Can We Reverse the Rise in Maternal Mortality?

This story was originally published by the UNC Gillings School of Public Health on June 14, 2022.

By Shellie Edge
Photography by Sarah Daniels

With more than 10,000 babies born in the U.S. each day, too many moments of parental joy are increasingly turning into instances of tragedy. Overall, the maternal death rate in the U.S. rose from 20.1 deaths per 100,000 live births in 2019 to 23.8 deaths per 100,000 in 2020, marking an 18% increase. The increase is particularly prevalent among non-Hispanic white, non-Hispanic Black and Hispanic births. However, students from UNC-Chapel Hill and NC State University are teaming up to reverse the concerning trend in North Carolina by trying to deeply understand the problem and gain insights about potential solutions.

The student team – named Maternal Mortality – recently won the finals for UNC-Chapel Hill’s edition of the Map the System (MTS) competition, a global event organized by Oxford University’s Skoll Centre for Social Entrepreneurship. Map the System challenges students to use systems thinking to understand complex social or environmental challenges and articulate their findings in a way that people can meaningfully understand, learn from or share.

As winners of the local MTS competition final at Carolina, the Maternal Mortality team earned a spot to compete against 44 top teams from around the world. The students will travel to Oxford University in the United Kingdom to participate in the global finals of the competition, where they will share their systems analysis with peers, the wider community, and practitioner experts and academic educators.

The team describes its work as illuminating SPARCS (systems, paradigms and restorative community solutions) for maternal health equity in N.C.

Sharita R. Thomas

“We’re not just presenting a problem, we’re illuminating how we can solve issues,” says Sharita Thomas, a doctoral candidate in health policy and management at the UNC Gillings School of Global Public Health. “Illuminating how we can work together to highlight solutions will not just impact maternal morbidity and mortality but also equity in general.”

“Participating in the Map the System competition at Carolina allows student teams to really examine a critical social issue through a unique approach of zooming in and out of multiple factors at play,” says Melissa Carrier, director of social innovation at Innovate Carolina. “Maternal Mortality did a wonderful job of using systems mapping to investigate maternal health equity in N.C. and come up with solutions that can create positive, systemic changes.”

Sharita R. Thomas, Maternal Mortality team member, shares her firsthand experience with systems mapping.

The Maternal Mortality team is an interdisciplinary group of five student researchers:

• Hiba Fatima, doctoral candidate in maternal and child health, UNC-Chapel Hill
• Sana Behnam Asl, doctoral candidate at the College of Design, NC State University
• Doyoung Kim, doctoral candidate in health policy and management, UNC-Chapel Hill
• Raunak Mahtani, doctoral candidate at the College of Design, NC State University
• Sharita R. Thomas, doctoral candidate in health policy and management, UNC-Chapel Hill

“Globally, equity means different things,” says Thomas. “But the one consistency about equity is that in order to achieve it, it involves challenging social systems, policies and paradigms. It’s such an important issue that everybody can identify with.”

Evaluating the Continuum of Maternal Care

The team’s work examined causes for the large disparity in maternal mortality for people of color to those who are non-Hispanic white within N.C., including those suffering from illnesses or adverse events that occur during the perinatal period, not just with maternal death. As a result, the team evaluated the entire continuum of care and all the systems that women interact with during and after their pregnancies.

“We’ve tried to understand the whole spectrum of maternal mortality and morbidity,” says Mahtani. “It’s a huge problem and is interrelated to other health, social and cultural systems. The common vocabulary and common tools of systems thinking have been really helpful for us to talk about this pressing issue as a team.”

Presented by Innovate Carolina, the UNC Gillings School of Global Public Health and Carolina Honors, Carolina’s MTS campus competition is open to all Carolina students and asks participants to create systems maps. The maps give students tools for exploring complex problems, uncovering knowledge gaps, identifying intervention points, and presenting insights that can shape systemic environmental and social impact. Systems mapping was a new approach for the team and helped the students explore connections and insights they otherwise may not have discovered.

“The systems thinking approach literally rocked my world and has forever changed the way I approach policy solutions,” says Thomas. “I was trained to pinpoint the best policy option based on certain criteria. But using the systems thinking approach means you’re not looking for one policy or one solution, but a true, systems thinking solution – one that’s a hierarchy of policies and interventions. It’s about being able to clearly define and comprehend all the elements of a system. I’m able to produce a suite of policy options that will impact the desired outcome or change.”

As part of its system mapping, the team looked at maternal mortality and health equity through root causes. These causes include events, patterns and trends, underlying structures and mental models. They also examined key stakeholders, existing solutions in N.C., and the impact of those solutions.

“It felt really different from earlier experiences,” says Mahtani. “Running into all the tiny hurdles within the process was so helpful in identifying how we might better use systems thinking in the future. It’s given us all a common vocabulary and common set of tools.”

“Coming into this topic we had different perspectives, but learning from all these different experiences was really helpful,” adds Behnam Asl. “Having a good perspective, bringing people together and working with our collaborators who are policy experts was great.”

Innovative Research Meets the Real World

To make the global MTS finals, Maternal Mortality competed against more than 40 student teams at Carolina. Four top teams presented in the final round of local competition, exploring a range of issues that included food insecurity, violence against indigenous women and the growing problem of student housing in college towns.

Hiba F.

“When they said we won, I felt so overwhelmed, and I really didn’t believe it,” says Fatima. “It was an amazing feeling because every other team was spectacular. It seemed like such a close competition, so being able to say that we won was very gratifying. I remember looking around to everyone else and thinking, ‘Did you hear what I heard? Is this happening for real?’”

The Maternal Mortality team is quick to confirm the value of systems thinking to numerous aspects of academic life, research and real-world problem-solving.

“I would encourage the use of diverse sources and talk with people who may not have always been the center of a conversation but should be… people with lived experiences should be the centered voice of an issue,” says Fatima. “For example, speaking with parents who had gone through this really helped us conceptualize our work, figure out how to move forward with data collection, and to create our narrative.”

“We are student researchers approaching a challenge from a research perspective, but we also got out and spoke to people,” says Thomas. “We’re not just sitting in the library researching. We wanted to hear lived experiences and incorporate those. Going forward, if you’re trying to do research like this, especially if you’re trying to solve problems for people and if you’re not a part of that group, involving the persons who are impacted is really important.”

Judges for the UNC finals competition included Riley Jones, JD, professor of practice and social entrepreneur-in-residence; Danielle Spurlock, PhD, assistant professor in land use and environmental planning; and Leah Frerichs, PhD, assistant professor in health policy and management.

Regardless of how the Maternal Mortality team finishes in the MTS global finals, the students plan to continue pursuing their solution in hopes to make a substantial impact on maternal equity and health across the state.

“We’re an amazing team,” says Fatima. “We have many ideas and so much rich data to explore. I think we’re going to continue to brainstorm together and see where the data takes us.”

“It was fascinating to see how the lens of systems thinking can be applied to so many different problem areas,” says Mahtani. “Even though there are common tools and approaches that we’ve all learned with systems thinking, it was fascinating to see how everybody approached challenges, combining our tools and skillsets in interesting and different ways.”

On the Global Stage

Watch the MTS global finals on Sunday, June 19, from 4:00-11:00 a.m. EDT, where six final teams – chosen based on their level of insight and application of systems thinking – will compete for cash prizes and audience favorite recognition. The final six presentations will be live-streamed, and registration is open to the general public. To watch the MTS global finals, register online.