For roughly the last two decades, New York City has been experiencing a maternal health crisis.
While rates of maternal mortality and morbidity — health conditions related to pregnancy — have declined, the numbers continue to show alarming racial disparities. Black women in NYC are eight times more likely than white women to die from pregnancy-related causes and nearly three times more likely to experience severe maternal morbidity.
Nationwide, experts say these disparities connect to a history of inequity inside and outside the medical system.
New York politicians have voiced commitments to addressing the problem. The city council passed a first-of-its-kind maternal health package this summer and Gov. Kathy Hochul budgeted $20 million for maternal health, promising more to come.
Dr. Wendy Wilcox currently oversees all of NYC Health + Hospital system’s women’s health services as Chief Women's Health Service Officer. Before that, she was the Departmental Chief of Obstetrics and Gynecology in the Kings County hospital, where she headed the city-funded maternal mortality and morbidity reduction initiative. She also served as co-chair of the 2018 NYS Task Force on Maternal Mortality and Disparate Racial Outcomes.
In April, Brooklyn Borough President Antonio Reynoso announced that Wilcox would co-chair his Maternal Health Taskforce. He has centered the issue, recently announcing a $250,000 multilingual public information campaign targeting Black and brown communities facing crisis-level maternal mortality rates.
“He has done the work,” Wilcox said, of Reynoso.
As part of our ‘Born in Brooklyn: Black Maternal Health’ series, we talked to Dr. Wilcox about the work she has done to improve health outcomes for mothers and the work that’s still left to do.
This interview has been edited for clarity and length.
BK Reader: You’ve served on maternal health task forces and panels before. How is Reynoso’s task force different?
Dr. Wendy Wilcox: BP Reynoso’s commitment to maternal health in Brooklyn — I think that’s what clearly makes this special.
I’ll just back up a little bit. If you look at New York City, Brooklyn, unfortunately, is one of the worst boroughs for maternal mortality and severe maternal morbidity, so Brooklyn is a focus. The task force is made up all of Black women because [Reynoso] said, ‘Who better to solve this problem than women from the population that’s being affected?’ So, for that I also give him a lot of credit.
The task force is multidisciplinary. We have people from mental health; we have people from community-based organizations; we have physicians like myself; we have a midwife who's the co-chair, Helena Grant, who’s the director of midwifery at Woodhull Hospital and also sits on many state committees on maternal health inequities; we have our nurse representatives. It’s just a really diverse group but we all come from the population that is being affected.
BKR: You noted in a SUNY panel that the severe maternal morbidity rates fell between 2014 and 2018 — the numbers fell from Black women being three times as likely as their white counterparts to suffer severe morbidity to 2.3 times as likely. Can you give some insight into how that was done? And can that be replicated to further reduce the disparity?
WW: Absolutely. Let’s take a step back as well. In 2012, New York State, as a state, ranked 48th out of 50 states for maternal mortality. And now we're 23rd, according to the latest 2018 report. Brooklyn is mirroring that. That is because of a lot of work that's being done within Brooklyn, as well as across the state. There are a group of committed stakeholders, not only elected leaders, like President Reynoso, but also our professional organizations [including the American College of Obstetricians and Gynecologists, the Greater New York Hospital Association, midwifery organizations, city and state health departments and more]. There are so many different ways in which people are trying to tackle a problem.
What happens is one of these groups — or a consortium of groups — will have a focus such as obstetric hemorrhage or depression screening and then all of the maternity hospitals become involved in this. NYC Health + Hospitals just got all 11 of our facilities to be ‘baby friendly,’ so that means we have a certification in breastfeeding. There’s constant work going on, both within the borough of Brooklyn and outside of it. It is through just chipping away at the problem, doing the work, that we move the needle.
BKR: Have you heard, throughout your career, from women who are afraid to give birth in the hospital?
WW: I have. I had a patient who recently said to me — because now that they have MyChart, they can see our charts — so my diagnosis for that visit was ‘supervision of high-risk pregnancy due to…’ And she goes, ‘You’re not putting me as high-risk are you?’ And I said, ‘Oh, yes I am, why are you concerned?’ She goes, ‘high risk, that scares me.’ And, I really did take extra time explaining to her my thought process and the reasons why I was putting that on her chart.
She said, ‘Oh, I get it. OK, thank you.’ That did it. Oftentimes, you just need the conversation.
BKR: How difficult is that in NYC H+H compared to a privatized health system? I ask because in 2018, 61% of pregnancy-associated deaths happened to individuals with Medicaid as their health insurance. So I’m wondering how much of this issue is connected to the health care system in the U.S. and the disparities that exist there already?
WW: I think it's hard no matter where you are… One of the tasks of my new role has been to try to get all of our facilities working on the same thing or 'rowing in the same direction,' as I like to say. While it's a challenge, it's one that I gladly accept. And I know other health systems are doing the same thing.
Even our private institutions in New York take Medicaid. When I used to work at a hospital system in the Bronx, I was part of the first wave of physicians when they basically started moving all of the stand-alone clinics to feed into the hospital. In New York, I don't really think it makes sense to parse things out like that between public and private. Certainly through our city council, through elected leaders like Borough President Reynoso, they help to put their finger on the scale and even out the equation.