How telehealth can narrow racial disparities

Marisa Fernandez
·3 min read

Data: CDC; Chart: Danielle Alberti/Axios

Racial disparities have been a constant problem in maternal health care, from rising death rates to the threat of severe COVID-19 among pregnant women. But now experts are hopeful that telehealth can help narrow those disparities.

Why it matters: It's not a complete solution to the racial barriers women of color face. But some experts are optimistic that telehealth — long-distance health care through videoconferences and other technology — can help reduce those barriers by offering flexibility in appointments and better access to diverse providers.

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  • "It is quite remarkable to me how much of a silver lining this has turned out to be for women of color in this space," Ian Hill, senior fellow at the Urban Institute, said of telehealth. "There’s a lot more focus on this issue than there was before, which is great."

The big picture: From sweeping state laws that limit access to reproductive care, to dismissiveness and lack of compassion from their health care providers, the concerns of women of color are often ignored.

  • In several interviews, pregnant women of color in Fresno, Oakland and San Francisco reported disrespectful treatment from their health care providers — including racism and discrimination — as well as stressful interactions with health care staff and a lack of information, a study shows.

  • Another study found that women of color reported higher rates of mistreatment by health care providers — like being shouted at or scolded — and that providers were more likely to ignore their pain and anxiety.

By the numbers: The U.S. had the highest maternal death rate among 11 developed countries in a recent study by the Commonwealth Fund, and it is one of the only countries where the rate is rising significantly.

  • In 2019, the maternal death rate for Black women was about 2.5 times the rate of white women and 3.5 times higher than Hispanic women, according to the Centers for Disease Control and Prevention’s most recent data.

What's happening: All 50 states have temporarily or permanently expanded telehealth coverage for Medicaid patients — texting, in-app messaging and video calls — since the pandemic started.

  • More than 65% of both Black women and Indigenous women and 60% of Hispanic women were covered by Medicaid when they gave birth in 2018.

  • Data shows pregnant women are at higher risk of developing severe COVID-19. The risk of exposure is five times greater among Black and Hispanic pregnant women.

The Urban Institute published a brief in October that outlined examples of how states, private insurers and other organizations have tried to address virtual maternal care during the pandemic, especially for women of color.

  • Alternative providers such as doulas and midwives, who have been shown to be more empathetic and improve health outcomes for pregnant women of color, are now covered virtually, researcher Emmy Burroughs tells Axios.

What's next: There is interest in seeing how "telehealth and technology platforms overall in this space can be used to address power dynamics" in maternal care, said Kimberly Seals Allers, founder of Irth, a Yelp-like ratings app that launched this year to help Black and brown women rate their care.

  • "Hospitals wait until someone dies, they have a maternal mortality review board and then they try to fix this from the grave," Seals Allers said. "We’re trying to do something different."

Yes, but: Several experts say expansion of virtual care won't solve every issue in Black and brown mothers' encounters with racist treatment from health care providers.

  • Language barriers, access to birth control and mistrust of technology are still hindrances that prevent some pregnant women from using these services.

Join Axios' Mike Allen and Hope King on Tuesday at 12:30 p.m. ET for a Hard Truths event on systemic racism in health care, featuring White House senior adviser Andy Slavitt, White House senior policy adviser Cameron Webb and California Surgeon General Nadine Burke Harris.

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