There is little doubt that the biggest event in women’s health in 2022 was the Dobbs decision from the Supreme Court. In June 2022, that decision overturned Roe v. Wade and threw the reproductive rights landscape into disarray. The state-by-state fight for choice will continue through 2023 and into the 2024 election season. As that battle continues, we also should be aware that there are other important women’s health issues and trends that will need and get our attention in 2023.
Equity & Women’s Health
During Black Maternal Health Week in April 2022, the CDC posted updated pregnancy-related information that described the state of maternal mortality in the United States and the existing disparities. Approximately 700 women die every year during pregnancy or within the year after giving birth, with over 60% of those being preventable. Black women are three times more likely to die from a pregnancy-related cause than White women.
Additionally, an increase in hypertensive disorders in pregnancy has been documented, with at least 1 in 7 deliveries being impacted by this condition. There are racial and ethnic disparities within this disease category as well, impacting 1 in 5 Black and 1 in 6 American Indian and Alaska Native delivering women. Factors that may contribute to these disparities include differences in access to and quality of healthcare, racial bias, and even psychosocial stress from experiencing racism.
Many health care systems will be specifically addressing these disparities in their communities and customizing interventions to meet the local need. These interventions could include training on unconscious bias, the identification of social factors or social determinants that impact health, and standardizing care across a system or community.
Some are investing in Community Health Workers (CHWs) to address the social determinants of poor health that impact low-income, minority populations, and immigrant populations. CHWs are trusted members of their local communities who share lived experiences and can help facilitate access to health care and provide health care information in ways that are culturally and linguistically appropriate. Multilingual and bilingual CHW teams at New York-Presbyterian Hospital and NYU Grossman School of Medicine have delivered tailored health coaching over the last 15 years. These same teams were proactively utilized during the pandemic and helped to identify and address root causes of disparities during the pandemic, according to a November 2020 article in The New England Journal of Medicine. In February 2021, the Chief Medical Officer for the Association of State and Territorial Health Officials (ASTHO), Marcus Plescia, MD, MPH, noted in an article, titled “Community Health Workers and the Heart of Public Health,” that the experience and lessons of the pandemic could change the way we practice public health, including the expansion of the role of CHWs in the workforce. This focus on health disparities aligns with the Joint Commission’s new health equity standards released at the end of 2022.
The Fourth Trimester
Experts in the field also are encouraging those who care for birthing pairs to be more intentional about the attention placed on the Fourth Trimester, which is the post-partum period. Since 2018, the American College of Obstetricians and Gynecologists has recommended that the clinicians proactively manage this critical time. Attention to the Fourth Trimester has increased because of the ongoing publicity and research related to disparate pregnancy outcomes that has emerged over the last few years.
In 2023, a strategy to improve outcomes during the Fourth Trimester, may include customization of needs for the birthing pair which includes identification of and attention to the social determinants of health that impact outcomes of the birthing pair, such as childcare access, healthcare access, mental health support, transportation needs, and financial challenges. There will also be a focus on women who live in healthcare deserts, particularly in rural locations: home visiting programs, social service networks, and navigation resources will be implemented to increase access to care and decrease poor outcomes for both mother and newborn. Federal funds from the American Rescue Plan Act (ARPA) grants are being used to support community-based programs that focus on improving maternal health equity and the reduction of disparities.
Post-Pandemic Landscape
Unfortunately, the pandemic will continue to impact women’s health in 2023, especially for pregnant women. It is important for women considering pregnancy, or who are currently pregnant to stay up to date with their COVID-19 vaccinations. Outcomes for unvaccinated pregnant women with COVID-19 are worse than the outcomes for vaccinated pregnant women across the board, which includes an increase in poor fetal and newborn outcomes.
Education and community outreach programs will focus on how to provide women’s’ health services and education in a culturally and linguistically acceptable way, recognizing that different people and groups have diverse and unique needs, and that public health programs must adapt to meet those needs to have a positive impact. Health literacy, and how to communicate public health information effectively, is improving and will need continue to be a focus in 2023.
Technology
Telemedicine and remote monitoring technology exploded during the pandemic out of necessity but will persist and even expand in 2023 to increase access to care, especially in remote areas where limited transportation options continue to be a barrier for poor or underserved populations. This expansion includes remote blood pressure, cardiac and glucose monitoring. Telehealth will be a key component of any collaborative mental health resource strategy, especially in rural communities. In addition, the prolific mobile application industry will continue to create phone friendly ways for information for women to be easily available, addressing topics like menses, pregnancy, breastfeeding, fertility, birth control, pelvic floor health and exercise.
There have been recent advances in the utilization of artificial intelligence (AI) in cancer diagnostics. Radiologists are using AI with the intent to improve the accuracy of breast cancer diagnoses by mammography, but it is unclear how AI may be of most benefit in the spectrum of women’s health services.
All these trends, which are centered on the needs of the individual and removing barriers to care will improve health care and outcomes for women through the next year and positively impact the lives of their families. As we work to eliminate health disparities, 2023 will prove to be an interesting year in women’s health.
Dr. Rachel Mandel is board certified in obstetrics and gynecology, and she is a Senior Advisor for Practice Transformation at Renaye James Healthcare Advisors.