Expert: Maternal Health Disparities, Role of Pharmacists in Improving Outcomes

In an interview with Pharmacy Times, Rebecca Snead, Pharmacist Senior Director, Strategic Initiatives and Long-Term Care from the National Community Pharmacists Association, discussed maternal health disparities such as lack of access to care and chronic conditions that impact pregnancy outcomes. She also covered factors contributing to rising maternal mortality rates in the US. Snead outlined the many ways pharmacists can support maternal health through screenings, education, immunizations and becoming safe destinations for pregnant women. Expanding pharmacist scope of practice and compensation were suggested to further improve maternal care.

What health disparities are related to pregnancy that can impact maternal health?

One is this lack of access to care, including immunizations. Individuals that have chronic diseases are most impacted — those with diabetes and hypertension. But I think that's the biggest contributing factor is just lack of access to care.

Maternal mortality has been increasing in the U.S. What are some factors that contribute to maternal mortality?

As previously mentioned, lack of access to care. That includes lack of access to maternity providers. I think that's where independent community pharmacists can really step up and step in. But also, the increasing number of individuals with chronic health conditions, as well as maternal mental health. If you have those 3 confounding factors, it really creates that perfect storm that contributes to maternal mortality in the US, and it absolutely has been staggering, and I think deserves our attention. I think that the first one, lack of access to care is one in which community pharmacists can have and really deserves a call to action. Independent community pharmacist with their disbursement you in our rural and underserved areas can play a huge part. And we'll talk about that in a minute.

Key Takeaways

Pharmacists can play a key role in improving maternal health by increasing access to care, particularly in rural/underserved areas.
Pharmacists are well-positioned to conduct screenings and provide education/counseling to address issues like diabetes, mental health, immunizations that impact pregnancy outcomes.
Creating safe spaces in pharmacies for pregnant women can help improve support and reduce disparities in outcomes.

What is the pharmacist’s role in maternal health, and how can they aid the rise of maternal mortality?

So, forgive me if, this is a personal passion of mine, so I get on my soapbox a little bit. But if you if you look at the Women's preventive services initiative, and their recommendations for well woman care, there is just a whole list of things that pharmacists can really contribute to. Then if you overlay what a pregnant woman would need, there are so many things that a pharmacist can do. You can start out by the obvious things like making sure that they have access to folic acid supplementation. You can screen them for diabetes, if they are an individual that is a candidate for diabetes that they get into proper care. But if they are diabetic, that they are properly managed, screened them for their weight management and making sure that you help coach them. If needed, do blood pressure screening, screen them to make sure that they're up to date on their immunizations, make sure that they get their annual flu vaccine, make sure that they have their Tdap. With pregnant women, you make sure that they get their Tdap during the appropriate time during pregnancy. So, with Tdap, they need it between week 27 and 36, I believe. Make sure that they get their RSV vaccine — and we're just so lucky now that we have an RSV vaccine. They get that in respiratory season, so that would be September 1 through January 31 and during the appropriate time, which would be week 32 through 36. So, make sure that they're up to date on their vaccines and encourage them that they have their family members appropriately vaccinated because they want to make sure that not only themselves, but their family members are up to date with their vaccines to protect that that baby. Make sure you screen them for substance use disorder and make sure and when you do that, that's not only substances that you might consider. But you want to make sure that you screen them for alcohol use, tobacco use, as well as any other drug substances. Make sure you screen them for depression which is very common during pregnancy. Make sure that you have them screened for proper diet during pregnancy, make sure that you screen them for hep B and C, any sexually transmitted infections, counseling, any HIV risk. It goes on and on. Any interpersonal violence screening and risk, that would be promote a risk to themselves and or their baby. And then getting back to our pharmacy roots, make sure that you have screened them for any medication therapy management that they may need, depending upon what chronic conditions they have, and what medications that they may be on. So, there is a lot that a pharmacist can do for that pregnant woman. We should make sure that we are getting them into appropriate prenatal care. As soon as we find out an individual that may be coming into our pharmacy, or we interact with into an individual that may be pregnant, get them into prenatal care, because many individuals that are pregnant, don't get or seek prenatal care until their second or third trimester, which then prompts them not to have a successful and healthy baby. And so, getting them into prenatal care early, really will prompt them to have a healthy baby and then in turn, have a healthy mom.

How can pharmacists help raise awareness of racial disparities that contribute to maternal health/mortality?

Well, you know, women of color— particularly black women are 3 to 4 times more likely to die from pregnancy related causes than white women. They also have higher rates of preterm births, low birth weights, and late or no premade prenatal care. Pharmacists can do a lot as they are caring for individuals, particularly people of color, to make sure that we are aware of this fact, and that we are making sure that they are getting the proper prenatal care. Going through that checklist of appropriate care and making sure that we are playing our part, to make sure that they get the appropriate care. I think that just knowledge is power, and making sure that we are aware that there are tremendous disparities in the outcomes of individuals, and making sure that we are their strongest advocate.

What are a few resources pharmacists can provide women to receive high quality care during pregnancy, childbirth, and after?

Independent community pharmacist are local health care problem solvers. We are so good at customizing solutions to the healthcare challenges that are out there. The most powerful thing I think that we can do as independent community pharmacist is to create a place in our pharmacies — a safe place for maternal and postpartum, and infant care. Become a destination where pregnant people and women feel supported in their journey. You'd be surprised with the lack of access to care. It's a scary place for many pregnant women. Many pregnant women don't feel supported, and pharmacies can become a destination, and a place where these women can be supported. I would challenge our independent community pharmacists to become that destination for our pregnant women to be supported, through their journey. I like to say that while pharmacists can improve outcomes, and many, many, many health conditions, pregnancy is something where we can prove our outcomes in 9 months are last. It is a remarkable thing because we can not only prove our outcomes in 9 months or less, but we can save a life. Oftentimes with pregnant women, we can save more than 1 life — we can save the life of the child that they're carrying, but also the mom, and that's powerful. There's a lot that we can do, and I think just becoming a safe destination for pregnant women is one of the most powerful things that the independent community pharmacists and all pharmacies can do.

I think there's just 2 thoughts. Pharmacists are vital members of the health care team. Particularly with pregnant women, there's still a lack of access and this accessibility definitely needs pharmacists on the team. We do need, as always, some additional regulatory changes to expand the scope of practice to allow pharmacists to practice. In some areas, we have a lot of the things that are needed, pharmacists can already do today. But expanded scope could allow us to do even more. It's not that we don't have the training to do it, we do, it's within our scope. It's just there are laws that may prevent us to do some of the things that we are needed to do. But also, we need appropriate compensation for these services. I would really challenge our state Medicaid agencies to really recognize and adequately compensate pharmacist and all providers. One of the reasons why we don't have adequate OBGYN access is because there's not adequate compensation to for OBGYN, it's at the state level. As of 2022, which is the most recent data that I could find, 41% of the births were financed by state Medicaid agencies. 41% of the births were financed by state Medicaid. That range between the lowest state was at 17% and the highest state was 61%, all birth. So, on average, it was 41%. That's close to 50% of the births are paid for by Medicaid that state funds. Your state agencies can have a tremendous impact if we can get state Medicaid to adequately compensate for the care of pregnant women and adequately recognize pharmacist and the role that they play and maternal care. I think that that is a crucial thing that needs to occur.I think that by appropriately paying for prenatal care we can not only save lives, but we also can save state budgets because we can have a healthy pregnancy and healthy babies and that will ultimately save a tremendous amount of dollars in the long run.