In Washtenaw County, an expectant mother faces a dilemma that is all too common. With no car or public transit routes in her neighborhood that align with her prenatal appointment times and work schedule, she’s at risk of missing critical healthcare visits, placing her and her baby’s lives at risk.
Now, imagine a program that offers her not just a ride, but a lifeline. This is where Feonix – Mobility Rising and University of Michigan – Community Health Services comes in, transforming tragic statistics into stories of hope and lives saved. With their support, she and over a hundred other mothers every year could find rides to essential medical care, increasing their chances of a healthy pregnancy.
Introduction
Healthcare in the United States faces a grim paradox. The U.S. is the global leader in science and technology, ranking first in new medical innovations and leading by a wide margin for Nobel prizes in medicine. Yet, the U.S. is also the worst-performing developed nation for maternal mortality, ranking 64th in the world behind Lebanon, Latvia and Egypt. African American mothers in the US face a mortality rate twice that of white, non-Hispanic women. The harrowing statistics do not stop there though – because a mother’s health is inextricably linked to her child, an infant born to a black mother is twice as likely to die before reaching their first birthday.
It is both profoundly distressing and yet a sign of hope that, according to the CDC, 80% of maternal deaths are entirely preventable.
So, what can be done? While one can marvel at the high level of innovation in science and medicine in this country, simple solutions using existing technology and infrastructure can have the most impact.
Working with The University of Michigan, UM Community Health Services, various policymakers and providers, Feonix is on a mission to eliminate social, economic, and racial disparities that impact maternal and infant health, one ride at a time.
Rebecca Yaciuk, local Feonix Community Development Manager, shares “We always work to address needs of each community, and Washtenaw County is no different. I am excited to not only address a large health need, but a specific community issue highlighted from our two main healthcare systems in Washtenaw and our local residents through their Community Health Need Assessment. Knowing that this will support mothers and children means the world to me.”
In this article, we’ll explore how Feonix is addressing the critical link between perinatal health and transportation and why improved access will change the narrative for at-risk mothers and their babies. We call on leaders, elected officials, and policymakers to read on and become champions for a future where no mother or child is left behind and to drive the wheels of change that set a new standard for maternal care and save lives.
Steering Toward Health Equity with Transportation
Maternal mortality isn’t a new problem. In fact, it has been on the rise since the year 2000 but figures have surged in recent years, with COVID-19 exacerbating existing problems, cutting through social safety nets, straining health systems and ultimately limiting women’s access to health care. In 2021, maternal deaths rose by a staggering 40% compared to a year prior.
The socioeconomic challenges created in the wake of the pandemic have left many reeling, with black and Latino communities disproportionately affected. Access to safe, reliable, and affordable transportation, a factor which underpins many other determinants of health and well-being, was compromised. Sadly, those who have been left most in need of transportation cannot afford to pay and do not have the social networks to help them overcome this obstacle.
This is particularly worrying for expecting mothers with lower incomes because multiple appointments are needed during pregnancy. Even a low-risk pregnancy requires around 21 medical trips during the antenatal period, while high-risk pregnancies require an average of 32, equating to 2-4 trips per month.
Amidst these challenges, one critical factor emerges as both a barrier and an opportunity: transportation. But how does this affect perinatal care? Let’s delve into the importance of reliable access.
Why Access to Perinatal Care is Critical
A mother and her child are often inseparable, and this includes their health. It has long been recognized that maternal care is a key determinant of infant health. So, when a woman has access to maternal care, this positively impacts the well-being of her child. There is a constellation of services that span screening, testing, treatment, and education that mothers need to thrive in pregnancy.
Local healthcare agency Packard Health provided prenatal care to over 100 women in 2023, many of them with complex medical and social needs. “Reliable transportation is critical to ensuring our vulnerable moms and babies receive the screening, testing, and treatment they need and deserve” says Rebecca Fleming, MPH, BSN, RN, and Director of Community Health Initiatives.
A vital cornerstone of prenatal care is the screening programs that identify complications well in advance and allow for early treatment. When a mother can’t access these, she’ll miss out on crucial services that can spot risks before they affect her or her infant. These include screening for problems such as high blood pressure, heart problems, low birth weight, and congenital abnormalities, complications responsible for the majority of maternal and infant deaths.
Other important prenatal screens include scans that can evaluate the risk of preterm birth, a major driver of infant mortality which is 1.5 times more prevalent in American Indian and Alaska Native mothers and twice as common in African American mothers compared to non-Hispanic white mothers, according to statistics from the CDC.
Education is another cornerstone of perinatal care, empowering mothers with knowledge crucial for navigating pregnancy and motherhood. Through education programs, mothers gain insights into complications such as preterm birth. Breastfeeding classes offer guidance on nurturing the newborn and family planning sessions provide strategies for future pregnancy prevention and timing, crucial for ensuring mother and child are ready for the journey ahead. The latter is particularly critical, not just as a means of controlling family size but as a proactive measure to mitigate the risks associated with unplanned pregnancies. Mothers with unplanned pregnancies are more likely to postpone or forgo prenatal care, increasing the danger of adverse outcomes. Beyond providing mothers with knowledge, education paves the way for healthier families and stronger communities.
However, aside from physical health, perinatal care has another important dimension that makes it vital for mothers in underserved communities.
Perinatal Care Goes Beyond Physical Health
Adequate perinatal care can also nurture a state of mental well-being. Challenging life circumstances inherent in marginalized and underserved communities compound the emotional and mental health toll that pregnancy can have, increasing the risk of complications that make access to care vital.
Experiencing long-term adversity during pregnancy leads to toxic stress, raising the risk of conditions associated with higher rates of maternal and infant mortality. These conditions include hypertension, blood clots and other cardiovascular diseases that are the leading cause of pregnancy-related deaths.
For Feonix, the goal is twofold: to increase the percentage of mothers getting adequate prenatal care and to boost positive health outcomes for mothers seeking perinatal care. These positive health outcomes include surrounding health factors for the mother, including anxiety, perceived stress and pregnancy-specific stress.
Understanding the vital role of perinatal care sets the stage for confronting the barriers that prevent it.
Overcoming Transportation Barriers
Transportation is a complex service integral to healthcare delivery. However, healthcare agencies and other organizations frequently face constraints of limited resources and time when it comes to finding solutions, resulting in obstacles for patients.
While social support exists for housing, food and employment insecurity, childcare, and medical needs, no program provides a “safety net” for transportation insecurity. Recognizing transportation as a key Social Determinant of Health, Feonix has partnered with the University of Michigan to transport mothers in Washtenaw County to perinatal care throughout their pregnancy and for up to 18 months after birth. Initially, the program will provide support to approximately 130 mothers each year.
The current transportation landscape is disjointed, with fragmented resources, policies, and programs, it often fails to serve those who need it the most. While existing Non-Emergency Medical Transportation (NEMT) services are available, they are hampered by complex and inflexible systems ill-equipped to handle last-minute appointments, leading to late arrivals or missed appointments that negatively affect patients and the healthcare system.
Feonix – Mobility Rising has launched a program to address the ongoing need for seamless transportation solutions for perinatal care. The program offers women rides to medical appointments and connects them with social service organizations that support holistic perinatal care. These organizations aid with finding baby items, healthy food, classes, contraception, and employment, among other services. Above all, the program is designed to respect the urgency and unpredictability of perinatal care needs.
Having laid out the transportation hurdles, it’s clear that a collaborative effort is necessary to turn the tide. This is where strategic partnerships come into play.
A United Front for Maternal Health
In the heart of Michigan, lies a champion for maternal and child health – Michigan Medicine, one of the state’s premier hospitals and academic centers has been a rich source of groundbreaking medical and technological advancements since 1850.
In partnership with Feonix, Michigan Medicine continues its mission to innovate and improve the world and advance healthcare. Together, the shared objective is to ensure that the narrative on maternal health can be changed locally and eventually throughout the United States.
Feonix has partnered with two of the brightest minds from the University of Michigan to gauge the program’s impact in real time. Dr. Lu Wang, from the School of Public Health, a Professor in Biostatistics with a doctorate from Harvard, has dedicated her work to the statistical analysis of healthcare interventions and programs. In addition, Dr. Tayo Fabusuyi, from the Transportation Research Institute, will be working on the program. Dr. Fabusuyi is a former economist at the African Development Bank whose work focuses on initiatives that support sustainable and resilient communities through efficiency and equity.
Drs. Wang and Fabusuyi will be delving deep, examining the metrics of cost efficiency, emergency room alleviation, and the simple yet profound success of getting mothers to vital appointments. Simultaneously, a dedicated sustainability task force will be charting a course for success and scalability.
“We are thrilled to be continuing our work with Feonix at the nexus of transportation and health by examining how providing transportation to prenatal care influences the health outcomes of pregnant women in Washtenaw County” shares Dr. Fabusuyi.
Dr. Wang invites others to consider that “[it] is critical to increase patients’ mobility for easier access to healthcare resources, especially among those who are in need of reliable transportation access for perinatal care. How to expand the concept of dynamic and individualized decision making to optimize the transportation resources in order to achieve personalized healthcare and improved urban health equity is what we are striving for, in partnership with Feonix – Mobility Rising”
In addition, the Washtenaw County Mobility Leadership Council, consisting of individuals in the transportation industry, those impacted by transportation, and mobility advocates, will serve as a crucial local connection for successful and sustainable change.
But the real heart of the program is the mothers who will be impacted by the program, their stories, experiences and their health and well-being.
As these partnerships forge a new path forward, it’s time to reflect on the broader implications of this initiative. The journey is not just about improving individual outcomes, but about driving systemic change.
Driving Change for Maternal Well-being
Feonix – Mobility Rising is steering a course towards a future where transportation no longer impedes maternal and infant health. Through their efforts, the aim is to build roads and bridge the gaps in our healthcare system, ensuring that mothers, regardless of race or economic status, receive the care they need. This is more than a service; it’s a commitment to life, to equity, and to the health of our communities.