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Developments in the Quest to Advance Equity in Maternal and Child Health in the Age of COVID-19: The Bad, the Good, and the Promising

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The U.S. has the highest rate of maternal mortality among the world’s high-income nations. To compound the problem, disparities in U.S. maternal mortality rates fall along racial, ethnic, and geographic lines. Almeta Cooper, National Manager for Health Equity, Moms Clean Air Force, speaks with Priya Bathija, Adjunct Professor, Loyola University Chicago School of Law, Andrea Ferrari, Partner, Jones Walker, Ashley Keith-Phillips, Assistant General Counsel, University Hospitals Health System, and Marki Stewart, Attorney, Coppersmith Brockelman, about how U.S. rates of maternal and child health compare globally and the types of disparities that exist, national efforts to address the crisis in light of the COVID-19 pandemic, and the challenges impacting those efforts. Andrea authored an article for AHLA’s special edition of the Journal of Health and Life Sciences Law dedicated to “Emerging Issues in Health Equity in the United States: Legal, Legislative, and Policy Perspectives.”

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Speaker 1:

This episode of ala Speaking of Health Law is brought to you by HLA members and donors like you. For more information, visit American health law.org.

Speaker 2:

Hello and welcome to our audience, to a discussion addressing the timely topic of US maternal and child health, the bad, the good, and the promising. Our discussion today is based on an article that was published in our American Health Law Journal of Health, Law and Life Sciences, uh, special issue that was devoted to emerging issues in health equity in the United States, legal, legislative, and policy perspectives. Um, and the specific article that was written by Andrea Ferrari relates to the quest to advance equity in Maternal and Child Health in the age of Covid 19, The bad, the good, and the promising. And based on that article, which we really encourage our audience to go and read in its entirety as well, of as all of the terrific articles that were in this special issue. But today, we're gonna build on that discussion, on that article, and have this discussion, uh, to help us learn even more about this important topic. But before we get into our discussion, I wanna give a special thank you to ALA and its leaders for publishing the special issue in May of this year, and addressing some of the difficult and important health equity issues facing, uh, healthcare leaders today. And also, I wanna encourage those who are listening to our podcast to think about what role, um, they as lawyers and other, uh, other healthcare leaders can play in addressing these issues. I also wanna acknowledge my co-editor, Harvey Tebo and I, again, I wanna encourage listeners to go online and read all of the excellent articles that are available to the public. My name is Almita Cooper, and I am the National Manager for Health Equity at Moms Clean Air Force. And I'm going to be the moderator today. I, I, now, I want to introduce our really excellent panel. Uh, we're honored to have today with us. Uh, Prya, uh, Prya is a healthcare leader that I've had the pleasure of knowing, uh, through actually throughout her entire, uh, healthcare career. Uh, Andrea Ferrari, as I've already mentioned, is the author of the ALA article, uh, and she is a partner at Jones Walker, and she's engaged in the national healthcare practice, uh, based in Miami. Ashley Keith Phillips is a healthcare attorney and assistant general counsel for University Hospital's health system in northeast Ohio. And Marky Stewart is a healthcare attorney practicing in Phoenix, Arizona at Coppersmith Brockleman at, uh, plc. I have to go back, uh, pre and apologize to you because I think I got excited about our friendship and didn't give your exact title. So I'm gonna let you say what your title is.

Speaker 3:

Okay, wonderful. Thanks, Aita. So I am currently an adjunct professor at Loyola University College of Law, um, and previously served as Vice President of Strategic initiatives for the American Hospital Association.

Speaker 2:

Thank you, Priya. Now, so now let's turn to today's conversation. And Pria, since we've already got you, uh, I wanna ask you to please share with our audience what the current state of maternal and child health in the nation is compared to global conditions of mothers and children's health.

Speaker 3:

Sure. Well, thanks Almita, and thank you to Andrea and ALA for inviting me to be part of this podcast. Um, so prior to the pandemic, it was estimated that 50,000 women suffer, um, severe health problems related to pregnancy. Um, and that 700 women die from pregnancy and delivery related complications each year in the United States. Um, that number rose from 700 to 861 during 2020, which was the first year of the pandemic. And while our listeners may not think that 700 or 861 sound that high, given the number of births we have in our country, um, maternal deaths in the United States are on the rise. Um, maternal mortality rates have more than doubled since 1987 in the United States. And this is in stark contrast to other developed countries who have seen a tremendous decrease in maternal mortality rates in the same time period. And there's so many different ways you can look at the data or slice the data, but no matter how you do it, the US is faring much worse than other developed countries. And the worst part of all of it is that most maternal deaths are preventable. A CDC study that was released yesterday, which for frame of reference for our listeners, was September 19th, 2022. Um, found that more than 80% or four out of five deaths were due to preventable causes. So at a high level, that's where we are as a country, um, and in comparison to other countries. But I'd like to dive a little bit more deeper into what we're seeing. Um, earlier this summer, I had the opportunity to tape a podcast with Neil Shaw, um, who is the Chief Medical Officer at Maven Clinic, and a globally recognized expert and leader in maternal health. And in that discussion, he said that maternal health is a bellwether for the wellbeing of society. So if society is unwell, moms will be unwell, and if moms are unwell, society will be unwell. And he said, as a result of that, that you can see all of the injustices show up in maternal health. So, for example, we see racial inequities, right? So we know black American, Indian, and Alaska native women are three to four times more likely to die of pregnancy complications than white women. Um, suicide, which is the leading cause of death in the year following childbirth. Um, when you look at that, data shows that Asian women are nine times more likely to report thoughts of suicide, um, in the immediate postpartum period compared to white women. Um, we also see gender inequities. Um, studies have shown that female patients and people of color are more likely to have their symptoms dismissed by medical providers. Um, and given the experience of women like Serena Williams, there's far more discussion around medical, gas, lighting, and really a fear, right? So if Serena's care team didn't listen to her about her body, when she's a professional athlete who makes a living off of knowing her body, what hope is there for the rest of us? We also see geographic inequities. For example, rural residents had a 9% greater chance of experiencing severe maternal morbidity and mortality compared to those living in urban areas. And last, we see generational inequities. Moms today are 50% more likely to die in childbirth than their mothers. And as a society, that's not the direction we wanna be moving in. So all of this is to say, and I hope our listeners get the gist, um, that we aren't doing very well as a country when it comes to maternal health. Um, but that also means we have a tremendous opportunity, um, to work together to do better. And I know we'll be talking about that a little bit more today.

Speaker 2:

Priya, that was a lot of very, uh, sobering information that you've just shared with us. And now that we have been able to hear what's happening nationally, I'd like to ask Ashley, uh, how does what Prya has just shared with us compared to your experience in northeast Ohio?

Speaker 4:

Yes, thanks, Amina and Priya. Those were some great examples of the types of inequities that we have to focus on and address. Um, I'm gonna talk a little bit about women of color, but I'm also gonna focus specifically on black women just because of the work that I've done in this space. Um, so black women specifically are somewhere between two and a half to four times more likely than white women to die from pregnancy related conditions. Um, and so that means depending on where you are, your your likelihood of having increased risk goes up or down between two and a half to four times more likely than white women. Here in Ohio specifically. Um, the pregnancy related deaths occur about 33% of the time while they are actually pregnant. But the remaining 67% of those deaths occur within the one year postpartum period after delivery. Um, so that means that we're looking at maternal health, not just at the time of pregnancy, not just at the time of delivery, but for that one year postpartum period, which is also very important where we see a lot, the large majority of those deaths occur. Um, so nationally, the leading cause, um, for, um, these types of pregnancy related, um, deaths is a cardiovascular event, something that's preventable, something that you can see, something that you can catch that we typically don't for, or don't, um, catch it in time here. In Ohio, though, the number one cause of death during that one year postpartum period is actually mental health related. So mental health includes things like psychiatric conditions, but it also includes items like overdoses, depression, um, and, um, suicide. Priya was mentioning before. So here in Ohio, we do have a lot of women who during that one year postpartum period, they do have psychiatric conditions or mental health conditions that result in their death. Um, unfortunately, we've seen that during covid 19, those risks have increased. So, among women of color, um, we, they were two to four times more likely to have experienced Covid 19, which means that they were more likely to have a severe outcome as a result of complications from being exposed to the virus. So we have already a baseline that's higher than the national average. And then we also have the Covid 19 experience. Um, we don't have the final numbers on that because of where we are in the pandemic, Um, but I expect that the, um, the inequity and maternal and fetal outcomes are going to be higher once we look at those, uh, statistics retroactively. Um, in addition, we also have information, I'm gonna talk a little bit about the infant mortality rate. Um, so infant mortality rate means the number of children who die before their first birthday of every 1000 live births. So we're talking about the first year of life. Um, and here in Ohio, black babies make up about 38% in Cuyahoga County, which is a county where I live, where Cleveland is. But they make up 73% of the infant deaths. So even though they're a very small percentage of the amount, number of deaths per year, they make up the majority, I'm sorry, births per year. They make up the majority of deaths per year here in the county. Um, in 2018, which was the most recent year I could find the finalized statistics score. The infant mortality rate for white babies in Cuyahoga County was 3.76, but for black babies it was 15.49. So we're looking at a huge drastic difference based on race here in Ohio. Um, so it's also important to point out these statistics that are related to maternal mortality and infant mortality are regardless of the socioeconomic factor of the black mother and baby. So a black woman in Cuyahoga County is more likely to experience an infant mortality event at any socioeconomic level than a white woman with less than a high school education. So there's no mitigating factors when it comes to socioeconomic status for, um, the case here in Ohio and Cuyahoga County, specifically,

Speaker 2:

Andrea, we've had a chance to hear from Priya and Ashley and to get their perspectives about what's happening from a national level and also in northeast Ohio. I think it would be helpful for our listening audience to get a perspective from you about where we are in the state of maternal and child health.

Speaker 5:

Thanks, Aita. Um, the issues with maternal and infant mortality in the US have been of concern for a number of years. Even before the Covid 19 public health crisis in, uh, 2018 and 2019, they were on the national radar and a focus of attention, uh, by the national, uh, uh, Department of Health and Human Services, by the Congress, by National Trade and Policy influencing organization such as the American Hospital Association and the Joint Commission. Um, in December of 2018, President Trump signed the preventing Maternal Deaths Act to establish infrastructure to help states collect data and better understand deaths of expectant and new mothers. Um, and that legislation authorized 12 million per year for five years for states to create review committees to identify maternal deaths and in each state, and analyze the factors that contributed to those deaths, and then recommend policy changes around the same time. The Joint Commission, the organization that accredits US hospitals, uh, was preparing new elements of performance, performance standards, if you will, for perinatal care, uh, to be applied to hospitals that have joint commission accreditation. And those standards were designed to help improve quality and safety of care to women during pregnancy and postpartum. Uh, then of course, covid hit and it sent healthcare systems into upheaval. And the new Joint commission perinatal standards were delayed a little bit while hospitals dealt with the overwhelming and immediate needs of preparing for responding to the Covid 19 public health emergency. So in a lot of ways, uh, Covid was a setback to the efforts to address issues in maternal and child health in the United States. Uh, but at the time when we conceived the article for the journal in, in late 2020, it seemed that COVID may actually have a silver lining in the way it was raising awareness of the issues that are likely contributors to the issues with maternal and child health. And, and I'll say generally speaking, there is, um, some truth to that silver lining. I think it's, it, there is definitely some silver lining to it. Generally speaking, there is significant overlap in the factors that created disparities and alarm during the covid public health emergency, and the factors that are likely contributors to the relatively poor and disparate rates of morbid and mortality for pregnant women, new mothers and babies in the US and the Covid era focus on measures to address these factors really may be helping us to address the historical and continuing challenges with maternal and child health and outcomes, even though outcomes themselves or relatively poor during the covid years. As, as others speakers have mentioned, um, the Covid emergency, I think really shown a spotlight on social determinants of health and the areas of critical need in healthcare infrastructure and delivery, such as addressing gaps in access to care and ensuring and adequate and culturally competent workforce that's supported by appropriate payment and quality infrastructure. There were a lot of actions and discussions around covid and the results, which included expansion of funding and support for telemedicine and broader, uh, healthcare workforce initiatives, uh, as, as examples are likely to continue as we focus, um, uh, on these issues even after the covid emergency ends. So I think Covid was bad for outcomes in the short term, but we're seeing evidence that the issues that raise, um, and the attention on those issues may be of benefit to the cause of maternal health in the long run, uh, with the US and the world really focused on these issues. Uh, in December of 2021, the White House issued a call to action to improve maternal health outcomes across the United States. Um, and there was strong support for the provisions of the Mom Thebus act in the build back better act at the close of 2021. Although, uh, those didn't pass individual states of, of both colors, both sides of the aisle took up the cause of expanding access to care for pregnant, uh, women and, uh, postpartum women, uh, which are, uh, which is a significant concern, uh, by extending Medicaid coverage from 60 days to, to one year postpartum. In June of 2022, the, the Biden administration issued a blueprint for addressing the maternal health crisis. And shortly thereafter, the Centers for Medicare and Medicaid Services cms, which really sets the standards for hospitals as the major payer for hospital services. And as the agency that sets rules for the federal government's portion of Medicaid, uh, issued a maternity care action plan that included plans for a birthing friendly hospital designation, as well as five new CMS focus areas. Uh, those focus areas include coverage and access to care, including Medicaid coverage extension from 60 days to one year postpartum, uh, data collection regarding maternal outcomes and factors affecting them. So going back to that theme from, uh, uh, uh, 2018, quality of care, uh, workforce expansion and enhancement, including expanded care teams, um, and increasing social supports for moms, these are all positives that indicate positive momentum on the issue. I think, um, on the downside and, and maybe in the bad category, uh, the Supreme Court's decision in Dobbs raises some new questions about options for treatment of emergency conditions for pregnant women, uh, in certain states. And that uncertainty, those questions will take some effort and time to sort out and, and may disrupt some progress and outcomes. Uh, I think also on the downside, this summer's heat and certain related environmental, uh, issues were significant concern for pregnant women and may have disproportionately affected those who were already disadvantaged by, uh, social determinants of health. Um, but on the promising side of the equation, in August of 2022, telemedicine legislation passed the house to allow expanded access to telemedicine to continue beyond the end of the covid public health emergency. And that could mean expanded care and support options for pregnant women on a more permanent basis. Um, also there is a new rural emergency hospital designation that potentially offers, um, an opportunity to save some access points for birthing and pregnancy care in rural areas where the problems have been pretty significant over the years. Um, also, I think as of this recording date, 14 or 15 states have extended guaranteed Medicaid coverage up to one year postpartum. And that can be, I think, uh, a help for ensuring continuity of care for women who rely on Medicaid. So I think they're still good, they're still bad, and they're still promising on the horizon. Um, and generally speaking, increased awareness and action after Covid is certainly in the category of Good.

Speaker 2:

Thank you, Andrea, uh, for giving us that a kind of detailed background about what's been happening in, uh, the US regarding maternal and child health. And now I think it would be helpful, uh, so that we could have Prya and Marky share with us and with the listeners, what are some of the challenges or causes impacting the state of maternal and child health in this country that you think should be shared with our listening audience. And if you would, Marky, could you please go first?

Speaker 6:

Yeah, absolutely. Thanks so much, eda. So, although the causes of maternal mortality vary in clinical terms, so whether it's mental health, cardiovascular disease, hypertension, or pulmonary embolism, by and large, many women die because they do not receive early effective or aggressive lifesaving treatment. So, as Prya mentioned, most maternal deaths in the US are preventable and are preceded by clinical warning signs that if caught in a timely manner can be treated. But many studies have shown that unintentional discrimination or implicit bias leads healthcare providers to dismiss women of color, delay care for women of color, and to deny treatment. Uh, women of color report that their own narratives about their symptoms are discounted disbelieved or simply ignored by their providers. And they're basically told, You're fine, despite their clinical warning sides signs or their statements of debilitating pain. And so it's this tendency to dismiss, delay and deny care to women of color that really leads to such disparate outcomes. And this is actually quite difficult for physicians to accept. So most physicians believe themselves to be egalitarian, and they sort of believed that they're ob objectivity and rationality in medical decision making, insulate them from biases. But study after study shows that this is not the case. And in fact, studies show that our subconscious biases play more of a role in our decision making than our explicitly held beliefs. And so with physicians, those biases will play a role in their treatment decisions. So whether that decision is to withhold complex information from a patient or deferring expensive treatments, or deciding not to refer a patient to a specialist or to choose a conservative course of treatment, instead, all of these decisions can harm women's health. And so the challenges, how do we deal with implicit bias? Um, and, and the good news is that implicit biases are actually malleable. They are not impossible to control, and there are evidence based methods and trainings that can reduce implicit bias. But the problem is that it, it really can't just be a requirement to attend one implicit bias seminar a year. These types of trainings need to happen regularly, and all people who interface with patients basically need to take these trainings. Um, so studies show that women of color are denied care at many points in the healthcare system. It may not be a physician, it may be a nurse, it may even be a front office receptionist. Um, and likewise, it may not be at a hospital that they're denied care. It might be in a primary care provider's office or an urgent care setting. So it's critical that everyone in all types of healthcare organizations receive this sort of ongoing implicit bias training. And, and last I'll just mention that another way to deal with implicit bias is to really just get around it by implementing objective treatment standards that sort of eliminate the role that implicit bias makes in treatment decisions. So the American College of Obstetrics and Gynecology, uh, ACOG has established what they call safety bundles, which mandate a series of treatment decisions when a patient objectively presents with specific clinical symptoms. So if the safety bundle says that you must order a CAT scan when a patient's, you know, blood pressure is at a certain point, that eliminates the subjective decision making of the provider. So by adopting sort of objective standards of care based on clinical warning signs, we can actually bypass the provider's implicit biases. So I sort of see it as two ways of dealing with it, you know, tackling the implicit bias head on, and then also navigating around it.

Speaker 2:

That's very interesting information. Marky Bria, I like to hear your perspective, and I believe you might be able to add something to the conversation as it relates to the impact of the digital world on healthcare treatment for women and children.

Speaker 3:

Yeah, absolutely. So I, I think I'll start with that CDC study I mentioned earlier, um, because it is sort of the most recent research we have, um, on maternal health. And they identified a couple of challenges that are standing in our way of improving mental maternal health in our country. Um, like Marky just covered, they highlighted the need for tailored strategies to fight persistent racism and racial disparities. Um, and so that includes the training, um, on implicit bias that Marky mentioned, and having that on a continual basis, um, happening regularly, having employees participate in that. Um, but we also need to go beyond training, right? To examine the disparities that come out of our learnings of working with patients and looking at data, um, and then taking action to eliminate them. So the implicit bias training is a really good first start, but then we need to go beyond that, um, to actually make change. Um, the CDC study also found that we have a lack of rigorous postpartum care and mental health resources for moms and families in our country, um, and they cited a long delay in diagnosis of postpartum conditions. So all of those are playing into where we are, um, in maternal health as a country. Um, other research has cited other causes, including, you know, the fact that women are having babies later in life. Um, we have a higher prevalence of c-sections in our country. Um, in some places we have a lack of standardized practices or poor coordination of care. Um, and in rural communities, as I mentioned earlier, we lack specialists and other maternal care providers. Um, so the definitely a lot of causes, um, and I think between Marky and myself, we've covered a lot of them, um, on this podcast. Um, and I'll meet a, you highlighted, um, sort of the digital challenges. And I think what we saw during the pandemic was a number of clinicians and healthcare providers, um, creating digital opportunities to connect with women and to provide them education throughout the pregnancy period, and to sort of reach out to them and manage their life conditions once a mother went home right in the postpartum period. Um, and that was all really strong work. But what our, what hospitals and health systems quickly found is that there were a lot of individuals who couldn't necessarily take advantage of those digital solutions because they lacked access to broadband, They lacked access to smartphones and other, or iPads, um, or they simply just didn't understand the digital solutions and how to use them. And so there are dif a number of different ways, and I actually, um, wrote an article in the same issue that Andrea's article on maternal health appeared, um, with Sarah Swank about the challenges around digital health equity, and really cited to a lot of good examples of how hospitals were tackling this in the maternal health space.

Speaker 2:

Oh, thank you for that. Uh, Priya and Mark of the, again, listening to the information that all of our panelists have been sharing with us today, uh, really gives insight in a way that's, I think, for many people just unexpected to imagine that in our country, that we have these deficits in the delivery of care to women and children. Um, as we are winding down in our discussion today, uh, while we don't have time for a deep dive, we would be remiss not to acknowledge the potential impact of the US Supreme Court's 2022 DOS decision, uh, overturning Roe versus Wade. And I asked Mark to share briefly how the Dobbs decision affects the conversation we're having today, Marky.

Speaker 6:

Yeah. So, well, as a result of Dobbs, there's no denying that women who would have terminated a pregnancy are now going to be forced to give birth in our maternal healthcare system. And childbirth in the US carries substantially greater mortality risk than does a legal abortion. So this will translate to more maternal deaths, unfortunately. Um, a recent study examined the likely effects on maternal mortality if all 50 states banned abortion. And that study found that we would see a 21% increase in all maternal deaths if all abortions were denied, and that black women specifically would experience a 33% increase in maternal deaths. And so, while we don't have all 50 states spanning abortion, we do have 24 states that have banned or are likely to be on abortion. And the quandary is that those 24 states tend to have poorer maternal mortality rates than the states that are allowing abortions. So 16 states total have refused to expand Medicaid to cover women for a full year of birth, uh, or a full year after birth instead of just two months, which is really unconscionable, given that most maternal deaths occur in the one year after birth. But all but three of those 16 states have banned abortion. So what we're seeing is that those states that are banning abortion have the highest rates of maternal mortality and have the poorest social safety nets. And so if states are deciding that they're going to force women into childbirth, it's all the more critical that those states do more to address the maternal health crisis.

Speaker 2:

Well, thank you, uh, for, for those insights. And now I, I think what I would like to do is to ask each panelist to participate in what I might think of as a lightning round and, uh, call the action to provide our listeners, especially our colleagues who are healthcare lawyers and healthcare leaders with a call to action about what they can do now, now that they've heard today's discussion. And so I would like to start, uh, with Marky and then Priya, Ashley, and then Andrea, give you the opportunity to round up the discussion. Marky. Uh,

Speaker 6:

Yeah. So, so what I would say is, if you're listening to this and you are an attorney for a hospital, find out if your hospital participates in the Alliance for Innovation on Maternal health. That is the organization that implements a cogs safety bundles, which are those objective treatment protocols that attempt to take away implicit bias, um, and subjective judgment when sort of these objective clinical warning signs are present. And if your hospital doesn't participate, urge your hospitals executives and boards, uh, to participate. And, and if you have to emphasize the liability concerns here, providing substandard care to any woman is a liability. And so if, if that's sort of a, the thing that you need to lean on to convince those executives and board members, you should absolutely

Speaker 2:

Do so. Thank you, Marky Pria.

Speaker 3:

So, when we were, um, prepping for this podcast, I plan to talk about how we need to listen to women, um, women know their bodies better than anyone, um, and can often tell when something doesn't feel right. So care teams and each of us as individuals, um, can play a role in listening to women and then responding accordingly by seeking or providing help. Um, but I spent the earlier part of this week in Washington, dc um, for Mom Congress, uh, where I was joined by hundreds of moms and non moms in advocating for, um, policy change. And it became so clear to me that the bigger problem we have is that our society doesn't value motherhood. Um, so in America, when a mother has a baby, we turn our attention to the baby in away from the mother. Um, and we don't even have a first clinical check in with the mother until six weeks after delivery. Um, we're also the only industrialized nation without federal aid to care for women after delivery or to care for their children as they move forward. Um, and there's so many people in our country who are struggling to find and afford childcare. Um, and then there's also a huge cost of motherhood, um, in the workplace. So my call to action is still to listen to women, um, but also to advocate for the valuation of motherhood in our society. Um, and that includes policies, um, not just from the government, but in workplaces, um, that ensure that we're taking care of and supporting mothers, um, because I really believe that it's only when we begin to value motherhood that we'll be able to take the steps we need to improve maternal health.

Speaker 2:

Thank you, Pria. Ashley?

Speaker 4:

Um, yes. I think if I have a call to action for everyone, it would be to get involved on a local level in efforts to reduce disparities and maternal and infant outcomes. Um, so I sit on the board of directors for Pregnant with Possibilities resource Center. It's a small nonprofit here in Ohio, and they are dedicated to providing, um, prenatal, perinatal, and postpartum support from others and educational courses and necessary essentials, um, for people who need them, such as formula, diapers, wipes. If you can't actively participate on one of those, um, organizations on, as a board member or as a volunteer, uh, donating to those efforts, sharing their posts on, so social media, spreading the word about their activities, or, uh, participating in fundraisers are a great way to get pretty big impact very quickly and stay very close to the, to the, um, root cause at, at the local level.

Speaker 2:

Uh, thank you for that, Ashley. And now I wanna turn to Andrea and give you the opportunity to have your the last say in terms of a call to action.

Speaker 7:

Sure. So, I would say if, um, your council for hospitals or healthcare providers, um, that, um, your role may be to help raise awareness of the issues and the solutions. Um, uh, I think with the cms, um, care action plan, we have a lot of opportunities, um, including the, the birthing friendly hospital designation and striving for, um, uh, meeting those criteria. Um, there's a lot of legislation pending, currently raising awareness of, of what that legislation says, um, and what opportunities it provides to us to help, um, advance the cause and, uh, advance awareness and find solutions.

Speaker 2:

Great. Thank you, Andrea. I just wanted to say to each of you and to our, uh, listeners today that this has been a very informative, uh, conversation for me. I've learned a lot you, each of the panelists that you've provided us with both, uh, stimulating, uh, thoughts about what we can do, provided us with information about what the, the really serious challenges are in terms of the delivery of maternal and child, uh, care in this country. And, um, I I also wanna say that I appreciate the fact that in your calls to action, I think these specific calls to action give us some hope that we can see improvements as well. So I wanna thank each of you. I wanna, again, encourage all of our listeners to go to the Hola website, access the special issue, read all of the articles as including the one that was written, that is the source of today's discussion. And I look forward to hearing, uh, more from each of, uh, each of you as you continue your work in this important area. And thank you for participating today.

Speaker 1:

Thank you for listening. If you enjoyed this episode, be sure to subscribe to ALA Speaking of Health Law, wherever you get your podcasts. To learn more about ALA and the educational resources available to the health law community, visit American health law.org.