, especially for Black mothers in our state. It’s time to set a new bar. The expectation of surviving pregnancy is the bare minimum. Women shouldn’t just survive pregnancy; they need to thrive and emerge from pregnancy in optimal health.

Nunez-Smith: The Connecticut Health Foundation set maternal health equity as a strategic priority for their work. We worked collaboratively to generate a blueprint unique to our state, highlighting our many, many assets and identifying opportunities to take tangible next steps right here.

Our team took a multifaceted approach to developing the blueprint. We learned from work done in other states and at the federal level. We met regularly with national subject matter experts; several leaders from across the country briefed the advisory committee on ongoing initiatives. We engaged community members and leaders—over 200 individuals—across the state to inform the emergent recommendations. Our team leveraged published and unpublished research and policy evaluations. We were afforded the time to honor the process co-designed with the advisory committee and we’re proud the final blueprint reflects this robust and rigorous process.

Without diminishing the importance of this historical milestone, we understand the blueprint is not the destination in and of itself. Hopefully, it serves as a catalyst and scaffold for the next phases of work, keeping in sharp focus the why that brought all of us to this work—which is to ensure everyone in our state reasonably expects they will be well before, during, and after pregnancy.

Nunez-Smith: The blueprint lays out five strategic priorities. The first is to raise awareness of severe maternal morbidity as a critical public health issue. The launch of the blueprint is contributing to elevating a statewide conversation. For many policymakers and clinicians, this blueprint presents the first opportunity to learn about the challenges we face and where solutions might be found.

The blueprint also calls for increasing access to a broad array of maternal health care providers as well as strengthening the connections between maternal health and behavioral services. Importantly, the blueprint specifically identifies the need to address health care discrimination and ensure the workforce is representative.

The blueprint also recommends a concerted effort to increase economic security and economic mobility among families. The document outlines a suite of first-year actions and extending the statewide landscape map to comprehensively capture the great work already underway. I’m hopeful that a year from now, we can reflect and celebrate the forward momentum and progress in CT.

Nunez-Smith: Collective action feels very much within our reach. We’re hearing from leaders across the state and health leaders from other jurisdictions, eager to prioritize severe maternal morbidity. This blueprint, which brings together so many different perspectives and leaders, lifts up the assets in the state, proposes actionable next steps, will accelerate progress towards improved health outcomes. This is a pivotal moment for maternal health in our state.