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Using the Socio-Ecological Model to Target Maternity Mortality

Of the developed countries, the United States has the most alarming rates of maternal mortality (MM). The heightened rates of MM are a current issue that should be addressed. MM is described as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes". Severe maternal morbidity is described as short-term or long-term complications of health that arise from delivery. An important factor to discuss with maternal issues and delivery is the racial disparities between African-American women and white women; the CDC states that pregnancy-related deaths for African-American women are three to four times higher than white women.

While fairly new, the Socio-Ecological Model (SEM) has been adopted as a potential solution for several issues around the world. Conceived of by Urie Bronfenbrenner in the 1970s, it was later developed as a theory in the 1980s. The SEM usually consists of four to five levels, all connected in layers, and is easily understood through a diagram.

Other problems to which the SEM has been applied as a solution model include violence, intimate partner violence, and maternal health care in general around the world, not specifically MM.

Adapted Socio-Ecological Model (SEM) as a solution framework for Maternal Mortality in the United States

The four levels of SEM include:

(1) The pregnant individual and the family, which includes the pregnant person, the partner, and relationships to close family and friends

(2) Community and society; this includes the neighborhood, the region, and socioeconomic class

(3) The healthcare system; this includes insurance, medical policy, and quality of care

(4) The historical context of racism, which is inclusive of both structural and institutionalized racism due to the history of slavery in the United States.

The pregnant individual and the family exist as a small circle within community and society, surrounded by the healthcare system, and is embedded in the larger circle of the broader contexts; one of these is the historical context of racism, seen in figure 1 above. The levels exist almost like the layers of an onion, layered and complex.

In this model of the SEM, the levels can be imagined having interdependent relationships. One level will affect the functionality of the other levels. If there are issues in one level, it will bleed into and affect other parts of the SEM. Therefore, in order to solve issues using the SEM, solutions must be acted on in each level simultaneously.

The solutions to MM are multi-faceted and occur across several levels of the SEM. The SEM provides a framework through which we can understand the various interventions aimed at solving the issue of MM in the United States. MM is an issue that holds global relevance. As one of the leading nations in the world, the United States should have better rates of MM. The United Nations has set a goal of reducing preventable MM by the year 2030 with about a decade to go more solutions should be implemented soon. We also see that the levels of the SEM exhibit interdependent relationships; each level affects the function of the nearby levels. Therefore, in order to use the SEM as a solution model towards the issue of MM in the United States requires all levels to work together.

One of the efforts towards reducing MM in Michigan includes Regional Perinatal Quality Collaboratives, here in Region 6, we serve the following counties: Genesee, Huron, Lapeer, Sanilac, Shiawassee, St. Clair and Tuscola. Be sure to join here to get updates on meetings and events.

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