Combating systemic inequities in maternity care: An interview with Dr. Neel Shah, Maven’s Chief Medical Officer

To best support birthing parents and their families, we must acknowledge how inequities influence maternal health outcomes. Care before, during, and after birth is deeply biased in the U.S., and we need to fundamentally reimagine our approach to maternal healthcare to combat these disparities. Dr. Neel Shah, Chief Medical Officer (CMO) at Maven Clinic and Assistant Professor at Harvard Medical School, was recently featured in Aftershock, a documentary examining the maternal mortality crisis and what needs to be done to enact real change.

We sat down with Dr. Shah to learn more about his work, the film, and his thoughts on how we can provide more equitable care in the United States.

You joined Maven as our CMO a year ago, but you’ve been working in the maternal health equity space for much longer. What motivated you to devote your career to improving health equity?

When I started medical school, I wasn’t planning to specialize in OB-GYN. However, I spent my first week of medical school at Women and Infants Hospital in Rhode Island, which delivers over 10,000 babies a year, and it was a life-changing experience. It’s impossible to be in a labor and delivery room without recognizing how incredible it is. The other part of what drew me in was the kind of people that specialize in OB-GYN. I wanted to work with people that I respected and admired, and providers who go into women’s health deeply care about social justice and wear it on their sleeves.

In my work as an OB-GYN, with my background in health policy, I found myself constantly questioning the status quo: Why aren’t we investing in maternal health like we’re investing in cancer, for example? As I was chasing down those answers, I learned that maternal healthcare suffers from a massive lack of resources, especially compared to other parts of the healthcare system. As I saw that play out through my work, I knew I needed to be a part of the solution. 

We hear a lot about the maternal mortality crisis in the United States. Could you provide more detail about what’s causing the high rates of people dying from childbirth-related causes?

There’s no way of understanding the maternal mortality crisis in the U.S. without seeing it through the lens of racial, gender, geographic, and generational inequity. The story in America right now is one of widening inequity, and it manifests in the eroding well-being of Americans. 

I strongly believe that maternal health is a bellwether for the well-being of our society as a whole because every injustice in our society shows up in birth outcomes. If you look at racial inequity: Black birthing parents are three times more likely to die in childbirth than their white counterparts. We see generational inequity show up in how people now are more likely to die from childbirth-related causes than their mothers were. Geographic inequity means that if you live in a rural area, you are much less likely to be near someone who can help you through pregnancy. 

I strongly believe that maternal health is a bellwether for the well-being of our society as a whole because every injustice in our society shows up in birth outcomes.

Women are expected to put their families first and their own well-being last, and we see that play out during pregnancy and postpartum. The maternal health system is designed to treat women as vessels for pregnancy and forget about them after they’ve had a baby. It’s entirely normative for your only check-up after giving birth to be a 15-minute appointment six weeks postpartum. And many of these parents are sleep-deprived and trying to raise an infant while also working full-time to earn a living wage because there is no mandated paid family leave in our country. 

Another factor contributing to maternal mortality is the healthcare system’s acceptance of the status quo, even when the status quo clearly isn’t working. In Manhattan, for example, one in three people get major surgery to give birth and one in 10 of their babies goes to the ICU—these are scary numbers, but we’ve normalized them.

You were recently featured in a documentary, Aftershock, which is now available on Hulu. Could you tell us a little about the film and what made you interested in contributing to it? 

Aftershock focuses on two Black families who lost their loved ones—Shamony Gibson and Amber Rose Isaac—to preventable deaths due to childbirth complications. The film sees the families galvanize activists, birth workers, and physicians to reckon with the US maternal health crisis.

I was compelled to contribute to the film because the filmmakers, Paula Eiselt and Tonya Lewis Lee, wanted to focus on solutions. We hear about these preventable deaths, but no one is showing the aftermath—the impact the maternal mortality crisis has on families and communities, and the work that these families are doing. In the film, they converge on a solution: healthcare systems have to be accountable to communities, and we see two bereaved families stepping up, taking leadership roles, and holding the healthcare system accountable. It’s such a powerful film, and since it’s been widely available, we’ve seen it spark a lot of very important conversations across the country. 

Aftershock takes a hard look at the maternal mortality crisis in the U.S. that is disproportionately affecting Black, Indigenous, and Latine people. Can you share an example of how systemic racism drives poor outcomes among these groups? 

Systemic racism manifests during pregnancy and birth in many ways. The film shows us going to Tulsa, OK, which is where the 1921 race massacre took place. During this massacre, an entire Black neighborhood got razed to the ground in one of the most sordid events of racial violence in our nation’s history. The area was completely divested from following this event. Schools and hospitals in this part of Tulsa systematically received less funding, and Black people from that neighborhood couldn’t receive bank loans to open new businesses. 

In the film, we went to the hospitals that serve this community and saw how structural racism still affects the lives of Black mothers in the area, reflected in their high rates of maternal mortality. When you look at death certificates, hemorrhages are generally listed as the leading cause of death, but that doesn’t give the full picture. It’s possible to have a severe hemorrhage and survive, or a moderate one and die. At its core, what increases the likelihood of a mother not surviving is an insidious form of racism. 

Fundamentally, what birthing parents are dying of in Tulsa—and across the country—are failures of communication, empathy, and teamwork. Only recently have we been naming these failures for what they are: systemic racism. Aftershock shows this well—for both Amber Rose and Shamony, two Black mothers, their concerns were dismissed over and over again, and they were not heard until it was too late. 

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