Survey Points to Digital Tools as a Way to Increase Equity in Maternal Health Care

Race-based inequities in health care are, unfortunately, not news. Study after study demonstrates imbalances in quality of and access to care that leave non-white patients at a disadvantage.

This is particularly true in the world of maternal health care in America. While a recent study from the American Journal of Obstetrics and Gynecology (ACOG) has contested the long-standing claim that the U.S. has an astronomically high maternal mortality rate as compared to other developed countries, some researchers maintain that pregnancy-related deaths are more common among non-white women. According to research from the nonprofit organization KFF, institutionalized racism and access to health insurance coverage for pregnant women as well as access to care are contributing factors to the problem.

A new study by Deloitte Center for Health Solutions offers a potential solution — or at least a remedy: digital health care tools, which, the researchers and survey respondents propose, could democratize access, increase the efficacy of medical communications, and even potentially reduce out-of-pocket patient costs.

Such tools are already being used by pregnant patients in and out of medical care settings across the United States. However, the study suggests improvements that could increase the ease of use and cultural relevance of such tools specifically for the marginalized groups who most stand to benefit from them. Among these improvements, researchers point out cultural tailoring, reduced costs, and improved integration across various platforms as some of the most important next steps.

Digital tools could make a more equitable American health care system

In July and August 2023, Deloitte Center for Health Solutions ran a survey of 2,000 people between the ages of 18 and 54 who’d experienced pregnancy within the last two years. Data was weighted so that factors including geographical area, income and education levels were representative for the average American within the 18-54 female demographic. Black and Hispanic respondents, as well as those with a lower income level ($50,000 or less), were oversampled.

Within this group, the study found that many pregnant patients are already using digitally enabled tools as part of their medical care. Online patient portals and mobile health apps were the most commonly used modalities — 63% and 62% of respondents used them, respectively — and the most common function of such tools was to schedule appointments (49%) and communicate with health care practitioners (36%).

However, the use of such tools could be significantly expanded, the study suggests. Other modalities that might increase pregnant patient access — or empower them with more information to bring to their health care providers — include wearable devices, telemedicine sessions, text-messaging platforms, remote patient monitoring devices and more.

And the tools can do more than increase access and facilitate better conversation between care teams and patients, respondents said. Fully 40% of those surveyed said they believe digital tools could reduce out-of-pocket patient costs, while smaller proportions say they could help ensure the correct care services are rendered, reduce delays in care, increase care safety and increase the ways in which patients’ preferences and cultural backgrounds are respected.

However, in order to meet these goals, the researchers suggest that improvements need to be made — specifically with cultural diversity in mind.

Improvements to increase uptake, lower friction and create inclusion

"In our survey, Black (30%), mixed-race (24%), and Hispanic (23%) respondents were nearly twice as likely as White (13%) respondents to say that digital tools for maternal health need to be more culturally informed," the study reads. Such changes might include increasing the number of languages in which information is provided or taking racial differences into account when describing or demonstrating conditions, symptoms and risk factors.

While, fortunately, between 63% and 73% of survey respondents said that they often or always felt listened to, believed and treated fairly by their care teams, Black or African-American patients were more likely to have negative experiences in these areas during their pregnancies — and to say that the digital tools they were using didn’t adequately meet their needs.

Respondents also pointed to the need to reduce the cost of such tools and platforms and to improve their ability to seamlessly integrate with each other.

While improving digital tools is highly unlikely to solve the problem of racial inequity in America’s health care system — where the uninsured rate is far greater for non-whites than their white counterparts (according to KFF data) and the high cost of health care leaves those with generationally lower socioeconomic statuses at an automatic disadvantage — it’s a start. This study lays out a solid roadmap toward achieving that goal.