Focus on Maternal Health

Maternal Health Crisis

The United States is the only developed country(leaves FCC.gov, opens PDF file in new browser window) with increasing maternal mortality and severe maternal morbidity rates. Research suggests that many of these deaths and complications can be prevented.(leaves FCC.gov, opens new browser window) Furthermore, this nationwide crisis impacts Non-Hispanic Black and Native American pregnant women at almost two to three times the rate of Non-Hispanic white pregnant women, and pregnant women living in rural areas without access to appropriate healthcare providers are 60% more likely to die(leaves FCC.gov, opens new browser window) than women living in non-rural areas. As Federal Communications Commission (FCC) Chairwoman Jessica Rosenworcel has noted(leaves FCC.gov, opens new browser window), “It is heartbreaking to see how difficult it is to welcome new additions to families in rural areas without the support needed for a healthy pregnancy. But solutions to this crisis exist and technology can help.”

In addition to the increasing maternal deaths and significant and widening disparities in maternal health outcomes:

• The U.S. is facing the increasing prevalence of chronic diseases, worsening mental health, and substance use disorders among reproductive age and pregnant women. For example, the number of women with opioid-related diagnoses at delivery increased by 131% between 2010 and 2017.(leaves FCC.gov, opens new browser window) Chronic diseases, mental health issues, and substance use have been associated with poor maternal health outcomes.
• Women have also started having children later in life, with the mean age of mothers at first birth reaching a record high, at 27.1 years.(opens PDF file in new browser window) These pregnant women may also have chronic diseases and other health issues that put them at greater risk of poor maternal health outcomes.
• Access to maternal health care remains a significant challenge, especially for women in rural areas and from lower income households. According to the March of Dimes(leaves FCC.gov, opens PDF file in new browser window), more than 2.2 million women of childbearing age live in maternity care deserts—where there are no hospitals or birth centers offering obstetric care and no obstetric providers—and an additional 4.7 million women live in counties with limited access to maternity care.
• Recent data show that over 80% of maternal deaths could be prevented.(leaves FCC.gov, opens PDF file in new browser window) Telehealth and other broadband-enabled solutions and technologies can be a part of the toolkit for improving maternal health and addressing preventable deaths. Prior work by the Connect2HealthFCC Task Force has also shown that populations living in counties that have higher broadband connectivity tend to have better health,(leaves FCC.gov, opens PDF file in new browser window) strongly suggesting that access to and adoption of broadband itself may be related to improvements in health and health outcomes.

Data Mapping to Save Moms' Lives Act

To address these tragic maternal health outcomes, the FCC is playing an increasingly greater role in advancing connected health and improving health care access through telehealth in the United States. In December 2022, President Biden signed the Data Mapping to Save Moms’ Lives Act (Public Law No: 117-247(leaves FCC.gov, opens new browser window)), which directs the FCC to incorporate publicly available data on maternal mortality and severe maternal morbidity into the agency’s Mapping Broadband Health in America platform, in consultation with the Centers for Disease Control and Prevention (CDC). Congress aimed to “increase the quality of maternal care and reduce the prevalence of poor maternal health outcomes”(leaves FCC.gov, opens PDF file in new browser window) by generating maps that provide insight on the intersection of broadband and maternal health “where maternal mortality rates are especially high and . . . where critical telehealth resources need to be deployed.”

As of June 18, 2023, the Mapping Broadband Health in America platform allows users to view the intersection of broadband connectivity and maternal health outcomes. Specifically, users can:

• Ask questions like, what is the status of Internet connectivity in areas where maternal mortality or severe maternal mortality is highest?
• Generate actionable insights for policies and programs about how broadband connectivity can be leveraged to improve maternal health outcomes and identify health disparities.
• Display selected data on broadband connectivity (e.g., access, Internet adoption, and download/upload speed) and maternal health outcomes with key variables to generate customized maps at the national, state, and county levels.
• View maternal mortality or severe maternal mortality rates filtered by maternal age, race/ethnicity, and rurality to visualize patterns, possible disparity issues, and locations where broadband-enabled interventions may be impactful. 

Mapping the Intersection of Broadband and Maternal Health- A Complex Task

Given the complexity of the data and compressed timeframe to respond to the Act, the Task Force planned and implemented a multi-phase approach. In Phase 1, the Task Force undertook an ongoing consultation with the CDC, relevant agencies within the Department of Health and Human Services, and other stakeholders to gather their input on the maternal health data and information to incorporate into the mapping platform. Based on this feedback, the Task Force developed an initial conceptual framework to guide this effort, as described below.

NOTE: Phase 1 variables are shown in pink with a double border; variables that may be added in Phase 2 are shown in gray with a single border.

The OUTCOMES box of the framework includes three measures for maternal mortality and severe maternal morbidity, including for not less than 1 year postpartum, as directed in the Act.

• Severe Maternal Morbidity Not all women who suffer serious and life-threatening complications of pregnancy die from these causes. Instead, many experience “unexpected outcomes of labor and delivery(leaves FCC.gov, opens new browser window) that result in significant short- or long-term consequences,” called severe maternal morbidity. These “near-misses” for maternal death include 21 severe indicators(leaves FCC.gov, opens new browser window) that women can experience during delivery hospitalization, like blood transfusion, hysterectomy, and ventilation or temporary tracheostomy.
  NOTE: Phase 1 variables are shown in pink with a double border; variables that may be added in Phase 2 are shown in gray with a single border.
• Maternal Mortality The World Health Organization defines maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy(opens PDF file in new browser window), from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes”.
• Late Maternal Deaths A large proportion of maternal deaths occur after 42 days and in the first year following pregnancy(leaves FCC.gov, opens PDF file in new browser window), including from causes that disproportionately affect populations suffering from disparities in maternal health outcomes.

In the mapping platform, maternal health outcome definitions can be found on the data page(opens new browser window). Information about our approach to intersecting broadband connectivity data with these outcomes can be found on the methodology page(opens new browser window).

Additional Key Variables

As a complement to the maternal mortality and severe maternal morbidity data, the Task Force also reviewed the available literature to identify relevant risk factors and social determinants of health that influence maternal health outcomes and where broadband-enabled interventions might help bridge the gaps. Phase 1 includes five such priority variables:

• Race/Ethnicity disparities in maternal health outcomes(leaves FCC.gov, opens PDF file in new browser window) continue to exist in communities across the country, regardless of other socioeconomic factors. Furthermore, people of color are most likely to face barriers to broadband access(leaves FCC.gov, opens new browser window).
• Maternal Age is associated with a greater risk of obstetrical complications(leaves FCC.gov, opens new browser window), maternal mortality rates are 6.8 times higher(leaves FCC.gov, opens new browser window) for women over 40 years old compared to women under 25. Telemedicine(leaves FCC.gov, opens new browser window) can be used to support high-risk pregnancies.
• Maternity Care Deserts are areas with little to no maternal care resources(leaves FCC.gov, opens PDF file in new browser window), which may also have lower access to broadband services. Some researchers estimate that 70% of counties(leaves FCC.gov, opens PDF file in new browser window) with the highest proportion of low-speed Internet providers did not have full access to maternity care.
• Mental Health Provider Shortage Areas are counties with limited mental health providers and resources. Maternal mental health conditions affect 1 in 5 women(leaves FCC.gov, opens new browser window) during or after pregnancy, and are one of the most common causes of pregnancy-related deaths (22.7%)(leaves FCC.gov, opens new browser window). Broadband connection can enable digital capabilities such as navigating care, identifying risks, building community, and connecting to counseling as needed. Telehealth services can help connect patients and mental health providers(leaves FCC.gov, opens new browser window).
• Rural Geographic Areas are associated with poorer maternal health outcomes(leaves FCC.gov, opens PDF file in new browser window) compared to their non-rural counterparts, including higher pregnancy-related mortality. The digital divide in rural areas means that these communities often have less access to broadband infrastructure than urban areas.

Future Work

The Mapping Broadband Health in America platform is a foundational tool for understanding the intersection of broadband and health, giving policymakers and other interested parties a concrete path to a more connected and healthier future for all Americans.

Broadband connectivity is showing promise as an integral resource to help improve maternal health outcomes, including:

• Acting as a distinct social determinant of health, which could help to improve health equity and close the digital divide.
• Providing an innovative means to deliver maternal health solutions and health care.
• Connecting users with the resources they need to get healthy or stay well.
• Enabling activities that are associated with better health such as employment and education.
• Mediating the ways in which the other established social determinants influence health and is, therefore, considered a “super” determinant of health.

Phase 2 (and beyond). During the next phases of this effort, the FCC and its Connect2Health Task Force plan to incorporate additional maternal health variables and functionalities into the mapping platform, conduct important research and data analytics on the intersection of broadband connectivity and maternal health, and pursue additional activities to advance the role of broadband connectivity in improving maternal health. Data under consideration for inclusion in future iterations of the platform include labor and delivery locations, gestational diabetes, obesity, opioid use disorders, postpartum depression/anxiety, preeclampsia, preterm birth, and additional demographic data (e.g., income, education).

The Task Force will continue to refine the conceptual approach going forward and welcomes comments and suggestions from interested parties via e-mail to engageC2H@fcc.gov(opens new browser window).