In this episode of This is Public Health, we're covering the important topic of maternal and infant health and what we’re doing to improve health outcomes in Illinois. Join us for a conversation with Dr. Lisa Masinter, OB/GYN and Deputy Director of the Office of Women's Health and Family Services at IDPH, and Dr. Robin L. Jones, OB/GYN, Institutional Lead for Birth Equity at Rush University Medical Center, and Chair of IDPH's Maternal Mortality Review Committee.
Dr. Masinter shares why maternal and infant health is a key pillar of the Healthy Illinois 2028 state health improvement plan, what Illinois is doing to address health equity issues, and how we can help newborns thrive in their first year. Dr. Jones explains the disparities in maternal mortality, barriers to equitable care and potential solutions, and the importance of addressing substance use disorders among pregnant persons and new mothers.
Jim Leach: Welcome to This is Public Health, a podcast from the Illinois Department of Public Health. We're wrapping up our series of discussions on the main priorities of Healthy Illinois 2028, the state health improvement plan. The last of these five pillars is maternal and infant health and joining us to discuss this important topic, Dr. Lisa Masinter. She's an OBGYN and serves as IDPH Deputy Director in the Office of Women's Health and Family Services, and Dr. Robin L. Jones, also an OBGYN, and institutional lead for birth equity at Rush University Medical Center. Dr. Jones is also the Chairperson of IDPH's Maternal Mortality Review Committee. Thank you both so much for being here.
Jim Leach: Lisa, I'd like to start with you to get a look at the big picture. Why is maternal health such a big part of the State Health Improvement Plan?
Dr. Lisa Masinter: Well, thank you so much for having us here and having us talk about this important issue today. I would like to just take a second and thank my colleague, Dr. Robin Jones, for being here. She continues to be a tremendous mentor for me for, I can't believe it, but twenty years, and we're so honored to have her partnership here at the state.
Dr. Lisa Masinter: Anyways, what we want to talk about today is the State Health Improvement Plan in maternal and infant health. And we know that historically, policymakers and researchers have considered infant mortality to be one of the best measures of the health of the community or a state because of the ties between infant health and the structural and community level factors affecting health, like housing, economic indices, and access and quality of care.
Dr. Lisa Masinter: We also know that poor maternal health care can lead to poor outcomes in infants, and pregnancy offers a unique opportunity to identify, treat, and manage conditions that can improve the health of individuals and the state.
Jim Leach: So, what is lacking in this area that needs to be addressed?
Dr. Lisa Masinter: Well, through the process of engagement of subject matter experts for the development of the State Health Improvement Plan, a few main areas rose to the top as goals that need to be addressed in maternal health to improve outcomes.
Dr. Lisa Masinter: The first is the need to improve accessibility, availability, and quality of equitable reproductive health and well-person preventive health care across the reproductive lifespan.
Dr. Lisa Masinter: The second is the need to promote a comprehensive, cohesive, and equitable system of care and support services for all people giving birth in the state to have a healthy pregnancy, labor and delivery, and first year postpartum.
Jim Leach: And we will talk in more detail about those particular goals coming up. I want to bring Dr. Jones into the conversation now. As was noted, you play a big role in the state’s effort to understand and find solutions to maternal mortality. So, talk to us, if you would, about the numbers and what they say about the risk to expectant and new mothers and what factors are leading to bad outcomes in some cases.
Dr. Robin Jones: Well, first, let me say thank you for the invitation to participate in this important discussion, and I’d also like to say this has been a team effort. I've had the honor and privilege of being the chairperson, but they're a group of dedicated individuals who volunteer their time to look at, review, and formulate factors and recommendations that address maternal morbidity and mortality, so thank you.
Dr. Robin Jones: And as we look at our most recent Maternal Morbidity and Mortality Report from 2023, we found that in Illinois, an average of 88 women die while pregnant or within one year of pregnancy. And the leading causes of the pregnancy-related deaths were substance use disorder, followed closely by cardiac and coronary conditions, preexisting medical conditions, sepsis or infection, mental health conditions, and embolism.
Dr. Robin Jones: Jim, it would be very remiss if we did not mention that many of those deaths were preventable, and black women continue to have the highest rate of pregnancy-related deaths.
Dr. Robin Jones: The maternal health inequities are stark with black women being twice – twice – as likely to die from pregnancy-related conditions and three times as likely to die from a pregnancy-related medical condition as white women.
Dr. Robin Jones: It's also important to note that more than half of the pregnancy-related deaths occurred more than 60 days postpartum, and that 60 days was traditionally considered the postpartum period. And so, as we notice that more than half occurred outside of the traditional 60 days postpartum, it shows that we need follow up further out than 60 days.
Dr. Robin Jones: Let me put this plug in your ear also. A preview to the next report. The last report looked at 2018 through 2020. But this next report, we all were aware that during 2020, the landscape of maternal health shifted immensely due to COVID-19 and during the 2020 through 2022 period, the number of deaths was well above the average, and as I stated earlier the average was 88, particularly when we look at 2020 and 2021.
Dr. Robin Jones: Jim, there's more to come with the next report, so stay tuned.
Jim Leach: And that makes it clear why this is such an important priority in this State Health Improvement Plan. As you noted, equity is a key focus on this, and we'll delve more deeply into that in just a moment as well.
Jim Leach: Lisa Masinter, I want to turn back to you. As you mentioned earlier, when there are concerns about maternal health, then infant health can also be negatively impacted. So, what are some of the issues we see that are related to infant health in the state of Illinois?
Dr. Lisa Masinter: So similar to our Maternal Morbidity and Mortality Report, we also recently released our most recent Infant Mortality Report. And while we found that the overall rate of infant mortality in the state has been declining over time, we still found similar inequities in infant outcomes like maternal outcomes.
Dr. Lisa Masinter: For example, we found that the mortality rate among infants born to black women was nearly three times that of infants born to white, Hispanic, and Asian women. And that this disparity is primarily influenced by trends in death due to prematurity and sleep-related deaths.
Jim Leach: You are listening to This is Public Health, a podcast from the Illinois Department of Public Health. Again, our focus is on maternal and infant health, and our guests are Dr. Lisa Masinter, IDPH Deputy Director in the Office of Women's Health and Family Services, and Dr. Robin L. Jones, Institutional Lead for Birth Equity at Rush University Medical Center and Chair of the IDPH Maternal Mortality Review Committee. Both of these doctors are OBGYNs and so very good resources for our conversation. We're talking about this because it's one of the key pillars in the Healthy Illinois 2028 State Health Improvement Plan, which lays out several strategies to address the concerns we've discussed about maternal and infant health.
Jim Leach: The first of these is to improve the accessibility, availability, and quality of equitable reproductive health and preventive health care services across the reproductive lifespan. And again, the word equitable is the key here. Dr. Jones, what are the barriers to equitable care, including medical and financial barriers, and how can they be addressed?
Dr. Robin Jones: This is an important question, and the barriers to equitable care lie in social, economic, and structural factors, so let's just start with poverty. Poverty and lack of insurance make it difficult to afford and access necessary medical care.
Dr. Robin Jones: Geographic barriers. Limited availability of services in rural or underserved areas can create significant barriers also.
Dr. Robin Jones: Language barriers, language differences can lead to miscommunication and also difficulty in assessing needed information.
Dr. Robin Jones: There are also cultural barriers. Mistrust among health care providers and patients from different cultural backgrounds exist, and this is an important barrier that we need to overcome.
Dr. Robin Jones: Structural racism and discrimination also contribute to form maternal health outcomes by creating barriers to receipt of high-quality health care and by negatively influencing health status. The stigmas, the biases that exist, these stigmas associated with substance use and mental health disorder can discourage people from seeking care.
Dr. Robin Jones: And then the shortage of qualified health care professionals, particularly in underserved areas, can limit access to care.
Dr. Robin Jones: How can the barriers be addressed?
Dr. Robin Jones: Well, let me say first, let me give you the good news. The first thing is I am happy to say, at least we are acknowledging that barriers do exist. We are acknowledging that structural racism, discrimination, or communication and coordination of health care exists. So, the first thing is acknowledgement.
Dr. Robin Jones: The communities that we're talking about throughout our state, they can benefit from dedicated resources. Removing the stigma that's associated with substance use and mental health disorders. Addressing fragmentation of care. Addressing implicit bias. Applying coaching and education to raise awareness throughout our hospital systems regarding implicit and explicit bias and discrimination. And then looking in the mirror. Looking in the mirror to uncover local or system-based biases that are routinely a part of our health care delivery system.
Dr. Robin Jones: Last but not least, it's important that we encourage shared decision making with our patients. We must respect, we must listen, and we must effectively communicate with the individuals that we're providing care to.
Jim Leach: Lisa, I want to bring you back into this to talk about some of the other specific steps that the state is undertaking right now to address these health equity issues.
Dr. Lisa Masinter: Happy to do so. And really, that's a hard act to follow, and I think everybody who's listening now can understand why Dr. Jones holds such a special place in my heart and my personal and career history.
Dr. Lisa Masinter: But what I'll say is, I'll touch on a few things that reflect and highlight where the state is trying to address all of the things that Dr. Jones elevated. By no means is this an exhaustive list but just a few specific examples. At the Illinois Department of Public Health, we fund multiple efforts through different funding mechanisms that are aimed to improve health throughout the reproductive lifespan.
Dr. Lisa Masinter: First, we fund the Illinois Perinatal Quality Collaborative and partnership with other funders with the goal there to implement quality improvement efforts across birthing hospitals in the state, again touching upon many of the things Dr. Jones just mentioned.
Dr. Lisa Masinter: We also fund something called Administrative Perinatal Centers that function as hubs of support for hospitals across the state to provide evidence-based care and also what's known as risk appropriate care, so that when someone walks into whatever hospital across the state of Illinois, carrying a high risk pregnancy, that person will be brought and communicated through the Administrative Perinatal Center to a higher level of care that can manage her risk.
Dr. Lisa Masinter: Likewise, someone with lower risk can be taken care of in a lower level of care hospital and the Administrative Perinatal Centers function as the hubs of that support.
Dr. Lisa Masinter: We also are working with the University of Illinois at Chicago to create and implement an emergency department training toolkit to provide education and resources for emergency departments, specifically in places where they don't have obstetric care and backup for pregnant and postpartum people who show up to get appropriate referral and treatment.
Dr. Lisa Masinter: Most recently, we funded twelve community organizations, and I can't go into detail, but they're all doing amazing work to be in the community, promoting maternal and birth equity from a community perspective and a community lens in partnership with many organizations in whatever part of the state where they're located.
Dr. Lisa Masinter: I also want to mention our partner agencies who are working overtime to uplift efforts as well. Dr. Jones mentioned having access to care. Illinois was the first state to extend Medicaid through one year postpartum. And in this calendar year, Illinois Medicaid is implementing new reimbursement for perinatal support service providers like doulas, lactation support providers, home visitors, and midwives who provide out of hospital births, with many of these support services being shown to impact and influence equity.
Dr. Lisa Masinter: The Department of Human Services provide grants to other community partners providing home visiting services and case management services, and they're the lead agency working on the impact of unstable housing and substance use disorder on maternal health.
Dr. Lisa Masinter: And lastly, I would like to highlight the importance of reproductive health care as a key driver to achieving maternal health equity. If we really want to prevent poor outcomes in pregnancy and poor infants, we want to ensure that all pregnancies happen when people are as healthy as possible and they're ready and planning to be pregnant.
Dr. Lisa Masinter: Illinois remains a state and has become a true beacon for reproductive health care, as evidenced by the commitment of our governor, our partner agencies, to implement as many efforts as possible in incredibly innovative ways to preserve access to high-quality, full-spectrum reproductive health care and for that, I am incredibly grateful and proud to be a part of the effort.
Jim Leach: Another strategy laid out in the State Health Improvement Plan is to promote a comprehensive system of care throughout pregnancy, labor and delivery, and during the first year postpartum, that was noted earlier the importance of that one-year mark. Lisa, how achievable is that goal?
Dr. Lisa Masinter: So, Dr. Jones also talked about fragmentation of care and the need for care coordination. This would ensure pregnant individuals received needed screenings, treatments, and referral to support for whatever they need. We found through the Maternal Mortality Review Committee that fragmentation of care is in many of the cases that we see where it just highlights why this is needed, and because of the breadth and the scope of the need, why it truly is an aspirational goal for the state to achieve this for a population.
Dr. Lisa Masinter: Although it is a very big nut to crack – it will take substantial commitment and time – an incredible strength of this state is the dedication to improving maternal health. From the highest levels of government, like the governor to our sister agencies, to philanthropy to community, everyone is tirelessly working to make this better, and I already know and can assure many of our listeners that there are many organizations and agencies putting time and effort towards exploring how to transform this current goal into a reality for the state.
Jim Leach: In addition to providing that care for mothers, the plan also calls for developing the kind of comprehensive care to support positive birth outcomes and infant development during that first year of life. So, what things are needed to help newborns thrive in that first year?
Dr. Lisa Masinter: So, any system that we envision that would improve maternal care coordination would also extend in supporting care coordination and support to infants through their first year of life as well. And so, our vision is that a system like that would support the entire family.
Dr. Lisa Masinter: I also mentioned earlier that one of the main contributors to disparities in infant mortality is sleep-related deaths. That also requires a multi-prong approach that many of the partners working on the state and health improvement plan can influence, and many are doing work in this area, whether through surveillance, education, and more. There is so much to be done, and there are many communities coming together to support families.
Jim Leach: For our final question, I want to turn back to Dr. Robin Jones, and you noted earlier, as does the Healthy Illinois 2028 report, about the link between some of the physical health issues affecting pregnant persons and new mothers and mental health and substance use issues among that group. So, Dr. Jones, how prevalent are those concerns and what can be done to address them?
Dr. Robin Jones: Thank you. Substance use disorder was the leading cause of pregnancy-related deaths in the 2023 report. So, it’s critical that the state and our nation continues to prioritize this issue.
Dr. Robin Jones: Let me say this, physical health, mental health, and substance use disorders – they’re connected. They're interconnected with each influencing each other. So, it is imperative that when addressing these issues, we do so in a holistic manner. That's the only way we really are going to end up promoting true overall health and well-being.
Dr. Robin Jones: Within this state, and actually in my tenure chairing the MMRC, I've been pleased to see an increase in attention as well as resources which are critical for substance use in Illinois. Namely, the Illinois Helpline, which is a public-facing 24/7 free confidential service that connects people to treatment and recovery providers across Illinois.
Dr. Robin Jones: There's also the Illinois Drug Overdose Prevention Program, which promotes the evidence-based strategy of overdose education and naloxone distribution. Let me state clearly, naloxone is a safe and effective opioid overdose reversal medication that we know saves lives.
Dr. Robin Jones: So, Illinois, thank you. Let's continue to lift up our residents who have a diagnosis of substance use and mental health disorder.
Jim Leach: We'll just mention that Illinois Helpline you referenced, that number is 833-2FINDHELP. 833-2FINDHELP for the Illinois Helpline for people to reach out to seek help with substance use issues.
Jim Leach: Again, a lot of the important and challenging issues here but a comprehensive wide-ranging plan to address them. I want to thank again our guests for giving us more information on this important subject. Dr. Lisa Masinter. She is an OBGYN and Deputy Director of the Office of Women's Health and Family Services for IDPH, and Dr. Robin Jones, also an OBGYN, as well as institutional lead for birth equity at Rush University Medical Center and Chair of IDPH's Maternal Mortality Review Committee.
Jim Leach: Thank you both so much for being here, and thanks to our audience for being here with us. Join us next time for another edition of This is Public Health with the Illinois Department of Public Health.
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