Black women are at greatest risk of dying from pregnancy-related complications. Emerging technologies, like artificial intelligence and remote patient monitoring devices, are showing promise in helping prevent such deaths.
The U.S. medical community is desperately looking for better ways to address the debilitating maternal mortality crisis. Over 1,200 women –– more than 30 percent of whom were Black –– died from maternal causes in 2021.
Hundreds of AI-enabled medical devices have already been cleared by the Food and Drug Administration, but innovations in maternal health, such as wearable ultrasounds, are relatively new and still awaiting approval. As these technologies begin reaching the market, some experts are concerned that, without proper guardrails in place, they may do more harm than good.
“If we don’t do this carefully, in a few years we may see that it’s actually harming babies or the mother, and people will say shut it down,” said Dr. Michael Abramoff, who recently authored a publication on AI bias and equity in health care.
Among wealthy nations, the U.S. has the highest rate of maternal mortality, which the Centers for Disease Control and Prevention (CDC) defines as “the death of a woman during pregnancy or within one year of the end of pregnancy.”
Black mothers have historically had high maternal mortality rates, caused primarily by limited access to quality health care and structural racism, both of which also contribute to a higher predisposition for chronic illnesses. In 2021, the maternal mortality rate was 69.9 deaths per 100,000 live births, 2.6 times the rate for white women, according to a CDC report released earlier this year.
“They’re the most at risk,” said Olivia Atley, a certified doula in Columbus, Ohio, who primarily works with Black women. “And not at risk because they’re deficient…but [because] their skin color is not the same as the majority of the folks who will be providing them care.”
Atley has guided dozens of moms through labor and birth and has provided postpartum care. Her experiences as a single, Black woman who struggled through her pregnancy motivated her to serve her community.
Efforts are already underway on Capitol Hill to improve outcomes for pregnant women, particularly Black women. Harnessing digital solutions like AI has growing support across party lines.
The Tech to Save Moms Act, a bipartisan bill introduced in the House and the Senate in July, aims to integrate these devices into maternal health care. If passed, the legislation would make investments to promote the integration and development of telehealth services and require reports on the effectiveness of AI and wearable technologies. Preview (opens in a new tab)
The legislation is part of a bigger package of bills called the Black Maternal Health Momnibus Act, which aims to address the maternal mortality crisis, particularly for underserved communities.
Rep. Nikema Williams (D-Ga.), who sits on the Black Maternal Health Caucus, introduced the Tech to Save Moms Act because of her own experience with preeclampsia, a life-threatening pregnancy-related blood pressure condition, while she was pregnant with her son, Carter.
“That is not the reality for so many other women that are in that situation. They don’t live to even tell the story and to see their baby grow up,” Williams said. “I have a role and a position of power now to speak up and to do something about this to change it.”
The congresswoman said the telemedicine boom during the COVID-19 pandemic also inspired her to pursue the proposed legislation.
Some companies in the medical industry are already leveraging newer forms of technology to fight maternal health disparities.
Lucina Analytics, a medical technology company, compiles data from health insurance plans, electronic health records and public data exchanges. It then uses that data to create AI predictive models to identify at-risk pregnant individuals by evaluating compounding factors such as disease, behavioral health disorders and chronic social stressors such as access to care or nutrition. Lucina founder and physician Dr. Matt Eakins said that, since 2020, the portion of pregnant women who they identified as “very high risk” has doubled to over 10 percent in 2023.
“We hear from patients all too often that, by the end of the week, sometimes food runs out and [they] have to choose between feeding [their] older kids or feeding [themselves]. And that’s really unfortunate,” Eakins said. “We try to identify and pull together a complete picture and use our predictive models to understand who’s at risk of having a poor maternity.”
Eakins said he thinks it is possible for every woman to see the health care system as a safe, inviting place to have their babies and that technology and tools can make that a reality.
But Atley warns that technology alone will not solve the issue.
“The end to racism is the fix,” Atley said. “But I probably won’t need a job if that happened, which would be perfectly fine by me because I would rather people be giving birth safely.”
The complicated relationship between Black individuals and the medical industry, one fostered by a history of racism and abuse, particularly regarding women’s health, poses a challenge. Atley said that this is a common reason why her patients seek out her support.
“Every single family that I closed out let me know how necessary it was,” Atley said. She said the lack of trust in medical providers and the medical system must be addressed before integrating technology into maternal care.
A whole new form of trust would need to be developed with innovations like AI, which have already shown racial biases. Rep. Williams said many are skeptical of AI because of these existing biases, even on Capitol Hill.
Both advocates and medical experts believe that, without implementing the necessary safeguards, this technology could further widen racial disparities.
“It can be said that it’s easier to change an algorithm than to change a human mindset,” said Dr. Jagmeet Singh, a professor of medicine at Harvard Medical School and author of “Future Care: Sensors, Artificial Intelligence, and the Reinvention of Medicine.”
Singh and other leaders in medical AI have outlined proactive steps to ensure algorithms address underlying human implicit biases.
Because AI models are trained on existing data sets, ensuring data equity is crucial to improving health outcomes. For example, existing biases and distrust in data sharing may prevent marginalized groups from contributing to data banks. Experts advise evaluating algorithm performances within subgroups, such as specific gender and racial populations, and making that information public to ensure transparency.
“We have to get it right from the start and what we show is that this is entirely feasible,” Abramoff said.
Experts warned that racial biases can exist in wearable patient monitoring devices, too.
Last month, more than two dozen attorneys general wrote a letter to the FDA urging officials to take action on the inaccuracy of pulse oximeters, electric devices attached to the fingertip to monitor oxygen levels, on people with darker skin.
Singh said it is crucial to address these issues.
“Digital inequity is equal to health inequity,” he said. Singh has researched the racial inequities in wearable devices.
Rural communities are also suffering from the maternal health crisis.
Providers, advocates and lawmakers are optimistic about technology’s use in rural and underserved communities, which are already benefiting from options like telehealth.
“There are far too many women needlessly dying during childbirth, especially in rural communities where access to quality care is difficult to find,” Rep. Dave Joyce (R-Ohio), who co-sponsored the Tech to Save Moms Act, said in a statement to the Medill News Service.
In 2022, over 500,000 babies were born to women who live in rural counties, while only seven percent of obstetric providers practice in rural counties, according to a report by the March of Dimes.
“In those areas, pregnancy is not happy. Pregnancy is something you survive,” said Linsey Griffith, who has been working as a certified doula for the last decade. Her upbringing in rural Ohio opened her eyes to the health care system’s disservice to expecting mothers like herself, with her own miscarriage inspiring her to advocate for other moms.
However, emerging technologies like AI will not solve the need for compassionate, in-person care and the shortage of birthing centers and health care providers.
“I have folks that do telehealth, I have folks that do virtual with me, but they still have to drive an hour and a half in labor or schedule their induction or their C-section to birth at a competent health care facility,” Griffith said. She noted that the lack of internet access in rural areas is also an impediment to digital solutions.
In 2021, Congress empowered states to expand Medicaid postpartum coverage to one year, and 37 states and the District of Columbia have already done so.
Advocates and physicians say that more needs to be done and that the solutions offered in the Black Maternal Health Momnibus Act, including continued research into the potential benefits of AI, are crucial for curbing the U.S.’ worsening maternal health crisis.
This includes increased funding support for community-based doulas, as medical experts including the American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine have noted the positive impact doula care has on a woman’s pregnancy and birthing experience.
However, out of the 14 bills in the Momnibus, only two — Tech to Save Moms and the reintroduced Protecting Moms Who Served Act — have bipartisan support. Leaders of the package are optimistic that those single bills can pass before there is broader support for the Momnibus.
“It’s dealmaking season,” said Rep. Lauren Underwood (D-Ill.), co-founder and co-chair of the Black Maternal Health Caucus, which is spearheading the Momnibus. “The Momnibus should be included in whatever legislative vehicles end up moving.”
Providers and advocates on the ground say urgent action is needed, but technology is only one piece of the puzzle.
“We’ve got to re-establish and affirm some quality relationships and rapport before we can step into that space,” Atley said. “There’s no one-size-fits-all for the circumstances that are at hand right now.”