The statistics around women’s health in the United States paint a grim picture; from family planning and sexual health to pre- and post-natal care, women are missing essential services at every age. Some of the most telling data is around maternal mortality rates; in 2017 there were 17.3 pregnancy-related deaths per 100,000, a number that has increased almost every year since 1987 when the CDC’s Pregnancy Mortality Surveillance System began.[1] In contrast, pregnancy-related deaths in the next-worst performing developed country are at 9.2 per 100,000 in the UK, with Finland performing the best at 3.8 deaths per 100,000 in 2015[2].
The numbers are even more tragic for Black women where the rate of pregnancy-related deaths is almost triple that of the national average at 41.7 per 100,000.[3] There is no simple explanation for these numbers, but in the course of my own research as an MPH student and doula-in-training, I’ve discovered how important it is to step backward and examine the scope of the problem rather than considering adverse pregnancy outcomes as siloed events. As ProPublica reported in this article chronicling pregnancy-related deaths in 2017, these fatalities are happening to women of all ages, races, and socio-economic statuses. There is no amount of money, education, or family support that seems to protect women, especially those of color; take Serena William’s story of her pregnancy, labor, and post-natal complications as proof.
To consider the whole scope of what these numbers tell us about our healthcare system, we must look at women’s sexual and reproductive health as a continuum. Women must be educated about their health early on and have access to preventive services like the HPV vaccine and regular cervical cancer screening as part of routine care. As female patients enter reproductive age, their providers must offer counseling for family planning, including asking questions about pregnancy intention and providing access to the full spectrum of contraceptive methods.
The New England Journal of Medicine published this article in 2016 reporting that 45% of pregnancies in 2011 were unplanned. Unintended pregnancies can have a profound impact on women’s long term physical, emotional, and financial health, a connection recognized by the CDC on their Contraception page and in the Healthy People 2030 goals. And for those women who do become pregnant, we know there is so much a trusted healthcare provider can offer, but given how poor maternal birth outcomes are, it is safe to say something is missing.
Like the rest of the team here at Azara, I believe in the power of data. While software will never be a complete solution to reducing unplanned pregnancies or lowering maternal mortality rates, I know that relevant, easy-to-use reporting across this continuum of women’s health can help shift these terrifying trends. We can learn so much by starting to track basic information like how many women are asked by a primary care provider, “do you want to become pregnant in the next year?”
Through Azara’s partnerships with clients we have greatly expanded our reporting around women’s health in the 3 years since I have been with the company. One of these partners is Upstream USA, a non-profit that provides training and technical assistance to primary care organizations with the goal that every woman has access to the full range of contraceptive options and counseling. I have had the privilege to work with Upstream since I started at Azara, collaborating with them to build custom measures tailored to their program goals.
Through this partnership, Azara now has a suite of measures to evaluate how women are counseled on and offered different types of contraception. And just this year, Caring Hands Community Health Center in Oklahoma partnered with Azara to build out the entire suite of Title X reports, a huge undertaking that I know will benefit so many of our customers who use this grant funding to offer men and women basic sexual and reproductive health services.
Thanks to these amazing partners, Azara is preparing to roll out our new Family Planning module which will include all Title X reporting tables, a suite of measures around pregnancy intention screening and contraceptive access, counseling, and provision, and a few more of the usual DRVS bonuses like alerts, registry data elements, and filters. We are also expanding our immunization management report this fall to include adolescents, which means more detailed analytics on HPV vaccine administration, and we continue to offer our Prenatal Passport and OB Episode reports to help DRVS users track their pregnant patients before and after delivery.
Women’s health is an area in which I am particularly passionate, and I believe that by offering women more complete sexual and reproductive care we can reduce healthcare inequalities for everyone. I know that reporting is not the only piece of the puzzle. We also need to foster strong partnerships with organizations like Upstream to ensure care teams have the resources they need, and we must continue to encourage data sharing and transparency in service to patients and improving their long-term health outcomes.
I am so proud of the work Azara is doing to support reporting around women’s health and am excited to see what we roll out next. There is so much more to this subject beyond contraceptive care, pregnancy, and childbirth, and we need you, our clients, to keep pushing us and bringing your suggestions so we can continue supporting this work. Thank you for your ideas, commitment, and passion as we look ahead to the future.
[2] https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31470-2.pdf