This month we shine the spotlight on Dr. Meg Prado, President of Women’s and Children’s Services at Envision Healthcare, a leading national medical group. She is board certified in general pediatrics and neonatal-perinatal medicine and is a fellow of the American Academy of Pediatrics. 

Prado joined Envision in 2001, practicing as a neonatologist at Miami Children's Hospital until 2007. She then moved to Colorado, where for 10 years, she served as the Neonatal Intensive Care Unit (NICU) Medical Director at St. Francis Medical Center in Colorado Springs. Returning to Florida in 2016, Prado was the Vice President of Women's and Children's at Envision and became President in November 2018.

She received her bachelor’s degree from the University of Miami and her medical degree from the University of Miami Miller School of Medicine. She completed her internship and residency in general pediatrics, followed by a neonatal-perinatal fellowship, at the University of Miami Jackson Memorial Hospital.  

She was the recipient of a National Institutes of Health training grant and conducted a year of basic science research in the area of molecular biology in the Department of Physiology and Biophysics at the University of Miami School of Medicine. In 2019,  Prado received a Master of Business Administration from Auburn University.  

In this edition of In Other Words, Dr. Prado discusses how providers can reduce healthcare disparities, specifically among pregnant women and infants. 

In Other Words...

As a mother, pediatric specialist and leader in women’s and children’s care, I have seen that the U.S. healthcare system does not treat expectant mothers of different backgrounds equitably. The fact that systemic racism has worked its way into how we deliver care, or fail to provide equitable care, is a harsh reality that clinicians caring for pregnant women, newborn babies and children must accept. Once we acknowledge this problem, we can begin to solve it. 

An individual’s ability to access healthcare is crucial to their long-term health and well-being and the overall health of our communities. Still, healthcare disparities exist in every specialty and aspect of the healthcare system. For the most vulnerable among us – mothers and their infants or children – this plague does not spare. When we examine clinical outcomes, it is clear that some Americans continue to receive inequitable attention and treatment based on race, ethnicity, religion, disability status, sexual orientation and the intersection of these identities. These disparities stem from a complex multitude of factors. To eradicate this problem, everyone – clinicians, hospitals, health systems, health insurance companies and federal and local governments – must work together.  

Historically, healthcare disparities have been mistakenly attributed to pre-existing genetic factors and lifestyle choices. Genetics plays some role in outcomes but is not, by itself, the only culprit. Years of research and data show that factors beyond an individual’s genetic fabric, like socioeconomic status, whether they have health insurance coverage and which zip code they live in, play a major role in their ability to access care.  

Social determinants of health, including inadequate prenatal care, are documented risk factors for premature birth and infant death as well as adverse outcomes for pregnant and postpartum women in the U.S. These social obstacles to healthcare and the corresponding outcome disparities are most evident in Black, American Indian and Alaska Native populations.  

In the U.S., the preterm birth (less than 37 weeks gestation at time of birth) rate among Black women is 50 percent higher than all other women. In addition, the national infant mortality rate is 5.7 per 1,000 live births; for Black women, it is 10.8 per 1,000 live births – nearly double the national rate. For a developed nation, these infant death and prematurity rates are unacceptably high.  

Systemic racism and the wealth gap in the U.S. deepen many health inequities. The COVID-19 pandemic has magnified and exacerbated these healthcare disparities, with the U.S. Centers for Disease Control and Prevention confirming that people of color are disproportionately impacted by the virus. Some of this can be attributed to racial discrimination, lack of access to care and fact that these populations are more likely to be exposed to the virus.  

The current health and economic crisis is compounding the issue, resulting in reduced incomes, lost health insurance coverage and postponed routine, preventative care like prenatal visits. We have yet to understand the full impact this will have on certain communities; however, we must act swiftly to try to mitigate it. 

Clinicians are obligated to provide high-quality care regardless of a patient’s race, gender, ethnicity or socioeconomic status. It is also our responsibility and oath to serve all patients and strive to improve outcomes. We can play a pivotal role in rebuilding and re-establishing trust within underserved communities, which will lead to a break-down of the systemic barriers that deter access to care, especially during pregnancy. Together, we must do better.  

To start, clinicians should be educated on implicit and explicit biases and how to avoid them in daily practice. Sensitivity training and standardization of care, including standardized order sets, can also remove barriers to equitability in care delivery.  

We also need to engage our communities and use the many resources available to address patients’ needs comprehensively. It’s plain and simple: Our communities, including mothers and their babies, are stronger and healthier when there is equal and equitable access to care. That is why approaches that leverage community involvement would be most effective at improving healthcare outcomes and reducing disparities. A community-level approach can show short-term improvements and address downstream disparities in healthcare access, which is likely to have the greatest benefits for mothers and babies in poor health and without access to quality care.  

It is important to note that community collaborations will require a level of commitment and organization that goes above and beyond current intervention models. However, the results show great promise in eliminating disparities. This approach can identify root causes, build on local resources and inspire robust research participation, leading to improved policies and meaningful changes.  

Even under perfect conditions, pregnancy and childbirth can be challenging. As we battle the COVID-19 pandemic, we must double-down on efforts started beforehand to address healthcare disparities and improve outcomes for all patients. This means we need to establish best practices – sometimes in real-time – for women, infants and children. Let us all strive to reduce these disparities so that every mother and child receives equitable healthcare and is able to live a happy, healthy and prosperous life.